ereconciliation a tasmanian perspective rory gilmour nov 2014 department of health and human...
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eReconciliation A Tasmanian Perspective
Rory Gilmour
Nov 2014
Department of Health and
Human Services
Department of Health and Human Services
Medication reconciliation is the formal process of obtaining and verifying a complete and accurate
list of a patient’s current medicines.
Department of Health and Human Services
BackgroundDHHS Tasmania:
4 public hospitals
Medication Reconciliation:originally ad hoc and not well structuredpaper based electronic (web based)
HCS developed the “Clinical Suite” enablingstate-wide access to information the sharing of information between disciplines linking medication management activities
Department of Health and Human Services
HCS Clinical Suite
Is a useful tool allowing:Pharmacists to complete
medication admission interviews medication reconciliations add, withdraw or update allergies, alerts and comorbidities medication profiles / counselling sheets episode notes
Department of Health and Human Services
HCS Clinical Suite
Within the same environment doctors complete discharge prescriptions discharge summaries outpatient prescriptions outpatient summaries add, withdraw or update allergies, alerts and comorbidities
Provides decision support and access to state formulary (MIMS, PBS, DHHS meds list and guides) patient medication and other alerts real time decision support
Department of Health and Human Services
Medication Admission Interview
Department of Health and Human Services
Medication Admission Interview conducted upon admission to hospital obtained using a systematic process (ie. using a defined checklist) utilise several sources check for commonly missed medications or items recently ceased or
changed. check for allergies and alerts check whether a supply of each medication is required on discharge. example
Department of Health and Human Services
Medication Admission Interview
Chart Review
(Paper)
Department of Health and Human Services
Chart Review
Department of Health and Human Services
Medication Admission Interview
Chart Review
(Paper)
Medication Reconciliatio
n
Department of Health and Human Services
Medication Reconciliation
A “Med Rec” should compare a patients medication history to the
medications that have been charted highlight potential issues or discrepancies in therapy
to all treating clinicians example
Paper copy placed in the patient’s progress notes
Department of Health and Human Services
Department of Health and Human Services
Medication Admission Interview
Chart Review
(Paper)
Medication Reconciliatio
n
Discharge Prescription
Department of Health and Human Services
Discharge PrescriptionInformation obtained from the
Medication Admission interview NIMC (inpatient drug chart)
is then used to prepare an electronic prescription
Still require a paper based Rx to enable PBS claiming
Some information withheld
Department of Health and Human Services
Some information withheld
Department of Health and Human Services
Department of Health and Human Services
Medication Admission Interview
Chart Review
(Paper)
Medication Reconciliatio
n
Discharge Prescription
Discharge Reconciliation
Department of Health and Human Services
Discharge Reconciliation
conducted by a clinical pharmacistreview and compare the electronic Rx with medication reconciliation
once reconciled – Rx dispensed
Department of Health and Human Services
Medication Admission Interview
Chart Review
(Paper)
Medication Reconciliatio
n
Discharge Prescription
Discharge Reconciliation
Discharge Dispensing
Department of Health and Human Services
Discharge Dispensingprescription dispensed details of medications dispensed sent to the Clinical Suite
patient’s Clinical Suite medication profile updated for future admissions as well as to aid in the completion of:
discharge medication summary (Dr)medication profile / counselling sheet (Ph)DAA label (Ph)
Department of Health and Human Services
Medication Admission Interview
Chart Review
(Paper)
Medication Reconciliatio
n
Discharge Prescription
Discharge Reconciliation
Discharge Dispensing
Discharge Summary
Department of Health and Human Services
Discharge SummaryPopulated by numerous systemsCompleted & signed off by treating doctorAllows for other allied health involvementEmailed to the patient’s:
GP digital medical record PCEHR (depending on consent status)
example
Department of Health and Human Services
eMedication ManagmentDHHS Tasmania has achieved eMM across the state
true closed loop needs to involve ALL care settings!
Department of Health and Human Services
Advantages
single medication record across all hospitalsallows for information sharingis informed by other systems (+/- … PAS, iPcy, etc)
standards compliant (AMT v3, SNOMED, Nehta stds)
promoting best practice in – Accurate and PBS compliant prescribing Past medication actions within reconciliations
easier reporting and statistic gatheringhelps provide better communication and handover (eg tasks and worklists)
Department of Health and Human Services
Disadvantagesinitially slower than hand written human error still possible (minimise not eliminate)currently does not check dose rangesrelies on availability / accuracy of other systemsmanual updating in some areasIT support 9 to 5, hospitals 24/7.user needs to be computer “savy”
Department of Health and Human Services
eReconciliationeReconciliation works if a hospital provides
reliable software (eg HCS) reliable wi-fi iPad / Android or Windows tablets and adequate training
Question: Would I return to paper based reconciliations?
Answer: Not if I don’t have to!
Department of Health and Human Services
QuestionsThanks for listening
Rory Gilmour
Nov 2014