Medication Reconciliation in the Era of Telepharmacy: An Innovator s Tale
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1 Medication Reconciliation in the Era of Telepharmacy: An Innovator s Tale Christopher A. Keeys, Pharm.D., BCPS, R.Ph. President, Clinical Pharmacy Associates, Inc. CEO, MedNovations, Inc. 5/20/2018 CPA/MedNovations
2 Medication Reconciliation/ Telepharmacy Practice Report Providing nighttime pharmaceutical services through telepharmacy CHRISTOPHER A. KEEYS, KENNETH DANDURAND, JUSTINE HARRIS, LOLA GBADAMOSI, JOAN VINCENT, BLAIR JACKSON-TYGER, AND JYMEANN KING Am J Health-Syst Pharm. 2002; 59:716-21
3 Medication Reconciliation/ Telepharmacy- After Hours Experience Problem- Over 50% of medication errors are due to prescribing errors Solutions- Prospective review of orders by pharmacists Preventing non-pharmacy personnel from accessing pharmacies after hours Challenge- More than 3000 hospitals nationwide in 1999, including acute care, rehabilitation, and psychiatric facilities, closed their pharmacy departments at night.
4 Medication Reconciliation/ Telepharmacy- After Hours Experience Order Clarifications (Interventions) After Hours: 226/1099 orders (21.7% of all orders reviewed) within an initial 3- month period A total of 125/226 orders clarified were resolved directly with a physician or nurse during the night shift.
5 Medication Reconciliation/ Telepharmacy- After Hours Experience Top Intervention Types Afterhours lack of required information, e.g., allergy history, weight ( = 42) restricted drugs, drugs protocol/guideline noncompliance ( = 41) Cross-allergenicity (n=35)
6 Medication Reconciliation/ Telepharmacy- After Hours Experience Top Intervention Types Afterhours pharmacokinetic dosing e.g., dosage adjustment for renal status/age ( = 25) therapeutic interchanges or formulary alternatives ( = 15) illegible handwriting or incomplete orders ( = 11)
7 Remote order entry: Innovative practice to reduce distractions and offer 24-hour pharmacy service From the April 17, 2002 issue
8 Medication Reconciliation/ Telepharmacy- After Hours Experience After Hours Medication Order Review by Hospitals (N= 425) hr Rx 30.1% 40.2% Telepharmacy Outsourced 3.1% 20.5% Telepharmacy- Affiliate 5.3% 14.5% On Call 1.9% 3.4% No Review 59.6% 21.4% Am J Health- System Pharm.Vol 72. July 1, /20/2018 CPA/MedNovations
9 Medication Reconciliation/ Telepharmacy Problem Based on the literature, past experience has shown that a lack of medication reconciliations accounts for 46% of all medication errors and approximately 20% of adverse drug events in the hospital setting. Barnsteiner JH. J I fus Nurs. 2005; 28(suppl 2):31-6. Rozich I, Roger R. J C i Outcomes Ma ag. 2001; 8:27-34.
10 Medication Reconciliation/Telepharmacy and Medication Use Process Order/Prescribing Preparation/Dispensing Transcription/Administration Monitoring/Patient Education
11 Medication Reconciliation Process 5 Steps 2 1 Develop a list of current medications (and allergies) Develop a list of medications to be prescribed 3 Compare the medications on the 2 lists 4 Make clinical decisions based on comparison 5 Communicate the list to the appropriate caregiver and patients 5/20/2018 CPA/MedNovations
12 Medication Reconciliation/ Telepharmacy Transitions of Care Patient Between Providers Levels of Care Care Settings 5/20/2018 CPA/MedNovations
13 Medication Reconciliation/ Telepharmacy- Case Study The ED physician in a Massachusetts hospital prescribes Zyvox 600mg twice a day to an adult male for persistent cellulitis. The same retail pharmacy dispensed the Zyvox that dispensed his other prescriptions including Celexa 20mg daily and Ambien 10mg at bed time.
