medication safety the role of medication reconciliation & medicine lists presenter name &...
TRANSCRIPT
Medication Safety
The Role of Medication Reconciliation &
Medicine Lists
Presenter Name & Organization
Objectives
• Be familiar with Washington Patient Safety Coalition• Understand where medication reconciliation, My
Medicine List, and safe transitions fit into the medication safety strategic plan.
• Understand the current regulatory drivers around medication reconciliation, such as The Joint Commission’s National Patient Safety Goal (NPSG)
• Advocate and implement medication reconciliation into workflow
• Promote patient awareness and utilization of My Medicine List
Patient Case
• 52 year old man goes to the clinic for a check-in visit with his Specialist provider.
• Patient’s electronic chart indicated he was to take 1 tablet of aspirin 325 daily.
Patient reported taking 18 tablets of aspirin 325mg daily for shoulder pain.
• This is almost 6,000 mg of Aspirin• New pain regimen was discussed
The Washington Patient Safety Coalition is dedicated to improving patient safety and reducing medical errors for individuals receiving health care in Washington, in all care settings.
Our Vision
• Safe care: every patient, every time, everywhere.
Our Values
• Patient-centered• Systems-oriented and
sustainable• Evidence-based• Inclusive• Resource-sensitive
Our Goals
• We will improve safety within and across all care settings by:
• Facilitating the exchange of information about best practices relative to patient safety.
• Disseminating new knowledge and new practices.
• Supporting coordinated/collaborative efforts and new partnerships.
• Raising awareness of the need for safe practices.
About the WPSC
www.wapatientsafety.org
The Concerns Around Medication Safety
• 1999 IOM report: estimated that medical errors cause 44,000 to 98,000 preventable deaths and one million additional injuries each year in U.S. hospitals, and cost over $850 billion.
• A 2006 follow-up to the IOM study found that medication errors are among the most common medical mistakes, harming at least 1.5 million people every year. According to the study, each year… 400,000 preventable drug-related injuries occur in hospitals 800,000 in long-term care settings 530,000 among Medicare recipients in outpatient clinics
Improving Medication Safety: Where to begin?
High Alert / High Risk
Agents
Adherence/ Compliance
Barriers
Drug Interactions
Patient Education
Medication Errors
Improved Packaging &
Labeling
Prescriber Education
Transitional Care Management
Transitional Care Management
Patients at Risk
Cornish PL et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med. 2005;165:424-429.
Nearly 40% of patients have ≥ 1 unintended medication discrepancy at hospital
admission!
A similar proportion are present at transfer within a hospital and in 14% of patients at hospital discharge.
Medication Reconciliation: A Definition?
No standard exists! The Joint Commission
recommends…The process of verifying that a patient’s current list of medications (including dose, route, and frequency) is correct and that the medications are currently
medically necessary and safe.
Greenwald et al. Making inpatient medication reconciliation patient centered, clinically relevant, and implementable: a consensus statement on key principles and necessary first steps. Jt Comm J Qual Patient Saf. 2010 Nov;36(11):504-13, 481.
ASHP-APhA Medication Reconciliation Goals
Medication reconciliation should be a patient-centered process, taking into account the patient’s level of health literacy and willingness to engage in his or /her personal health care.
Target improvement in patient well-being through education, empowerment, and active involvement
Achieve by promoting communication among patients and healthcare providers
ASHP – APhA Medication Reconciliation Initiative Workgroup Meeting . February 12, 2007
Achieving Medication Safety Goals via Medication Reconciliation
Drive Systems (Re)Design and Process Improvement
Maximize Use of Technology
Facilitate Cultural Change
Catalyst Driving Change
• WPSC• Regulatory
Organizations• Reimburseme
nt Models
Drive Systems (Re)Design and Process Improvement
Healthcare Systems Design:Must Support the Med Rec
ProcessCollect
Clarify
Verify
Reconcile
Educate
Communicate
Change in…• Care Setting• Medications
Pt & Family
Medication Info Sources
Physicians
Pharmacies
Care Facilities
Medical Records
3rd Party Vendors
Pre-Admit Outpt
Medication List
Inpatient Med List
Pre-Admit Outpt
Medication List
Patient condition & diagnosis
Inpatient Med List
Outpatient Medication
List
Pre-Admit Outpt
Medication List
Pt & Family
Physicians
Pharmacies
Care Facilities
HOSPITAL ADMISSION PROCESSDISCHARGE
PROCESS COMMUNITY PROCESS
Clarification/Verification
Discharge Medication Reconciliation
Medication Reconciliation: Not So Simple!
