Obtaining the Best Medication History Toni Kettner, RN, BSN, MHA Medication Project Safety Specialist Jody Rothe, RN, WCC, DON-CLTC Program Manager Medication Safety Webinar Series Part one of four
Objectives Following this presentation the audience will be able to: Define medication reconciliation and its purpose in medication safety Describe the benefits of medication reconciliation Identify barriers/obstacles in performing medication reconciliation Highlight effective interviewing strategies to improve medication reconciliation MetaStar represents Wisconsin in Lake Superior Quality Innovation Network. 2 Define Medication Reconciliation 3
Medication Reconciliation Defined The process of identifying the most accurate list of all medications that the patient is taking, including name, dosage, frequency, and route, is by comparing the medical record to an external list of medications obtained from a patient, hospital, or other provider. (Centers for Medicare and Medicaid/Institute for Healthcare Improvement) Medication reconciliation is the formal process in which health care professionals partner with patients to ensure accurate and complete medication information transfer at interfaces of care. (World Health Organization) 4 Medication Reconciliation Defined Medication reconciliation is a complex process that impacts all patients as they move through all health care settings. The process involves comparison of a patient's current medication regimen against a physician's admission, transfer, or discharge orders to identify discrepancies. (Agency for Healthcare Research and Quality) Study data shows that an effective process can detect and avert most medication discrepancies, potentially avoiding a large number of adverse drug events and related costs for care of affected patients. (Agency for Healthcare Research and Quality) 5
Purpose of Medication Reconciliation 6 Purpose of Medication Reconciliation Adverse drug events (ADEs) are a serious public health problem. It is estimated that: 82 percent of American adults take at least one medication and 29 percent take five or more 700,000 emergency department visits and 120,000 hospitalizations are due to ADEs annually $3.5 billion is spent on extra medical costs of ADEs annually At least 40 percent of costs of ambulatory (non-hospital settings) ADEs are estimated to be preventable A large percentage are considered PREVENTABLE! 7
Purpose of Medication Reconciliation The effectiveness of a sound medication reconciliation process among all healthcare settings is an essential component of safe patient care Provides a framework to improve efficiency and save time and costs The estimated cost of a preventable ADE is estimated to be $4,800 per event (Centers for Disease Control) 8 Benefits of Medication Reconciliation Reduces work and re-work associated with the management of medication orders (Institute for Healthcare Improvement) Improves patient outcomes Improves patient satisfaction Improves transitions from one setting to another 9
Purpose of Medication Reconciliation Reimbursement Patient Safety Medication Reconciliation Improved Outcomes Cost Avoidance 10 Barriers 11
Barriers to Performing Medication Reconciliation Lack of a clearly defined process that can be shared across settings Stakeholders Electronic Health Record (EHR)/Other Technology access issues, privacy and security concerns, lack of infrastructure Different processes in various locations Confusion around role responsibilities/accountability (who really is the best person to perform) Education and training of staff conducting patient interviews 12 Barriers to Performing Medication Reconciliation Patient/family/caregiver engagement and lack of awareness about medical condition and medications Staff lack the time The focus has been on completing a form or entering data into the EHR rather than meeting the intent of the intervention Providers are reluctant to order medications prescribed by others 13
Initiating a Medication 14 Initiating the Medication Assume all medication lists are inaccurate! 15
Initiating a Medication Use the resources available: Current orders Medication lists inpatient, outpatient, Home Health, Discharge Summary The Patient s List Request the patient bring ALL medications with them to appointments Pharmacies Where does the patient get their medications filled? 16 Initiating a Medication Techniques to improve communication with patients during medication reconciliation and to assess level of understanding: Use both open and closed ended interview questions What do you take for your high cholesterol? Do you take medication for your high cholesterol? Ask questions that include information about the routes of administration Do you put any medications on your skin, in your eyes, in your ears, etc.? Ask what medications they take for medical conditions What do you take for your diabetes? 17
Initiating a Medication Ask the patient about medications other physicians may have prescribed Does your asthma doctor prescribe any medications for you? Ask patients when they take their medications Patients may forget about infrequent dosing monthly Ask patients if they or their physician recently started any new medications, stopped taking any medications or made any changes 18 Initiating a Medication For inquiring about Over-the-Counter (OTC) mediations What else are you taking that doesn t need a prescription? What do you take when you get a headache? Do you take anything to fall asleep? For all medications, ask about the dose, time, strength and route 19
Initiating a Medication Remember that BRAND and generic names can create confusion Allow patients to use their own words to describe what they are taking Health literacy has a huge impact on medication understanding Print off a copy of the current medication list and encourage them to take it with them to appointments and share with their pharmacy 20 Medication Reconciliation Process MATCH (Medication at Transitions and Clinical Handoffs) Toolkit for Medication Reconciliation https://www.ahrq.gov/professionals/qualitypatient-safety/patient-safetyresources/resources/match/index.html We will continue to use this tool as a reference for the rest of the series 21
Questions? 22 Next Steps Review Match Toolkit Chapters 1-3 Follow the steps and complete the tools Consider your bassline assessment and your goals Contact Toni for additional guidance and assistance Complete satisfaction survey Register for May 31, 2017 webinar Following it you will receive a follow up assessment to identify progress with the 9 questions 23
Contact Toni Kettner Medication Safety Project Specialist (608) 441-8290 tkettner@metastar.com www.lsqin.org www.metastar.com MetaStar represents Wisconsin in Lake Superior Quality Innovation Network. 24 This material was prepared by the Lake Superior Quality Innovation Network, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS policy. 11SOW-MI/MN/WI-C3-17-31 022017