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Medication Reconciliation at Osborne Park

Hospital

•Karen Chapman, Senior Pharmacist

•Aaron Cook, SQuIRe Project Officer

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Background

• State-wide SQuIRe program

• Why the need for a Med-Rec project?

• AIMS data and anecdotal evidence

• Medication reconciliation previously performed but poorly documented

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Target Areas

• Reconciliation Project on 3 aged care & rehab wards

• Safety initiatives across other wards

• Majority of patients over 65 years of age, multiple co-morbidities, visual and/or hearing impairments, fluctuating cognitive state, language barriers, multiple medications (average 15), multiple medical professionals seen prior to OPH admission = high risk patients

• Average length of stay on rehab wards is 19 days (reduce)

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Medication Reconciliation Process

• Admission: take medication history, confirm and reconcile

• Discharge/transfer: reconcile, liaise/communicate information to next point of care

• Aiming to achieve a new system which creates accountability, continuity of care and communication, saving time (overall) = safer care for patients

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‘My Own Medicines’ List

Developed for maternity patients to list their medications and ADRs prior to admission

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‘My Medication’ Bags

To encourage patients to bring in their own medications, assisting with reconciliation and safe medication storage during admission.

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Pharmacy Admission Data Sheet

Admission data sheets are completed to list and cross check all medications and indications

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Medication Reconciliation Form

Ensures admission and discharge processes have been completed correctly and details any discrepancies identified

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This is what happens when Doctors make medication errors……!

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Discharge Dispensing Checklist

Discharge dispensing checklist to ensure all stages of discharge process completed

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General Practitioner and Community Pharmacy Facsimile

Created to promote community liaison

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Promotion & Education

• Launched ‘My Medicine bag’ campaign for OPH

• Created and launched the OPH ‘My Own Medicine’ List through the antenatal clinic

• Provided ‘My Medicine bags’ to all rehabilitation wards

• Local community centre posters and presentation promoting a patient’s own medication management

• Regular education sessions with medical and nursing staff

• Liaison with patient’s family, carers, GP and community pharmacist

• Commenced home medicines review initiative with patient’s GP

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Promotion

• Local newspaper (Stirling Times) article and picture

• Northern Lights (OPH’s monthly newsletter/magazine) article and picture

• Osborne GP Network Ltd fax article

• Promotion of ‘My Own Medicines’ on inpatient televisions

• OPH Internet article

• OPH telephone ‘messages on hold’ to promote bringing own medications to hospital

• Liaison with OPH Community Advisory Council

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Improvements in Admission Process

Pharmacists documenting and processing a complete medication history on admission, confirming and reconciling it, has risen from 0% (0/20 patients, March 2007) on 1 ward, to 100% (76/76 patients, August 2008) across 3 wards.

0

20

40

60

80

100

Mar May Jul Sep Nov Jan Mar May Jul

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Improvements in Discharge Process

Similarly, documenting the reconciliation of medications and appropriate liaison/correspondence on discharge has improved from 35% (7/20 patients, March 2007) on 1 ward, to 100% (69/69 patients, August 2008) on 3 wards.

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20

40

60

80

100

Mar May Jul Sep Nov Jan Mar May Jul

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Discrepancies Found on Admission

• May 2008: 56 patients (2 wards), 146 medication discrepancies/errors

• June 2008: 47 patients (2 wards), 88 medication discrepancies/errors

• July 2008: 92 patients (3 wards), 122 medication discrepancies/errors

• August 2008: 76 patients (3 wards), 110 medication discrepancies/errors

0

20

40

60

80

100

120

140

160

May Jun Jul Aug

Patients

Discrep/Errors

Omissions

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Challenges• Time and resources required for complete

reconciliation (which is reliant upon communication with multiple sources)

• Reliance on Pharmacists …….

‘Don’t worry, the Pharmacist will correct it’

• Transient (rotational) nature of some medical staff resulting in a continuous need to retrain, up skill etc

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Future Plans – Medication Safety Initiatives

• Labelling, documentation size increase

• Continue strong engagement of medical staff

• Trial medication storage in centralised area

• Continue community promotion/awareness

• Investigate electronic medical record alternatives

• Investigate methods for preventing/reducing interruptions during Nurse medication rounds

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Questions