Real Life Example: Inpatient Admission
• Patient admitted through ED– ED Not a good setting for collecting information
• Triage, stabilize, transfer or discharge• Solution: ED Med Rec Techs
– Complete when admitted on unit?• Nurses busy admitting patient• Med Rec challenging and time consuming
– Use what was collected in ED? Verify but not thoroughly?• Provider prints off what is in system
– Unverified, from last admission– Errors perpetuated on Transfer and at Discharge– Garbage In = Garbage Out
Real Life Example: Franciscan Health System
• Patient Arrives at ED– ED Med Rec Tech
• Interviews patient or caregivers• Records medication information from patient medication
bottles• Calls outpatient pharmacies, queries available sources,
GH Epic, FMG Elysium, etc., contacts patient’s PCPs• Clarifies information with family or caregiver• Generates a complete and accurate home med list that
is reviewed by a pharmacist• List provided to ED or admitting provider to complete
medication reconciliation.– Accurate home medication improves transitions in
care– Provides a good foundation for Discharge Med Rec
Real Life Example: Group Health
Post-Discharge Medication Reconciliation
Discharge Home Primary Care
• Patients identified who are high risk for readmit
• Information sent to Clinical Pharmacists for follow up
• Pharmacist calls patient 1 - 3 days post-discharge
• Med recon and comprehensive medication review
• Pharmacist updates patient’s physician
• Makes medicationrecommendations
80% of patients have at leastone discrepancy resolved.
Safe Transitions Involve Many!
• Safe transitions are best when we maximize a multi-disciplinary approach
• Group Health: Specialty Medication Reconciliation involves a variety of disciplines– Medical Assistant: medication verification– Specialist: medication review and hand-off to
pharmacist– Pharmacist: comprehensive medication
reconciliation and communication to patient and appropriate physicians
– Primary Care Provider: authorize prescriptions and carry out ongoing care of patient’s therapy
INCENTIVIZING CHANGE VIA REGULATORY PROCESSMandating change and prioritizationTechnology Adoption
The Joint Commission Medication Reconciliation
Requirements
2005
2006
2007
2008
2009 2010
• TJC introduces NPSG 8
• “Med Rec” required for accreditation
• NPSG minor revisions
• NPSG major revisions planned
• Scoring suspended and some simplification
• New standards created & released
A 6-year journey to improve patient safety
2012
• Implementation of new standard
TJC 2011 Medication Reconciliation
National Patient Safety Goal #3: “Improve the safety of using medications”
NPSG.03.06.01: “Maintain and communicate accurate patient medication information”
Applies to:• Hospitals, including Critical Access Hospitals• Ambulatory Care• Office (Ambulatory) Surgery• Home Care• Long-term Care• Behavioral Health
Medicare Reimbursement
The Patient Protection and Affordable Care Act (H.R.
3590)
At Risk: 1% reduction in FY2013 and will Rise to 3% by FY2015
Hospital Consumer Assessment of Healthcare
Providers and Systems (HCAHPS) (Section 3001)
At Risk: 1% in FY2013 growing annually to 2% in FY2017
(70% Core Measures + HAI and 30% HCAHPS)
Core Measures(Section 3001)
Healthcare-Associated Infections (HAI)(Section 3001)
COPD, CABG, PTCA, etc.
