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Medication Reconciliation July 12, 2005


Medication Reconciliation. July 12, 2005. Glenn Billman, M.D. ... Medication Reconciliation ... 2005 NPSG Goal 8: Medication Reconciliation ... – PowerPoint PPT presentation

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Title: Medication Reconciliation July 12, 2005

Medication Reconciliation July 12, 2005
  • Glenn Billman, M.D.,
  • Medical Safety Officer, Childrens Hospitals and
    Clinics of Minnesota

  • First, do no harm.

The Issue
  • Medicine used to be simple, ineffective and
    relatively safe.
  • Now it is complex, effective, and potentially
  • Sir Cyril Chantler

Optimal care for patients requires totally
effective communication regarding medication use
among numerous people of varying disciplines in
multiple locations over time including the
families themselves.
Our Challenge
Our Aim Implement Medication Reconciliation
  • Implement a Process that will ensure that
    patients and their caregivers possess the most
    accurate, and up to date medication list possible

Definition 1
  • Medication Reconciliation
  • Reconciliation is the process of comparing
    what medication the patient is taking at the time
    of admission or entry to a new setting or level
    of care, with what the organization is providing
    (admission or new medication orders) to avoid
    errors such as conflicts or unintentional

Definition 2
  • Medication Reconciliation
  • All medications appropriately and consciously
    continued, discontinued, or modified at all
    transitions of care.

Why Should We Do This?
  • 140 discrepancies in 81 patients (1.7/pt)
  • 65 omissions
  • 59 wrong dose/frequency
  • 16 wrong drug
  • 32.9 discrepancies rates as potentially moderate
    harm 5.7 severe harm
  • Arch Intern Med, Feb 2005

Why Should We Do This?
  • Ineffective medication reconciliation upon
    hospital admission
  • up to 50 of medication errors
  • up to 20 of future ADEs

1) Increased Percent of Patients That Completed
Medication Coordination
Why Should We Do This?Because Its Doable !
Why Should We Do This?Because It Works !
Why Should We Do This?Because It Works !
4) An Increase In The Number Of Days Between ED
Visits Related To ADEs
Why Should We Do This?Efficiency !
Why Should We Do This?Its Cost Effective !
Investing In Safety
Do First
Dedicated Unit Pharmacist
Automated ADE Monitoring
Bar Code Reconciliation
Diagnosis Specific Order Sets
Pharmacist Patient Interview
Medication Reconciliation
Impact on ADE
Pharmacy Managed Protocols
Pharmacist Order Entry
Zero Tolerance Ordering Standards
Preprinted Order Forms
Intervention Database
Pocket Formulary
Medication Competency Testing
Dont Bother
Cost To Implement
2005 NPSG Goal 8 Medication Reconciliation
  • Accurately and completely reconciles medications
    across the continuum of care
  • 8a During 2005, for full implementation by
    January 2006, develop a process for obtaining and
    documenting a complete list of the patients
    current medications upon the patients admission
    to the organization and with the involvement of
    the patient. This process includes a comparison
    of the medications the organization provides to
    those on the list.

2005 NPSG Goal 8 Medication Reconciliation
  • Accurately and completely reconciles medications
    across the continuum of care
  • 8b A complete list of the patients medications
    is communicated to the next provider of service
    when it refers or transfers the patient to
    another setting, service, practitioner, or level
    of care within and outside the organization.

Medication Reconciliation Is A Tool To Help
Bridge Gaps That Occur At Transitions and
Transfers of Care
  • Process steps
  • The medication history is completed
  • The physician reviews and acts upon each
  • The medication orders are written
  • A 2nd person reviews medication history
  • That 2nd person resolves discrepancies

Reconciliation Virtually all hospitals who have
successfully addressed admission reconciliation
have created a special form as part of the
solution. These forms pretty much look alike.
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What is included?
  • Current home meds / OTC / Herbals, including
    dose, route frequency
  • Time of last dose
  • Source of the information
  • The medications ordered at admission
  • An Assessment of patient compliance

There is no perfect medication list. Quit
thinking there is. Do not be paralyzed by trying
to perfect the list.
Steve Meisel, PharmD
Who uses the form?
  • The nursing staff or pharmacist use the form to
    collect information at admission.
  • The physician uses the form as a reference and/or
    order when writing initial orders for
    medications. In some cases the form itself
    serves as the order form, thereby obviating the
    need to rewrite orders.
  • Both physicians and nurses use the form
    throughout the patients stay as a reference.

Source of the information
  • The patient/family
  • The patients pharmacy
  • Previous medical records
  • The patients medication bottles
  • The physicians office

A completed Medication List is only the Half Way
Point.Reconciliation is real work!
A Big Problem Is Often Just Getting An Accurate
Medication List
  • Patient brings in incorrect list.
  • Patient does not take what is marked on bottle.
  • Patient does not know what is on and family,
    pharmacy not available.
  • Wrong name of med on ED sheet.
  • Med bottles dont jive with what the patient
  • Patient is unable to tell you. No family
    available. MD on call does not know either.
  • Cant call the pharmacy after hours.

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The Intent and Value of Medication Reconciliation
Is In Having An Accurate Medication List.
Transfer Reconciliation
  • Critical especially upon transfer in and out of
    intensive care and other specialty units
  • As much as 60 of the care plan after transfer
    may be different than what the physician expects
  • Can utilize internal computer systems to
    facilitate, but there must be an active decision
    to continue, discontinue, or modify each line

Transfer Reconciliation
  • Automatic stops of certain critical-care-specific
    drugs (e.g. dopamine) are acceptable provided
    those stop orders appear in the medical record.
  • ? Benzodiazepines
  • Requirement to re-write all orders upon transfer
    introduces new opportunities for error

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Discharge Reconciliation
  • The patients reconciled list of admission
    medications is compared against the physicians
    discharge orders along with the last days MAR.
  • The lists can either come from the computer
    system or be integrated with the original
    admissions list.

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To Be Successful
  • Put the patient first (this isn't someone else's
  • You need to have some good change methodology to
    be able to develop a good product
  • You need to use this to replace something else
    i.e. medication history in nursing data base

To Be Successful
  • Understand Your Processes
  • Process flow
  • Data flow
  • Roles and responsibilities
  • Procedures
  • Build Incrementally Start Small
  • Leadership Support is Critical
  • Project champions

To Be Successful
  • You must have organization alignment (physician,
    nursing, pharmacy, administration)
  • Process Owner and Sub-Process Owners
  • A champion for the entire process
  • Have a good education program when rolling it out
  • Appropriately Resource the project
  • You Need To Start!

Questions / Comments/ Discussion
Contact Information
  • Contact Glenn Billman
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