medication reconciliation 2013
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Medication Reconciliation 2013. What is medication reconciliation? Active decision about medication requirements during a transition of care after reviewing home medications for possible drug-drug interactions, drug duplications, dosing errors, or omissions[1] Adding a new medication - PowerPoint PPT PresentationTRANSCRIPT
Medication Reconciliation 2013
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Medication Reconciliation
What is medication reconciliation?Active decision about medication requirements during a transition
of care after reviewing home medications for possible drug-drug interactions, drug duplications, dosing errors, or omissions[1] Adding a new medication Stopping an existing medication Changing an existing medication (dose and/or frequency)
Medication reconciliation should be considered at major transitions of patient care Ambulatory facility/ED visit Admission to hospital/other facility Transfer to a different level of care in same facility Discharge from hospital/other facility
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Medication Reconciliation Facts
Why is medication reconciliation important?2,022 reports of medication reconciliation errors from September
2004 to July 2005 reported to US Pharmacopeia (USP)[2] 22% occur at admission 66% occur at transition in level of care 12% occur at discharge
1.5 million preventable adverse drug events (ADEs) occur annually as a result of medication errors $3 billion per year cost associated with preventable ADEs
50% of all hospital-related medication errors and 20% of all ADEs result from poor communication at the transitions of care[3,4]
ADEs result in 2.5% of ED visits for all unintentional injuries and 6.7% of those leading to hospitalization[5]
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Medication Reconciliation
Why is medication reconciliation required?
Quality of care: reduce adverse events lower cost
Professionalism: prevent errors in care
Regulatory: The Joint Commission requirement
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UCI Med Reconciliation Process
Obtain an accurate home medication list at start of patient encounter by Physician/NP/PA Nurse Pharmacist MA
Use various tools in Quest for viewing/updating home medication list and inpatient medication list for reconciliation at major transitions of care
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UCI Med Reconciliation Process
What features does each tool have for medication list? OMR Rx Writer OR Manager Clinical Summary Tab Orders Tab
(ORM) Med Reconciliation View Pharmacy View
View home medications
View inpatient medications
View home medications
Update home medications
View home medications
Update home medications
Rx new home medications
View home medications
Update home medications
Rx new home medications
Order inpatient medications
View inpatient medications
Manage inpatient medications
Order inpatient medications
Order icon
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UCI Med Reconciliation Process
Select your primary role:
Adult patient care
Neonatal patient care
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UCI Process - Adult Patient Care
Admission to hospital Obtain/document medication Hx
Everyone has a role
Reconcile home/inpatient medication
Physician/NP/PA gets medication Hx from patient and Quest tools and documents medication list in H&P and/or OMR
Nurse gets medication Hx from patient, H&P, and Quest tools and documents medication list in OMR with status of review
Physician/NP/PA reconciles home medications with inpatient orders in Order Reconciliation Manager (ORM) within 24 h of admission
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Documenting Home Medications
Updating the home medication list in Quest tools maintains a consistent list of home medications that can be referenced in the Clinical Summary Medication Reconciliation view
Status of home medication list is indicated
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New Quest Tools - OMR
+Add home medication Update status of home medication list: taking, not taking, unknown, or incomplete
Mark as reviewed
?? Needs follow-up for incomplete info
No longer taking
Home Med Review status
Edit medication dose or frequency
Edit Pharmacy info
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New Quest Tools - ORM
Select here for admission reconciliation.Status of medication reconciliation displays
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New Quest Tools - ORM
=Home medication list (in OMR) not done=Home medication list (in OMR) incomplete=Home medication list (in OMR) complete
Only works if home medication list was complete and all medications are reconciled;otherwise, it will save as “incomplete”
Floating menu arrow
If home medication list needs editing, it can be done by using ++Enter function, launching OMR, or editing each drug individually
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Admission Reconciliation [Expanded View]
Stop/hold on admission=
Floating menu arrow
Reconciliation options for home medications appear after hovering over floating menu arrow (see previous slide)
Convert to inpatient order=Change dose/frequency or alternative drug