AMI, PNE, HF
Readmission Rates(Section 3025)
At Risk: 1% reduction beginning FY2015
Hospital Acquired Conditions (HAC)(Section 3008)
5
Value-Based Purchasing (VBP)
Readmissions are…
Frequent• 18% of all Medicare hospitalizations are 30-day re-
hospitalizations• Average rates are >20% for certain patient populationsPotentially avoidable• 76% of Medicare re-hospitalizations were “potentially
preventable”Costly• $15B annually in Medicare of which $13B may be
unnecessaryActionable for improvement• Research and quality improvement initiatives have
demonstrated >30% reduction of 30-day readmission rates for a variety of populations
MedPAC 2007 Report to Congress; Promoting Greater Efficiency in Medicare
http://www.medpac.gov/documents/jun07_entirereport.pdf
Medications and medication use are often implicated in unexpected readmissions!
Med Reconciliation & Readmissions
Intervention: Med Recon
Comparison: No Med Recon
30%37%
11%
21%
0
5
10
15
20
25
30
35
40
Number of Patient
Readmits
Readmission Rates
14 day30 Day
How much does ahospital readmit cost?
Our analysis showsthat for every 25
patients that receives med recon post-
discharge, 1 hospital readmit is prevented.
$14,500
For the 2012 calendaryear, the program will
save an estimated1 million dollars
Kilcup M, Schultz D, et al. Post-discharge pharmacist medication reconciliation: Impact on readmission rates and financial savings. J Am Pharm Assoc. 2013: Jan/Feb, 53:1.
Phase of Care
AdmissionInpatient
StayDischarge Home
Pharmacy Service Provided
Perform Admission Assessment
Determine factors in admission/readmission
• Medication history• Medication reconciliation• Errors of omission (EBM)• Adverse drug events (ADE)• Medication adherence• Medication access
Determine post-hospital needs• Where will patient likely
receive care?• Who are caregivers?• Barriers to care?
Care Optimization
Provide effective teaching & enhanced learning
• Identify barriers to learning• Medication management• Disease self-management• Medication adherence• Use “Teach Back” method• Provide tools
Optimize the medication regimen• Initiate indicated medications• Discontinue unnecessary or
unsafe medications• Simplify the medication
regimen
Prepare for Transition in Care
Medication regimen review• Medication reconciliation• Provide medication list and
related information to:o Patient/caregivero Physician/medical teamo Pharmacy/pharmacist
Verify appropriate post-
discharge care plan• Match discharge follow-up to
need (readmission risk stratification)
• Ensure proper information is provided regarding contact information, action plan for care and symptom or AE management
Provide Appropriate Post-Discharge Care
Contact patient/caregiver• Live or virtual visit
Patient status and medication review
• Medication reconciliation• Medication adherence• ADE surveillance• Medication access• Med management/ Disease
management
Communicate to other providers any pertinent medical information or findings
Opportunities for Pharmacy: Readmissions Preventing
Interventions
Achieving Medication Safety Goals via Medication Reconciliation
Drive Systems (Re)Design and Process Improvement
Maximize Use of Technology
Facilitate Cultural Change
Catalyst Driving Change
• WPSC• Regulatory Organizations
• Reimbursement Models
Maximize Use of Technology
Achieving Medication Safety Goals via Medication Reconciliation
Drive Systems (Re)Design and Process Improvement
Maximize Use of Technology
Facilitate Cultural Change
Catalyst Driving Change
• WPSC• Regulatory Organizations
• Reimbursement Models
Facilitate Cultural Change
My Medicine ListHeighten Public
Awareness
• Emphasize the need for patients to take an active role in managing their medicines.
• The initiative’s goal is for every person to maintain an up-to-date list and to share it with his/her health care provider.
What's in a “Medicines” List
• Respiratory therapy-related medications
• Parenteral nutrition• Blood derivatives• Intravenous solutions
(plain or with additives)
• Diagnostic and contrast agents
• Radioactive medications
• Prescription medications
• Sample medications• Vitamins• Herbal & Alternative
Meds• Nutriceuticals & Dietary
Supplements• Over-the-counter
drugs• Vaccines
Any product designated by the FDA as a drug!
How Can You Help?Remember the 3 As
• ASK every patient about his or her medicine list at each encounter.
• ADVISE your patients to carry a list• ASSIST your patients with resources & tools
What you don’t know about your patients could harm them!
Refer your patients to
mymedicinelist.org for information and resources
