Partnering with Patients in Medication Safety
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1 Partnering with Patients in Medication Safety February 6 th, 2018 PPC 2018 Alice Watt, RPh. B.Sc (Pharm) ISMP Canada ISMP Canada 1
2 Presenter Disclosure Presenter s Name: Alice Watt I have no current or past relationships with commercial entities Speaking Fees for current program: I have received no speaker s fee for this learning activity
3 Commercial Support Disclosure This learning activity has received in-kind support from CSHP in the form of a 2 day complementary registration to this conference.
4 Objectives Participants will leave with an increased understanding of: the rationale for partnering with patients in medication safety the role and responsibilities of patients/families in medication safety and how hospital pharmacists can help
5 Objectives Participants will leave with an increased understanding of: the evidence pertaining to patient and family engagement strategies and their impact on medication safety supporting tips, tools and resources, leading innovation and practices that help engage patients in safe medication use
6 Rationale for Partnering with Patients ISMP Canada 6
7 Colleen s Story November 10, Your Discharge is Someone's Admission, National MedRec Webinar, Colleen Cameron, Clinical Pharmacist at Grand River Hospital in Kitchener Ontario
8 MRS. C ISMP Canada 8
9 Can you show me how you would take warfarin 7 mg? = 27 mg = 7 mg
10 Why the confusion? Taking 7 mg using 5 1 is Math Taking 7 mg using 1 is Counting
11 WHO Global Safety Challenge ISMP Canada 11
12 Medical error is the 3 rd leading cause of death in Canada Medication errors are among the most common and harmful of patient safety incidents (CIHI;CPSI, 2016; Slawomirksi, Auraaen, & Klazinga, 2017). CPSI The Case for Investing in Patient Safety in Canada, 2017
13 ISMP Canada Safety Bulletin, May 25, 2017 ISMP Canada 13
14 We had no idea this could even happen. Mother whose 8 year old child died after receiving a wrong drug ISMP Canada 14
15 Supporting FULL ENGAGEMENT of patients improving safety and effectiveness of medication use is the most powerful strategy for improving safety Lyle Bootman, Co-chair, Committee on Identifying and Preventing Medication Errors, Institute of Medicine, July 2006 ISMP Canada 15
16 Role of Patients ISMP Canada 16
17 Partnering with patients values their insights and experience, and empowers them to take an active role in their care. Patients are the extra sets of eyes and ears that should be integrated into the safety process of all health care organizations Engaging Patients in Patient Safety - a Canadian Guide CPSI 2017 ISMP Canada 17
18 Patient/Family contributions to medication safety Self-knowledge and knowledge of family members Managing/monitoring medications Coordinating among providers Research Reporting Helping guide improvement Helen Haskell s Presentation: Patient engagement in medication safety at the point of care roles, responsibilities, September 15, 2016 WHO/CPSI ISMP Canada 18
19 Role of Patients Ask questions about your medications Say back to clinicians in your own words what you think they have told you. Safety Is Personal: Partnering with Patients and Families for the Safest Care. Lucien Leape Foundation ISMP Canada 19
20 Role of Patients Ask the pharmacist to review your medications with you prior to discharge Prior to discharge, ask for a list of the medications you should be taking at home Institute of Medicine Preventing Medication Errors. Washington, DC: The National Academies Press. ISMP Canada 20
21 Role of Pharmacists ISMP Canada 21
22 By engaging patients, pharmacists can help improve : patient s knowledge patient s adherence patient satisfaction and quality of life patient s hospital experience Chisholm-Burns MA, et al. Med Care 2010;48(10): ISMP Canada 22
23 Effect of an In-Hospital Multifaceted Clinical Pharmacist Intervention on the Risk of Readmission >1,400 Danish adults, acute admission ward who were using five or more medications. A multifaceted clinical pharmacist intervention at discharge could reduce the number of visits to the emergency department (ED) and readmissions to the hospital Ravn-Nielsen Lv et. Al. Effect of an In-Hospital Multifaceted Clinical Pharmacist Intervention on the Risk of Readmission: A Randomized Clinical Trial. JAMA Intern Med Jan 29. ISMP Canada 23
24 Effect of an In-Hospital Multifaceted Clinical Pharmacist Intervention on the Risk of Readmission The extended intervention had a significant effect on the numbers of patients who were readmitted within 30 days (NNT=12) or within 180 days(nnt =11) This study shows that hospital pharmacists may play an important role in preventing hospital readmissions Ravn-Nielsen Lv et. Al. Effect of an In-Hospital Multifaceted Clinical Pharmacist Intervention on the Risk of Readmission: A Randomized Clinical Trial. JAMA Intern Med Jan 29. ISMP Canada 24
25 Systematic Review: Identifying the Optimal Role for Pharmacists in Care Transitions MedRec alone is insufficient Combine with patient counselling and clinical medication review Link with outreaching hospital pharmacist or community pharmacist/family doctor Ensing HT, et. Al. Identifying the Optimal Role for Pharmacists in Care Transitions: A Systematic Review. J Manag Care Spec Pharm Aug;21(8):