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Admission Reconciliation
If there is an existing inpatient order, it will match up with closest home medication for reconciliationHome Medications Inpatient Medications
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Admission Reconciliation
Home Medications Inpatient Medications
Patient was no longer taking this drug, so it becomes crossed out
Held on admission
Continued as inpatient order
All home medications reconciled
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Admission Reconciliation
Enter additional admission medications
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Discharge Reconciliation
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Discharge Reconciliation
Use Discharge Note to launch discharge reconciliation (ORM)
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Discharge Reconciliation
Launch discharge medication reconciliation (ORM) from new Discharge Note
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New Quest Tools - ORM
Discharge medication reconciliation
Select here for discharge reconciliation.Status of medication reconciliation displays
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Discharge Reconciliation
If home medications prior to admission were incomplete, add or edit here
After discharge reconciliation, the new home medication list at discharge will display on right side column
ITEMS TO RECONCILE= active inpatient and pre-admission medications
e-Rx new discharge prescriptions here
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Discharge Reconciliation
There are also quick action buttons for each medication in Discharge Reconciliation that are only enabled if there is a match in Prescription Writer for “quick prescription”:
If not enabled, you can still use the menu options to reconcile or prescribe:
Continue at home w/o Rx “quick” discharge e-Rx Not required or stop
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Discharge Reconciliation
Home medication that was converted to inpatient order
Home medication that was not continued as inpatient order
Discharge reconciliation options for pre-admission home medication
Discharge reconciliation options for inpatient medication
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New Quest Tools - ORM
Choose expanded view in Format Layout to see all drugs
Pill indicates inpatient medication
House/pill = home medication
House/pill = home medication
Indicates variations of same drug(2)
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New Quest Tools - ORM
Choose expanded view in Format Layout to see all drugs
Inpatient medication
Both versions expanded
House/pill = home medication
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Discharge Reconciliation
Discharge medication reconciliation actions: Tylenol was not ordered as inpatient drug but resumed at discharge Oral Dilantin prior to admission was converted to IV as inpatient order and then
back to oral with e-Rx at discharge IV Dilantin ordered as inpatient was not continued at discharge
Pre-admission oral Dilantin is crossed off since new e-Rx created at discharge
Inpatient IV Dilantin crossed off since not continued at discharge
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Discharge Reconciliation
Add discharge medication instructions in note after ORM is “complete”
Required for Discharge Instructions to print. Will only auto-check if ORM is “complete”; otherwise, selection will clear
Continue Home Medications
Tylenol 325 mg, 2 tablets every 4 hours as needed for pain or fever
New PrescriptionDilantin extended release 30 mg, 1 capsule at bedtimeSent to CVS, Orange (714) 555-5500
Click to update discharge medication list in Discharge Note
Instruction Categories:Continue Home Medications
•These Home Medications Are Not Changed
•These Home Medications Are Changed
New Prescription(s)
Stop These Home Medications
Discharge to Another Facility
Discharge to another facility does not require ORM
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Select to open active inpatient orders
Required for Discharge Instructions to print
Printing Discharge Medications
Patient Discharge Instructions will not print until: the status of medication reconciliation is complete and verified
by Pharmacy for patients going to home, B&C, AL, etc. or Discharge Note indicates that transfer orders are “complete” for
patients discharging to another facility (SNF, LTAC, or other acute care setting).
New prescriptions or any updates to the medication list after the status of medication reconciliation is completed will cause it to become “incomplete” again
Discharge medication reconciliation needs to be re-done for any new Rx Discharge medication list needs to be refreshed in Discharge Note
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Re-do Discharge Reconciliation
A reconciliation can be reset to incomplete if saved in error or additional information was received. Re-launch ORM:
1) Select “View/Maintain History” tab
2) Select “Discharge” Reconciliation Type
3) Click “Set to Incomplete” and return to “Reconciliation Orders” tab
Admission Medication History: You can update the home medication
list via OMR while in the H&P note and pull that list into your note.
