Improving Medication Safety on Transitions of Care

Ged Hawthorn-Snr Clinical Pharmacist Education and Training Shannon Townsend- Emergency Medicine Registrar Orange Health Service 2015

Orange Health Service

Med Rec- How do we compare?

• Using adapted QLD health MAP since 2008

• Adopted NSW Health MMP 2011

• 2012- Project Med Rec on admission

• Since then around 75% pts have MMP

• Discharge process

CEC Continuity of Medication Management Audit

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Omission Discrepancy Either Omission or Discrepancy

Percentage of patients with at least one medication omission or discrepancy at discharge – OBH 2013

A Series of Audits

96%

58%

46%

13%

61%

79%

0%

88%

69%

48%

13%

67%

82%

13%

100%

72%

50%

20.00%

73%

85%

18%

22%

0%

Patients taking medications with a discharge summary

Patients with more than 5 mediciens on discharge

Patients on medicines, that had one or more medications omitted

Patients with a discharge summary that had additionalunexplained medicines

Patients with at least one omission or discrepancy on theirdischarge summary

Patients on medicnes which were ceased, new or changed duringadmission

Patients with discharge summary that had a rationale for allchanges to medicines

Patients who received a patient friendly medication list

percentage of identical med lists and discharge summaries

1/01/2013 OHS

1/06/2013 OHS

1/06/2014 CCU

Time for Action

• Engaging Staff: Feedback, Highlighting risk, engaging,

empowering, pts story, solution focused

• The Team: Pharmacists, JMOs, Regs,

NUM, CNC, CNE, IT, Pt

Safety

• Combined Aim: Improve the accuracy of medication documentation and increase patient

education by 20% within 6 months

Planning & implementing solutions

Incorrect documentation and lack of patient education regarding medicines on discharge

D/C summary written in Latin

Communication

Pt verbally counselled but not documented Need pharmacist on round for direct and effective communication

No Multi-d communication tool

No template for meds in EMR

IT

No eMMP and discharge checklist Transcription

errors

JMO hands documents to ward clerk rather than to engage in conversation with pt.

Bed pressure, high turnover, not enough time to prepare d/c.

Weekend Discharges no reconciliation process

Busy staff conflicting tasks to do

Processes

JMO writing d/c unfamiliar with pt Underfunded pharmacist

FTE/ no redundancy Pt not seen by pharmacist on d/c

Staffing

Systems don’t integrate

Pharmacist not available on ward at time of discharge

No clear plan from team re meds

No formal multi-d discharge process.

Nursing not taking ownership of medication counselling.

Possible solutions High Impact Low Effort

Increase communication

Remove latin abbreviations

Develop medicine list template

Nursing flagging high risk patients

Create a Multi-D eMMP

Medication safety discharge checklist

Rostering pharmacist time

Discharge flow sheet for staff to follow

Possible solutions High Impact High Effort

• Customise eMR for useful discharge templates Costs $

• Education for nurses to do medication reconciliation Time

• Employ more pharmacists Attempting to

• Having one integrated eHealth system I’ll keep dreaming!

• Pharmacist increase med rec on discharge

• Streamline medical rounding

• Clinical streams for pharmacists to provide redundancy

Enablers | Barriers Smaller Hospital Motivated staff Consultant buy in SIBR Model Pharmacist med rec on ward Patient Focus Research demonstrating importance CEC toolkit MMP

Pharmacy not built into discharge process Staffing Multi-D engagement Med Rec Union’s and position descriptions Med Rec not seen as everyone’s business Individuals

SIBR In Action

Outcomes and evaluation

2015 Western NSW LHD Living Well Together Health Awards

Outcomes and evaluation

Sustaining change

2015 Western NSW LHD Living Well Together Health Awards

• Policies on medication reconciliation developed

• MMP, BPMH and HETI med rec training during orientation

• Cardiologists briefed to educate JMOs on discharge expectations

• eMMP is now in use in ICU and is available for ICIP across district

• Medication reconciliation is a large focus of all pharmacists work

• Engagement and results shown to new team on ward

How to gain support from the Exec

•Financial Savings Number of discrepancies per patient (1.55- from baseline audit data) x Number of patients per year through cardiovascular ward (1654- from health round table report) x Percent of patients with discrepancies that would result in an adverse drug event (9.4% of errors on a cardiology ward that could result in harm[1]) x Percent effectiveness of process (85% of discrepancies avoided through med rec process, global and local result) x Cost of an average adverse drug event ($2500 conservative)

= Annual gross cost savings ($512 100)

•Accreditation - helps to meet 15 standard 4 requirements.

•Strategic Fit

Financial model developed by Steven B. Meisel, Pharm D Minneapolis. [1] Magalha˜es GF, Santos GBNdC, Rosa MB, Noblat LdACB (2014) Medication Reconciliation in Patients Hospitalized in aCardiology Unit. PLoS ONE 9(12): e11549doi:10.1371/journal.pone.0115491

Questions