Long Term Care Pharmacy Medication Reconciliation in The Electronic Age Courtney Doherty Oland R.Ph, MBA President The LTC setting is currently under enormous transformation silver tsunami - greater demand/ more DEMANDING Facility staff expertise level/ expectations Diversification in the definition of Long Term Care Increased demands for specialty solutions that are timely, convenient, clinically appropriate and cost effective Explosion of Technology Collaborative practice including vaccinations 1
Federal Guidelines & Rules NCPDP 10.6 vs HL7 State Guidelines & Rules Pharmacy Board Rules (Tech Ratio s / Access/ Outdated/Retail Oriented) DHHS Licensing Rules (often conflict /incompatible/outdated/ Acute Care Oriented) Sate Board of Nursing Rules Unclear/? LTC Multi-Dose Packaging Compliance Packaging Fill Schemes Cycle/ anniversary/ on demand DEA Agent issues Transmission of Rx E RX and Remote Dispensing A transition in care is defined by the American Geriatrics Society as a set of actions designed to ensure the coordination and continuity of healthcare as patients transfer between different locations or different levels of care within the same location. Successful transitional care depends upon a comprehensive treatment plan, shared by healthcare providers at both the transferring facility and the receiving facility or community-based provider(s). Clinicians, welltrained in chronic, complex care needs and focused on the patient's goals, preferences and evolving clinical status, are mandatory. A successful transition of care moves beyond the obligatory medication reconciliation and includes patient and caregiver education and extensive coordination of services between the healthcare professionals involved in each transition. 2
Case Study Alfred, a healthy 81-year old, was hospitalized for a knee replacement. He was started on a blood thinner to prevent blood clots following surgery. Shortly thereafter, he developed symptoms suggestive of internal bleeding. The blood thinner was stopped pending testing. Meanwhile, Alfred was transferred to a rehab facility. Three days later, he was lethargic, experiencing chest pain, difficulty breathing and was subsequently sent to the emergency room. He was diagnosed with multiple blood clots. Testing for possible internal bleeding had never been completed and the rehab facility did not question his post-surgical transfer orders, which were missing a blood thinner. Missed opportunities from both the discharging and receiving healthcare providers caused not only a re-hospitalization, but almost cost Alfred his life. Formulary Utilization and Therapeutic Interchange E-Kits / Starter Dose Kits On call Requirement 24/7 Medication Therapy Management (MTM) Chart order vs Traditional Prescription E Prescribing Triangle PBM Pressure / Lack of Flexibility 3
A taste of the Present! A taste of the future! 4
This is what they sell! This is what they sell! 5
Why EHR Are Imperative for Nursing Homes/ LTC Even without federal EHR adoption incentives, skilled nursing settings will soon find that they have to adopt EHRs Three factors will motivate the move to technology: Stage 2 requirements: The Stage 2 Meaningful Use requirements require hospitals and physicians to submit written care summaries for every care transition. That includes the point when a patient moves between a hospital and a nursing home. Interoperability: The Stage 2 Meaningful Use requirements also stipulate that EHR systems must be interoperable. This requirement will ease concerns among nursing home administrators that the software they purchase will not be able to interact with hospital-based systems. 6
Why EHR Are Imperative for Nursing Homes Physician expectations: Young physicians who grew up using technology will expect skilled nursing settings to have EHRs. These physicians are unlikely to work in long-term care settings that don't have the tools they already use. What Your Electronic Health Record Can Communicate ADT ( Admit, Discharge, Transfer Information ) Billing Information Resupply request formerly a refill New Order NOT Legally ERX Unless done by a prescriber! Renewal Request (Pharmacy Prescriber) Cancel Rx (d/c) 7
Electronic prescribing Electronic prescribing is a way for your prescribers (your doctor or other health care provider who is legally allowed to write prescriptions) to send your prescriptions electronically and directly to your pharmacy. can check which drugs your insurance covers and prescribe a drug that costs you less. Electronic prescriptions are easier for the pharmacist to read than handwritten prescriptions. This means there's less chance that you'll get the wrong drug or dose. will have secure access to your prescription history, so they can be alerted to potential drug interactions, allergies, and other warnings. Electronic prescribing Continued can check which drugs your insurance covers and prescribe a drug that costs you less. Electronic prescriptions are easier for the pharmacist to read than handwritten prescriptions. This means there's less chance that you'll get the wrong drug or dose. will have secure access to your prescription history, so they can be alerted to potential drug interactions, allergies, and other warnings. 8
erx/her Process: The Players LTC Facilities Pharmacy Information system erx/her Process: The Players How will you determine who is and who is not qualified to enter of edit information within the e-hr? LTC Facilities Prescriber Portal Prescriber or agent Nursing staff - RN, LPN Medication Aids - CRMA/CNAM 9
erx Process: Prescription Initiated Rx Sys tem Sure Scripts Pharmacy Information EHR LTC Facilities erx Process: Rx Transmitted Rx Sure Scripts Connection Pharmacy Information Or LTC Facilities EHR 10
erx Process: Rx Fulfilled Rx Sure Scripts Connection Pharmacy Information DocuTrack Dispensing s LTC Facilities EHR erx Process: Confirmations / Refills Sent Prescri bers Rx Sure Scripts Connection Pharmacy Information DocuTrack Dispensing s EHR LTC Facilities 11
What Has Not Been Addressed? Facility Workflow Changes Who can do what! Staff Qualifications and Training State Surveyor Guidance Patient Safety Courtney Doherty Oland R.Ph, MBA President Michael Swan Health Facility Survey Manager Division of Licensing and Regulatory Services (207) 287-5825 Michael.Swan@maine.gov Division of Licensing and Regulatory Services Patient Safety Courtney Doherty Oland R.Ph, MBA President 12