Indicates the home medication list, collected by the nurse, is complete
Medication Reconciliation: Admission reconciliation is to be done
within 24 hours of admit Remember to hover over the
medication list to use the floating menu arrow to select reconciliation options
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Summary of Key Points
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Discharge: Discharge medication reconciliation (ORM) automatically updates
Prescription Writer and the medication list on the patient’s Discharge Instructions
In the Discharge Note for patients transferred to another facility, you are directed to review and select appropriate current orders to be continued. • This constitutes the Discharge Order/Treatment Plan that includes
medications• Medication reconciliation (ORM) is not done on these types of
discharges
Summary of Key Points
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Discharge (cont.): New prescriptions or edits in Prescription Writer will reset the
discharge medication reconciliation to an incomplete status.• Return to the Discharge Note,• Launch medication reconciliation (ORM) and complete it,
• “Refresh” medication list in the Discharge Note Nursing will not be able to discharge the patient until medication
reconciliation and Pharmacy review is complete.• Discharge Instructions will not print until reconciliation is complete
Summary of Key Points
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Medication Reconciliation - Adult
Please make selection:End trainingReview Adult patient care admission medication reconciliationReview Adult patient care discharge medication reconciliationNeonatal patient care
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UCI Process - Neonatal Care
Admission to hospital Obtain/document medication Hx
Everyone has a role
Reconcile home/inpatient medication
If transfer, physician/NP/PA gets medication Hx from family and/or transfer records and documents medication list in H&P and/or OMR
If admitted from home, nurse gets medication Hx from family, H&P, and QUEST tools and documents medication list in OMR with status of review
Physician/NP/PA uses medication Hx to order inpatient medications
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Documenting Home Medications
Updating the home medication list in Quest tools maintains a consistent list of home medications that can be referenced in the Clinical Summary Medication Reconciliation view
Status of home medication list is indicated
37
New Quest Tools - OMR
+Add home medication Update status of home medication list: taking, not taking, unknown, or incomplete
Mark as reviewed
?? Needs follow-up for incomplete info
No longer taking
Home Med Review status
Edit medication dose or frequency
Edit Pharmacy info
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Discharge Medication Reconciliation - ORM
Launch discharge medication reconciliation
Select here for discharge reconciliation.Status of medication reconciliation displays
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Discharge Reconciliation
If home medications prior to admission were incomplete, add or edit here
After discharge reconciliation, the new home medication list at discharge will display on right side column
ITEMS TO RECONCILE= active inpatient and pre-admission medications
e-Rx new discharge prescriptions here
40
Discharge Reconciliation
There are also quick action buttons for each medication in Discharge Reconciliation that are only enabled if there is a match in Prescription Writer for “quick prescription”:
If not enabled, you can still use the menu options to reconcile or prescribe:
Continue at home w/o Rx “quick” discharge e-Rx Not required or stop
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Discharge Reconciliation
Home medication that was converted to inpatient order
Home medication that was not continued as inpatient order
Discharge reconciliation options for pre-admission home medication
Discharge reconciliation options for inpatient medication
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New Quest Tools - ORM
Choose expanded view in Format Layout to see all drugs
Pill indicates inpatient medication
House/pill = home medication
House/pill = home medication
Indicates variations of same drug(2)
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New Quest Tools - ORM
Choose expanded view in Format Layout to see all drugs
Inpatient medication
Both versions expanded
House/pill = home medication
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Discharge Reconciliation
Discharge medication reconciliation actions: Tylenol was not ordered as inpatient drug but resumed at discharge Oral Dilantin prior to admission was converted to IV as inpatient order and then
back to oral with e-Rx at discharge IV Dilantin ordered as inpatient was not continued at discharge
Pre-admission oral Dilantin is crossed off since new e-Rx created at discharge
Inpatient IV Dilantin crossed off since not continued at discharge
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Re-do Discharge Reconciliation
A reconciliation can be reset to incomplete if saved in error or additional information was received. Re-launch ORM:
1) Select “View/Maintain History” tab
2) Select “Discharge” Reconciliation Type
3) Click “Set to Incomplete” and return to “Reconciliation Orders” tab
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Medication Reconciliation - Neonatal
Please make selection:End trainingReview Adult patient care admission medication reconciliationReview Adult patient care discharge medication reconciliationReview Neonatal patient care
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References
[1] Pentecost MJ. "Improving health care quality: current concepts," Permanente Journal, 2007 Winter; 11(1): 75-8. Available at: www.ncbi.nlm.nih.gov/pmc/articles/PMC3061389/ . Accessed May 13, 2013.
[2] The Joint Commission. Using medication reconciliation to prevent errors. Sentinel Event Alert. Issue 35. January 25, 2006. Available at: http://www. jointcommission.org/assets/1/18/SEA_35.PDF. Accessed May 13, 2013.
[3] Institute for Healthcare Improvement. 5 Million Lives: Preventing Adverse Drug Events (Medication Reconciliation): How-to Guide. Available at: http://www.ihi.org/IHI/Programs/Campaign/ADEsMedReconciliation.htm. Published Oct. 1, 2008. Accessed May 13, 2013.
[4] The Joint Commission. 2011 National Patient Safety Goals. Available at: http://www.jointcommission.org/assets/1/6/NPSG_EPs_Scoring_ HAP_20110706.pdf. Accessed May 13, 2013.
[5] Budnitz DS, Pollock DA, Weidenbach KN, et al. “National surveillance of emergency department visits for outpatient adverse drug events,” JAMA, 2006; 296: 1858-66.