Medication Reconciliation

Wendy Jordan, Pharm.D.Inpatient Pharmacy ManagerSt. Bernards Medical Center

Jonesboro, AR

Disclosure

The speaker does not have anything to disclose

Objectives

Describe pharmacy department involvement in medication reconciliation

List the possible barriers and limitations related to designing and implementing a successful medication reconciliation program

Discuss the successes and outcomes of an implemented medication reconciliation program

St. Bernards Medical Center

438 licensed beds (avg census = 196 ) Average Daily Admissions = 47 46% ED Admissions Pharmacy Department

16.5 Pharmacist FTEs 18.5 Technician FTEs APPE Students

Pharmacy Services

TPN Service Hospitalists Rounding Service IV to PO Anticoagulation Monitoring Renal Dosing Kinetics Service NICU/ICU Pharmacists Outpatient Services

May 2012

• A3 Lean Event• 74% Error rate on med histories• No standard method of gathering data• Lack of ownership• IT issues• Workflow/Communication Issues

July 2012

• Pharmacy Student Project (1)• ED staff vs. Pharmacy Students• 8.2 minutes vs. 25 minutes• 30% unverified medications vs. 6.3%• 27.5% of recalled medications had errors• 39% of pts had containers or med lists• FTEs needed = 3 (for pts admitted from ED)

May 2013

• Med Rec Team• LPN staffed team during initiation• RN staffed team/Utilization

Management (UM)

Sept 2013

• Pharmacy Student Project (2)• Retrospective review • Average errors/admission = 3.2• Most common error = Omissions• Average time to correct = 12.6 mins• Corrected med history = 37.6 mins

Medication History Team

Began February 2015 Hybrid system – Pharmacy Techs,

Pharmacists, UM Team, and Admitting Nurses Pharmacy Techs – 4 FTEs and 2 PRNs Excluded Patients – Hospice and OB Pharmacy receives consults for complicated

med histories

Pharmacists

Serve as trainers for our med history technicians

Provide oversight Research more complicated issues Help with inpatient order corrections

Pharmacy Technician Training

Certification Required Community and Hospital Trained Technicians 6 to 12 weeks – oversight by a decentralized

pharmacist Medical Terminology Test Top 200 Test Topic Discussions

◄ Jan 2015 ~ April 2015 ~ Mar 2015 ►

Sun Mon Tue Wed Thu Fri Sat

31 MB Topic Discussion: Med History Intro, Policy/ Procedure, Med Rec Pitfalls, HIPPA, Med Terminology & Abbrev

1 MB Topic Discussion: Dosage Forms, Routes, Med Suffix/Prefix, Intro to Top 200 OE Observation

2 MB Topic Discussion: High Alert Meds, Allergies vs Adverse Rxn OE Observation Independent Study

3 LJ OE Observation Independent Study

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6 LK/MB Topic Discussion: Components of an Interview, Eval Form Med Hx Observation

7 LK Topic Discussion: Meditech Training Med Hx Observation

8 LJ Topic Discussion: Meditech Training Med Hx Observation

9 LJ Topic Discussion: Meditech Training Med Hx Observation

10 LJ Medical Abbrev Exam* Med Hx Observation

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13 LK 8:30-11:30 Melissa 12:30-3:30 Leah Med Hx Observation

14 AH 8:30-11:30 Melissa 12:30-3:30 Leah Med Hx Observation

15 LK 8:30-11:30 Melissa 12:30-3:30 Leah Med Hx Observation

16 LJ 8:30-11:30 Melissa 12:30-3:30 Leah Med Hx Observation

17 LJ 8:30-11:30 Melissa 12:30-3:30 Leah Med Hx Observation

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20 8:30-11:30 Melissa 12:30-3:30 Leah Med Hx Observation

21 8:30-11:30 Melissa 12:30-3:30 Leah Med Hx Observation

22 8:30-11:30 Melissa 12:30-3:30 Leah Med Hx Observation

23 8:30-11:30 Melissa 12:30-3:30 Leah Med Hx Observation

24 8:30-11:30 Melissa 12:30-3:30 Leah Med Hx Observation Interview Eval Form*

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26 27 8:30-11:30 Melissa 12:30-3:30 Leah Med Hx Observation

28 8:30-11:30 Melissa 12:30-3:30 Leah Med Hx Observation

29 8:30-11:30 Melissa 12:30-3:30 Leah Med Hx Observation

30 8:30-11:30 Melissa 12:30-3:30 Leah Med Hx Observation

1 8:30-11:30 Melissa 12:30-3:30 Leah Med Hx Observation

Helpful Tools

Training Manual – definitions, policies and procedures, high alert medications, Meditech information, etc.

Interview Scenarios Medical Release Forms Updated Community Pharmacy Information Access to Outpatient Clinic EMRs DrFirst

Things to think about…

Sources of information (family, patient, physicians, pharmacies, bottles, etc.)

Herbals, OTCs, and PRNs Prescribed Directions vs. Patient History IT Functionality and Downstream Effects Physician, Nursing, and Pharmacy Workflow Communication with Community Pharmacies,

Physician Practices, etc.

Today…

Hybrid Medication History Team Pharmacy staff verifies/completes 22.9% of

home medications 22 mins for completed med history 37 mins for corrected med history

Ed coverage Pharmacy

Floor/Float coverage Pharmacy

ED Coverage UM Team

Floor coverage Nursing

Two 12 hour shifts and PRN

Sun Mon Tues Wed Thurs Fri Sat FTEs #of Staff Shifts

7:00 AM 0.6 2 PRN

8:00 AM 2 2 Overnight

9:00 AM 1.5 1.3 12 Hr Morning

10:00 AM 2.1 2.3 12 Hr Evening

11:00 AM 6.2 7.6 Totals

12:00 PM

1:00 PM Hours of Coverage 239

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Tomorrow…

Transitions of Care Discharge Counseling Electronic Communication with Community

Pharmacies Further Expansion of the Med History Team