the evolution and outcomes of pharmacist medication history services

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The Evolution and Outcomes of Pharmacist Medication History ServicesMatt Kresl Pharm.D BCPSClinical Pharmacy Manager Abbott Northwestern HospitalInnovation Summit September 26th 2015

DisclosureThere are no conflicts of interest or relevant financial interests in making this presentation and have indicated that my presentation does not include discussion of an unlabeled use of a commercial product, or an investigational use not yet approved for any purpose.2

ObjectivesDescribe the challenges of accurate medication history taking in admitted inpatientsReview additional services pharmacists offer beyond list acquisitionUnderstand the data on process and outcome improvements with medication history services3

Patient Story #194 y/o M admitted through ED with emesis, headache and weakness Arrived via ambulanceLives in assisted living Hospitalist unclear on cause EMS information non-contributory Pharmacist asked to review medications in EDPoor historian given condition at time of interview

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Patient Story #1Pharmacist calls home pharmacyPharmacist calls assisted living facilityConvinces RN to go into patients room to obtain medicationsFound medications strewn all across home including empty Tylenol PM and Aleve PM 5

Patient Story # 1Patient diagnosed with anticholinergic OD and treatedPatient discharged back to assisted living with RN administered medications6

Abbotts StoryEmergency Department (2011)Hospitalist Consult Service (2013)MDRs (2014)Integrated Pharmacist Delivery Model (2015)

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Process -More Than Just a ListWhy pharmacy staff?Experience and training Outlined processes Focus and attention 8

Process Pharmacy Staff Note9

Process Pharmacist Navigator10

PRN Services Collaboration with Other Services 11

PRN Services Referral to Outpatient Pharmacist12

PRN Services Tracking Mechanisms13

PRN Services IDP Note Placement14

The Data What Do We Know? 15

1. Bates DW, Spell N, Cullen DJ, et al. The costs of adverse drug events in hospitalized patients. JAMA 1997;277(4):307-11.2. Reducing and Preventing Adverse Drug Events To Decrease Hospital Costs http://www.ahrq.gov/qual/aderia/aderia.htm3. Steven B. Meisel, PharmD at the Joint Commission/Institute for Safe Medication Practices Medication Reconciliation Conference, Nov. 14, 2005.

The Data What Do We Know? 16

Patient Story # 225 y/o F admitted with abdominal painED MD asks about medication use with patient during workupPatient self reports taking no additional medicationsPharmacist enters room and asks about medication use17

Patient Case # 2Asks about over-the-counter and herbal products (not discussed prior)Patient states she is taking 10 grams/day PO acetaminophen for last 2 + weeksPatient admitted and treated for chronic acetaminophen overdose Patient education on appropriate OTC use completed 18

ReferencesBates DW, Spell N, Cullen DJ, et al. The costs of adverse drug events in hospitalized patients. JAMA 1997;277(4):307-11.Reducing and Preventing Adverse Drug Events To Decrease Hospital Costs http://www.ahrq.gov/qual/aderia/aderia.htmSteven B. Meisel, PharmD at the Joint Commission/Institute for Safe Medication Practices Medication Reconciliation Conference, Nov. 14, 2005.The Institute for Healthcare Improvement. Protecting 5 million lives from harm. http://www.ihi.org/IHI/Programs/Campaign/Campaign.htm?TabId=1. Accessed September 14, 2015 American Society of Health-System Pharmacists. ASHP Medication Reconciliation (Med Rec) Toolkit. http://www.ashp.org/menu/PracticePolicy/ResourceCenters/PatientSafety/ASHPMedicationReconciliationToolkit_1.aspx. Accessed September 14, 2015. 19

Contact InformationMatt Kresl PharmD BCPS800 E. 28th Street - Mail Route 11321Minneapolis, MN 55407-3799Phone: 612-863-8333Fax: 612-863-3799matt.kresl@allina.com

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