Medication Reconciliation
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1 Medication Reconciliation Wendy Jordan, Pharm.D. Inpatient Pharmacy Manager St. Bernards Medical Center Jonesboro, AR
2 Disclosure The speaker does not have anything to disclose
3 Objectives Describe pharmacy department involvement in medication reconciliation List the possible barriers and limitations related to designing and implementing a successful medication reconciliation program Discuss the successes and outcomes of an implemented medication reconciliation program
4 St. Bernards Medical Center 438 licensed beds (avg census = 196 ) Average Daily Admissions = 47 46% ED Admissions Pharmacy Department 16.5 Pharmacist FTEs 18.5 Technician FTEs APPE Students
5 Pharmacy Services TPN Service Hospitalists Rounding Service IV to PO Anticoagulation Monitoring Renal Dosing Kinetics Service NICU/ICU Pharmacists Outpatient Services
6 May 2012 A3 Lean Event 74% Error rate on med histories No standard method of gathering data Lack of ownership IT issues Workflow/Communication Issues July 2012 Pharmacy Student Project (1) ED staff vs. Pharmacy Students 8.2 minutes vs. 25 minutes 30% unverified medications vs. 6.3% 27.5% of recalled medications had errors 39% of pts had containers or med lists FTEs needed = 3 (for pts admitted from ED)
7 May 2013 Med Rec Team LPN staffed team during initiation RN staffed team/utilization Management (UM) Sept 2013 Pharmacy Student Project (2) Retrospective review Average errors/admission = 3.2 Most common error = Omissions Average time to correct = 12.6 mins Corrected med history = 37.6 mins
8 Medication History Team Began February 2015 Hybrid system Pharmacy Techs, Pharmacists, UM Team, and Admitting Nurses Pharmacy Techs 4 FTEs and 2 PRNs Excluded Patients Hospice and OB Pharmacy receives consults for complicated med histories
9 Pharmacists Serve as trainers for our med history technicians Provide oversight Research more complicated issues Help with inpatient order corrections
10 Pharmacy Technician Training Certification Required Community and Hospital Trained Technicians 6 to 12 weeks oversight by a decentralized pharmacist Medical Terminology Test Top 200 Test Topic Discussions
11 Jan 2015 ~ April 2015 ~ Mar 2015 Sun Mon Tue Wed Thu Fri Sat 31 MB 1 MB 2 MB 3 LJ 4 Topic Discussion: Med Topic Discussion: Topic Discussion: High OE Observation History Intro, Policy/ Dosage Forms, Routes, Alert Meds, Allergies vs Independent Study Procedure, Med Rec Pitfalls, HIPPA, Med Terminology & Abbrev Med Suffix/Prefix, Intro to Top 200 OE Observation Adverse Rxn OE Observation Independent Study 5 6 LK/MB Topic Discussion: Components of an Interview, Eval Form 7 LK Topic Discussion: Meditech Training 8 LJ Topic Discussion: Meditech Training 9 LJ Topic Discussion: Meditech Training 10 LJ Medical Abbrev Exam* LK 14 AH 15 LK 16 LJ 17 LJ Interview Eval Form*
12 Helpful Tools Training Manual definitions, policies and procedures, high alert medications, Meditech information, etc. Interview Scenarios Medical Release Forms Updated Community Pharmacy Information Access to Outpatient Clinic EMRs DrFirst
13
14 Things to think about Sources of information (family, patient, physicians, pharmacies, bottles, etc.) Herbals, OTCs, and PRNs Prescribed Directions vs. Patient History IT Functionality and Downstream Effects Physician, Nursing, and Pharmacy Workflow Communication with Community Pharmacies, Physician Practices, etc.
15 Today Hybrid Medication History Team Pharmacy staff verifies/completes 22.9% of home medications 22 mins for completed med history 37 mins for corrected med history
16 Ed coverage Pharmacy Floor/Float coverage Pharmacy ED Coverage UM Team Floor coverage Nursing
17 Two 12 hour shifts and PRN Sun Mon Tues Wed Thurs Fri Sat FTEs #of Staff Shifts 7:00 AM PRN 8:00 AM 2 2 Overnight 9:00 AM Hr Morning 10:00 AM Hr Evening 11:00 AM Totals 12:00 PM 1:00 PM Hours of Coverage 239 2:00 PM 3:00 PM 4:00 PM 5:00 PM 6:00 PM 7:00 PM 8:00 PM 9:00 PM 10:00 PM 11:00 PM 12:00 AM 1:00 AM 2:00 AM 3:00 AM 4:00 AM 5:00 AM 6:00 AM
18 Tomorrow Transitions of Care Discharge Counseling Electronic Communication with Community Pharmacies Further Expansion of the Med History Team
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