14 Medication Reconciliation/ Telepharmacy- Case Study Severe headache, tremors, neck stiffness, increased HR and BP brought him back to the ED within 24 hours with r/o meningitis. The initial workup was negative. After review by their clinical pharmacist via phone, the Zyvox was stopped and Bactrim was started for cellulitis. The event resolved without hospitalization. The suspected ADR- serotonin syndrome due to an unreconciled DDI (Zyvox and Celexa)
15 Medication Reconciliation/ Telepharmacy Pharmacies miss half of dangerous drug combinations (Chicago Tribu e, December 15, 2016) N= 255 Pharmacies- Chain and Independents in Chicago area 52% failed test of major drug- drug interactions
16 Medication Reconciliation/ Telepharmacy Challenge Performing medication reconciliations competently requires effective systems, time, and accuracy. Individuals performing medication reconciliation should have extensive medication knowledge and understanding of medication use across the continuum of healthcare. Am J Health-Syst Pharm. 2014; 71:
17 Prescribing Physician (MD) Podiatrist (DPM) Dentist (DDS) Nurse Anesthetist (CRNA) Nurse Practitioner (NP) Physician Assistant (PA) Nurse Midwife (NM) Clinical Pharmacist (R.Ph) Nurse Radiology Technologist (CRT) Respiratory Therapist (RT) Preparation/ Dispensing Pharmacist (R.Ph) Pharmacy Technician Nurse Anesthetist (CRNA) Anesthesia Tech Nurse (RN) MD/DP/DDS PA Nurse Practitioner Technologist Respiratory Therapist Other Technicians Transcription/ Administration Nurse (RN) Licensed Practicing Nurse (LPN) Unit Secretaries (transcription only) MD/DPM/DDS Scribes (R.Ph) NP PA NM RT CRT Technologists Pharmacy Technicians Monitoring/Patient Education MD/ DPM /DDS Nurse (NP/CRNA/NM/RN/LP N) R.Ph and Pharm Tech PA RT Clinical Dietician CRT Pathologists Lab Specialists Case Coordinators
18 Medication Histories Hospital/ Health System Staffing Models RN- MD Managed without RPh/ PharmD or CPhT Onsite RN- MD Managed with Consulting RPh/ PharmD Onsite or Telepharmacy RPh/PharmD- MD with RN =/- CPhT support Onsite or Onsite Combined with Telepharmacy CPhT-RN-MD without RPh/PharmD Consulting Onsite
19 Medication Reconciliation Established & Innovative Practices Medication Therapy Management (MTM) Service Telepharmacy +/- onsite support Patient Centered Care pharmacists provided Nurse/discharge planner coordinated MR Public Health Outreach Workers ED Pharmacy Practices Pharmacist-managed MR/Discharge planning services Nursing Home Consultant pharmacist Interdisciplinary teams Medical homes Rounding Collaborative Practice Models 5/20/2018 CPA/MedNovations
20 Medication Reconciliation/ Telepharmacy Innovation in Technologies Databases- Prescription, PDMP, Immunization Communications Technology- / Text E-prescribing/EHR/ Health Information Exchanges (HEI) Videoconferencing/Webcam Automation- Medication Distribution Systems Clinical Decision -Support/ Computerization Telemedicine/ Telepharmacy Drug Information/ Patient focused Drug Information- Electronic/Mobile Web-Based Patient Medication Histories 5/20/2018 CPA/MedNovations
21 Medication Reconciliation/Telepharmacy Quality Improvement and Risk Management/ ROI Medication Incident/Error Reporting Audits Retrospective and Concurrent Failure Mode Effect Analysis (FMEA) Adverse Drug Event Reporting Pharmacists Intervention Reporting Root Cause Analysis Sentinel Event Reporting Tracers Computerized Alerts/Audits: e-prescribing/ EHR Meaningful use measures CMS ICD-10CM- Coding Audits 5/20/2018 CPA/MedNovations
22 Medication Reconciliation/ Telepharmacy Case Study Pharmacist-managed inpatient discharge medication reconciliation: A combined onsite and telepharmacy model Christopher Keeys, Bamidele Kalejaiye, Michelle Skinner, Mandana Eimen, JoAnn Neufer, Gisele Sidbury, Norman Buster, and Joan Vincent Am J Health-Syst Pharm. 2014; 71:
23 Medication Reconciliation/ Telepharmacy Errors 634 errors out of 6402 medication lists resolved during completion of discharge medication list Patient Care Services Skilled Nursing Rehabilitation N=193 (30%) Orthopedics Service N=181 (29%) Medical Surgical N=167 (26%)
24 Medication Reconciliation/ Telepharmacy Top 10 Error Types Allergy Omission Automatic Substitution not Reversed Order Clarification Discontinued Medication Unreconciled Medication Dosage Adjustment Drug Interaction Duplicate Therapy Incomplete Prescription
25 Discharge Medication Reconciliation Type of Intervention 6 leading categories ( N=65 ) of interventions 5/20/2018 CPA/MedNovations
26 Medication Reconciliation at Discharge: Indications Completed (N=1140) 5/20/2018 CPA/MedNovations
27 Medications to be Reconciled Changing (USA) New FDA-approved Drugs and biologicals Revised Safety Labeling of new and older medications drug interactions, precautions/contraindications New formulation of existing drugs Extended Release, topicals, combination products Expanding list OTC and Nutraceuticals Use in special populations, e.g. children, persons living with HIV, and elderly 5/20/2018 CPA/MedNovations
28 Medication Reconciliation- ED to Hospitalization (Telepharmacy) 5/20/2018 CPA/MedNovations
29 Medication Reconciliation (ED-Admit) 24/7 R.Ph monitors ED Admit via EHR In hospital, access med list for transfers and start of discharge Med list Rx/ Admission Meds Patient Med List/RxDB resolves errors/update Med Rec in ED- EHR/ e- prescribing Updated Med List and send to nursing unit on admission/ehr- Hospital 5/20/2018 CPA/MedNovations
30 Telepharmacy & Medication Reconciliation For Immediate Release Monday, April 16, 2018 Board of Health Launches Mednovate Connect - Telehealth Initiative for County s Senior Residents 5/20/2018 CPA/MedNovations
31 Question and Answer Session 5/20/2018 CPA/MedNovations
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