Improving medication management in the emergency department at Royal Perth Hospital - PowerPoint PPT Presentation

Loading...

PPT – Improving medication management in the emergency department at Royal Perth Hospital PowerPoint presentation | free to download - id: 44f436-M2M0N



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Improving medication management in the emergency department at Royal Perth Hospital

Description:

Improving medication management in the emergency department at Royal Perth Hospital Lea Dias - ED Pharmacist Barry Jenkins, Chief Pharmacist Dr Frank Sanfilippo ... – PowerPoint PPT presentation

Number of Views:95
Avg rating:3.0/5.0
Slides: 20
Provided by: safetyandq
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Improving medication management in the emergency department at Royal Perth Hospital


1
Improving medication management in the emergency
department at Royal Perth Hospital
  • Lea Dias - ED Pharmacist
  • Barry Jenkins, Chief Pharmacist
  • Dr Frank Sanfilippo, Population Health, UWA
  • Stephen Witney - ED Technician

2
Background
  • ED is under-serviced by pharmacy at RPH
  • Significant medication safety concerns
  • Significant continuity of care issues
  • Funding obtained for a pharmacist and technician
    from Oct 05 - June 06

3
Aim
  • Introduce a comprehensive service
  • patient own medication bags
  • frequent stock checks and analysis
  • access to a clinical pharmacist during business
    hrs
  • introduce an electronic drug formulary
  • investigate the role of the pharmacist
    technician
  • Conduct a Pilot study
  • assess the accuracy of medication history taking
  • assess the impact of pharmacy involvement

4
Achievements
  • Patient Own Medication Bags (POMBs) introduced
    and written into hospital policy
  • Drug protocols and administration guidelines on
    ED intranet
  • Service to nursing medical staff improved
  • Pilot study completed and analysed

5
Ongoing
  • E-formulary trial
  • POMBs
  • roll-out rest of RPH
  • Discussion with SJA.
  • Possible use State-wide?
  • Business case to continue the pharmacy service.

6
(No Transcript)
7
Pilot study summary
  • Primary objective
  • To compare the accuracy of medications recorded
    on the medication chart against a validated
    medication history taken by the pharmacist for
    high-risk patients.
  • Secondary objective
  • Assess the utility of the pharmacy service in
    reviewing high risk patients and resolving
    medication related problems.

8
Method
  • Service
  • 1FTE clinical pharmacist, 1FTE Technician
  • Mon-Fri 800am-430pm
  • Sample - high risk patients
  • Inclusion criteria
  • admitted patients with a completed drug chart
  • ? 65 years old or ? 5 medications
  • Exclusion criteria
  • nil medications pre-admission
  • Recruitment
  • once or twice daily ward rounds in all ED areas
  • 9th April - 30th May 06 (period of 7 weeks)

9
Method
  • Role of the technician
  • Record pre-admission medication information
  • patients own medications/list or WebsterPak
  • GP letters
  • nursing home/pharmacy medication list
  • previous admission at RPH
  • discharge letters
  • Record medications charted on admission

10
Method
  • Role of the pharmacist
  • Validate history with at least two sources
  • Reconcile pre-admission medication history with
    charted medications
  • Classify discrepancy as
  • intentional (deliberate changes) eg. withheld,
    new or cease drug, OR
  • unintentional (errors) eg. drug omission, drug
    commission, or incorrect dose.
  • Communicate discrepancies
  • written in blue notes
  • verbally with team or ward pharmacist
  • attach Medication Action Plan to chart

11
Method
12
Method
  • Introduced towards the end of the study.

13
Analysis
  • Data analysed using SPSS
  • Lost to follow up
  • subjects that satisfied the selection criteria
    but were lost to the ward/discharged before being
    seen by the ED Pharmacist
  • these subjects were not included in the results
  • Patients not screened
  • lack of resources did not permit all high-risk
    pts to be reviewed and included in the results.
  • sub-sample of these patients to test for
    selection bias

14
Results
15
Results 2
16
Distribution of unintentional errors
Patients
Unintentional errors
17
Discussion
  • Unintentional discrepancies (errors)
  • mean of 2.1 per patient
  • Intentional (deliberate) changes
  • mean of 0.9 per patient
  • On discharge must account for-
  • all errors not corrected in ED and
  • all deliberate changes initiated in ED and
  • all other discrepancies arising from the ward

18
Case 1
  • 95yo, Italian lady
  • presents with ?pulm oedema
  • 3 errors identified
  • dose incorrect frusemide
  • irbesartan charted (drug commission)
  • gliclazide charted (drug commission)
  • withhold gliclazide and instructions to begin an
    insulin infusion
  • no history of diabetes
  • daughter/mother medication mix up
  • discrepancies corrected in ED

19
(No Transcript)
20
Case report 1 Medication Action Plan
  • ED Pharmacist
  • GP confirmed
  • no history of diabetes
  • daughter/mother medication mix up
  • irbesartan ceased
  • frusemide increased
  • discussed digoxin/clarithromycin interaction
  • blue notes indicated withhold gliclazide, begin
    insulin infusion (admitting team)
  • discrepancies corrected in ED
  • digoxin level 3.5
  • Ward pharmacist
  • follow up digoxin, allopurinol, ibuprofen

21
(No Transcript)
22
Case report 2 Medication Action Plan
  • ED Pharmacist
  • patients own medications
  • brand names used on the Websterpak
  • meds charted by admitting team
  • ceased phenytoin
  • add carbamazepine
  • discrepancies corrected in ED by admitting team
  • Ward Pharmacist
  • to follow up liquid paraffin in ? aspiration
    pneumonia

23
(No Transcript)
24
Case report 3 Medication Action Plan
  • ED Pharmacist
  • GP confirmed
  • recent discharge from Swan Elderley Mental Health
    Service 1 week ago
  • changed antidepressant to sertraline at SEMHS
  • increased dose of sotalol at SEMHS
  • ceased fosinopril/hydrochlorothiazide in Nov 05
  • dose of atorvastatin
  • discrepancies corrected in ED by admitting team
  • morning doses of venlafaxine and fosinopril had
    been given
  • history obtained from a previous admission (Aug
    05)

25
Case report 4 Medication Action Plan
  • ED Pharmacist
  • GP contacted 18/04/06 confirmed
  • no medication changes communicated on discharge
    09/03/06
  • patient had recommenced allopurinol, frusemide
    and diclofenac
  • pantoprazole not continued
  • Ward pharmacist
  • warfarin counselling
  • follow up allopurinol, diclofenac, frusemide

26
Conclusion
  • Primary objectiveTo compare the accuracy of
    medications recorded on the medication chart
    against a validated medication history taken by
    the pharmacist for high-risk patients.
  • there is a high incidence of unintentional error
    in admission medication histories for high-risk
    patients
  • Secondary ObjectiveAssess the utility of the
    pharmacy service in reviewing high risk patients
    and resolving medication related problems
  • a pharmacist/technician based pharmacy service
    identified, and in a third of cases, corrected,
    unintentional medication errors

27
Key messages
  • Dont rely on old information - validate it
  • Accurate discharge letter is vital
  • Undetected errors made on admission may go
    uncorrected at discharge
  • Medical and nursing staff benefit from clinical
    pharmacy services
  • A dedicated ED pharmacy service improves the
    medication management of admitted patients
About PowerShow.com