26 Role for the hospital pharmacist Pharmacist listens to, understands and respects the patient s story about experiences and expectations that will affect the use of medications. Educates patient about diseases and medications during their hospital stay Medication education at discharge CSHP Excellence in Hospital Pharmacy cshp.ca/excellence ISMP Canada 26
27 Role for the hospital pharmacist MedRec At Discharge Plan of care at transitions of care is communicated to the next care provider Involve patient in care decisions View patients as valuable, effective partners in shared decision-making. CSHP Excellence in Hospital Pharmacy cshp.ca/excellence ISMP Canada 27
28 Role for the hospital pharmacist Provide patient and providers in circle of care with an up-to-date medication list Provide medication information and engagement tools that support patients at their literacy level/language. Engage patients as equal partners in safety improvement and care design activities. Safety Is Personal: Partnering with Patients and Families for the Safest Care. Lucien Leape Foundation ISMP Canada 28
29 Role for the hospital pharmacist Provide clear information, apologies, and support to patients and families when things go wrong. CPSI Canadian Disclosure Guidelines ISMP Canada 29
30 Evidence of Patient / Family Engagement Strategies ISMP Canada 30
31 Systematic Review: Evaluation of patient and family engagement strategies to improve medication safety Key engagement strategies Patient education MedRec strategies Kim JM et al. Evaluation of patient and family engagement strategies to improve medication safety. The Patient. 2017:1-14. ISMP Canada 31
32 Systematic Review: Evaluation of patient and family engagement strategies to improve medication safety 55% of the studies (n=19) significant improvement on at least one medication safety outcome Kim JM et al. Evaluation of patient and family engagement strategies to improve medication safety. The Patient. 2017:1-14. ISMP Canada 32
33 Ladder of patient and family engagement Kim JM et al. Evaluation of patient and family engagement strategies to improve medication safety. The Patient. 2017:1-14. ISMP Canada 33
34 Tips, Tools & Resources ISMP Canada 34
35 Tip: Communication is key How do we talk with patients? Focus on need-to-know & need-to-do Demonstrate/draw pictures Use clearly, written education materials Use Motivational Interviewing and TeachBack method Health Literacy: Hidden Barriers and Practical Strategies. ISMP Canada 35
36 Use TeachBack Method to Confirm patient understanding Tell me what you ve understood. I want to make sure I explained your medicine clearly. Can you tell me how you will take your medicine? Do you understand? Health Literacy: Hidden Barriers and Practical Strategies. Do you have any questions? ISMP Canada 36
37 Hospital to Home Facilitating Safe Medications at Transitions A Toolkit and Checklist for Hospital Pharmacists ISMP Canada 37
38 Hospital to Home Medication Focused Transitions Checklist 1. Create Best Possible Medication Discharge plan 2. Chat and Check patient s understanding of meds 3. Connect with community partners to ensure supports in place 4. Complete transition ISMP Canada 38
39 Co-Designed with Patients
40 ISMP Canada 40
41 MyMedRec Medication Record Book App for iphone Android Blackberry
42 Opioids for pain after surgery: Your questions answered ISMP Canada 42
43 Storage and Disposal of unused medications card
44 Mayo Clinic Shared Decision Making National Resource Center
45
46 Patient engagement is changing CGM Patient engagement Self Care Population health management Telehealth Virtual Care Access to labs/records Connecting/collaborating Incentives Peer to Peer ElevateHealth 2017/ Adapted from Lydia Lee Support 46
47 Do the best you can until you know better. Then when you know better, you do better. Maya Angelou, renowned poet ISMP Canada 47
48 Let s continue the conversation and share your ideas FB: MedRec Network MedSafety PSN Contact: alice.watt@ismp-canada.org ISMP Canada 48
49 ISMP Canada 49 49
50 References 1. November 10, Your Discharge is Someone's Admission, National MedRec Webinar, Colleen Cameron, Clinical Pharmacist at Grand River Hospital in Kitchener Ontario 2. WHO Global Safety Challenge: 3. CPSI The Case for Investing in Patient Safety in Canada, August CPSI Canadian Disclosure Guidelines ISMP Canada Safety Bulletin, May 25, CPSI - Engaging Patients in Patient Safety - a Canadian Guide, Kim JM et al. Evaluation of patient and family engagement strategies to improve medication safety. The Patient. 2017: Ensing HT, et. Al. Identifying the Optimal Role for Pharmacists in Care Transitions: A Systematic Review. J Manag Care Spec Pharm Aug;21(8): Health Literacy: Hidden Barriers and Practical Strategies ElevateHealth 2017/ Adapted from Lydia Lee. Used with permission. 11. WHO/CPSI - Helen Haskell s Presentation: Patient engagement in medication safety at the point of care roles, responsibilities, September 15, National Patient Safety Foundation s Lucian Leape Institute. Safety Is Personal: Partnering with Patients and Families for the Safest Care. Boston, MA: National Patient Safety Foundation; Mayo Clinic Shared Decision tools: ISMP Canada 50
51 Recommended Resources ISMP Canada 51
52 Patient Engagement Video 52
53 ISMP Canada 53
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