![Page 1: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/1.jpg)
Medication Reconciliation in Continuing Care
Getting It Right TogetherCreating a Culture of Safety
September 8, 2008
Dr. Paula Creighton MD, FRCP(C)Geriatric Medicine Specialist
Cape Breton District Health Authority
![Page 2: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/2.jpg)
September 2008 Dr. Paula Creighton Page 2
Outline
Understand why Medication Reconciliation
is getting so much attention through:
• Understanding how adverse drug events (ADEs) commonly occur
• Identify practical steps that can reduce the risk of ADEs in practice
• Identify key features of a safer system
![Page 3: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/3.jpg)
September 2008 Dr. Paula Creighton Page 3
![Page 4: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/4.jpg)
September 2008 Dr. Paula Creighton Page 4
![Page 5: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/5.jpg)
September 2008 Dr. Paula Creighton Page 5
Definition Adverse Event
• UNINTENDED act or event during care
• May result in potential harm
• Harm = increase length of stay
= temporary/permanent disability
= death
![Page 6: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/6.jpg)
September 2008 Dr. Paula Creighton Page 6
![Page 7: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/7.jpg)
September 2008 Dr. Paula Creighton Page 7
How ADEs occur?
• Increase range of medicines to treat or prevent disease
• Multiple co-morbid conditions
• Age-related changes physiology
Tsilimingras, Rosen, &. Berlowitz 2003.
Canadian Patient Safety (CPSI) Institute 2006
![Page 8: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/8.jpg)
September 2008 Dr. Paula Creighton Page 8
How ADEs occur?
• Multiple health care practitioners
• Frequent visit to hospital setting (hospitalization, procedures, tests)
• Adherence problems
Tsilimingras, Rosen, &. Berlowitz 2003.
Canadian Patient Safety (CPSI) Institute 2006
![Page 9: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/9.jpg)
September 2008 Dr. Paula Creighton Page 9
How ADEs occur?
• OTC medication use
• Impaired vision, dexterity, literacy
Tsilimingras, Rosen, &. Berlowitz 2003.
Canadian Patient Safety (CPSI) Institute 2006
![Page 10: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/10.jpg)
September 2008 Dr. Paula Creighton Page 10
When ADEs occur?
• Entry and exit points of clinical encounters
Cornish P. et al Arch Intern Med 2005:165; 424-429
![Page 11: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/11.jpg)
September 2008 Dr. Paula Creighton Page 11
• Labels
• Lists
• Verbal (open ended inquiry)
• Someone else has/will complete
Traditional Medication History
![Page 12: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/12.jpg)
September 2008 Dr. Paula Creighton Page 12
Limitations to Traditional Medication History
Discrepancies:
• Unintentional
• Undocumented Intentional
![Page 13: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/13.jpg)
September 2008 Dr. Paula Creighton Page 13
Unintentional Discrepancies
•Over-the-counter medications
•Shared prescriptions
•Labels “as directed”
•Prescription change without script
•Samples
![Page 14: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/14.jpg)
September 2008 Dr. Paula Creighton Page 14
Undocumented Intentional Discrepancies
• What changed and why?
• Convey a clear understanding of desired outcomes to therapy.
• Written communication with patient/family and pharmacist
![Page 15: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/15.jpg)
September 2008 Dr. Paula Creighton Page 15
Get Involved
Now!safer healthcare
![Page 16: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/16.jpg)
September 2008 Dr. Paula Creighton Page 16
Key Features toward a Safer System
Change
![Page 17: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/17.jpg)
September 2008 Dr. Paula Creighton Page 17
Key for a Safer System
•Doing our jobs differently…
…If you always do what you have always done;
You always will get what you always got
![Page 18: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/18.jpg)
September 2008 Dr. Paula Creighton Page 18
Practical steps to reduce risk of ADEs
• “To prescribe according to best evidence from scientific research and to be mindful of the precepts of patient autonomy”
Holland R, Wright D. Medication Review for Older Adults. Geriatrics and Aging March 2006, Vol 9. No.3.
![Page 19: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/19.jpg)
September 2008 Dr. Paula Creighton Page 19
Practical steps to reduce risk of ADEs
• When might it be best to withhold or discontinue medications that are otherwise appropriate on the basis of guidelines?
![Page 20: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/20.jpg)
September 2008 Dr. Paula Creighton Page 20
Practical steps to reduce risk of ADEs
• Consider life expectancy
• Goals of care and quality of life defined by patient/family
• Potential benefit & risk of medications
![Page 21: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/21.jpg)
September 2008 Dr. Paula Creighton Page 21
Practical steps to reduce risk of ADEs
Start low,
Go slow,
Or don’t start at all!
![Page 22: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/22.jpg)
September 2008 Dr. Paula Creighton Page 22
Practical steps to reduce risk of ADEs
Partnering with Patients
“Nothing about me, without me”
(author unknown)
![Page 23: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/23.jpg)
September 2008 Dr. Paula Creighton Page 23
Medication Reconciliation
Partnering with Patients
• patient/family interview
![Page 24: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/24.jpg)
September 2008 Dr. Paula Creighton Page 24
Practical steps to reduce risk of ADEs
• Humans require formal cues/processes to stay on track reliably
• Reliable work processes account for the known imperfections of humans
Adapted from PSO Training Course (IHI) 2004
![Page 25: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/25.jpg)
September 2008 Dr. Paula Creighton Page 25
Medication ReconciliationMEDICATION RECONCILIATION: include on list below Over the counter products, Samples, Shared pills
Drug NameDrug
Strength
When Taken
Indicate if: -New-Change from label-Effects from new and change
Morning Noon Evening Bedtime
1
2
3
4
5
6
![Page 26: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/26.jpg)
September 2008 Dr. Paula Creighton Page 26
Threats for Change toward a Safer System
• Power Gradient
• Fear
• (Mis)-Perception “touchy, feely” initiatives
![Page 27: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/27.jpg)
September 2008 Dr. Paula Creighton Page 27
Key for Change toward a Safer System
Self audit:
• More mirrors and fewer windows
![Page 28: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/28.jpg)
September 2008 Dr. Paula Creighton Page 28
Self Audit
• "One of the major impediments to convincing people of the prevalence and seriousness of cognitive error is the faith they have in their own thinking abilities"
Croskerry, P. The Science of Human Factors in Healthcare, QHN, October 2003
![Page 29: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/29.jpg)
September 2008 Dr. Paula Creighton Page 29
Key for Change toward a Safer System
“ Many little people
Doing many little things
In many little places
Can change the world.”(Chinese Proverb; author unknown)
Susan Sheridan, Chair, Patients for Patient Safety Strand, WHO World Alliance for Patient Safety; Co-Founder, Consumers Advancing Patient Safety, Eagle, Idaho
![Page 30: Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric](https://reader036.vdocuments.net/reader036/viewer/2022070412/56649d1a5503460f949efe9f/html5/thumbnails/30.jpg)
September 2008 Dr. Paula Creighton Page 30
Get Involved
Now!safer healthcare