Fall 2014 Graduating Class

200 bed, rural, acute care facility See clients as more then health care needs Enhance quality of care, and exceed needs of those who seek treatment (Trinity Health, 2014) (Altru Health Systems, 2014)

PATIENTS Exceeding needs of patient within our community RESPECT Understanding of qualities and abilities that make each person unique, treating others with dignity TEAM Each member of the team is important PASSION Workers dedicated to make a difference (Trinity Health, 2014) (Altru Health Systems, 2014)

Medication reconciliation is the process of comparing a patient's medication orders to all of the medications that the patient has been taking. National Patient Safety Goal 03.06.01 (Joint Commission, 2006)

Pharmacists Anderegg, Wilkinson, Couldry, Grauer, and Howser (2014) Pharmacy Technicians Cooper, Lilliston, Brooks, and Swords (2014) Registered nurses Tessier, Henneman, Nathanson, Plotkin, and Heelon (2010)

(Tessier, Henneman, Nathason, Plotkin, and Heelon, 2010)

The emergency department must develop and adhere to medication reconciliation procedures to maximize safe medication practices on admission through the Emergency Room. Medication reconciliation nurse from 0700-1900. This must be completed within twenty-four hours upon admission. (University of Texas Medical Branch, 2012)

Upon the patient s admission or presentation and with the involvement of the patient or designee, a list of the patient s current medications is obtained and documented in the patient s health record. Medications ordered for the patient while under the care of the organization are compared to those on the list. (University of Texas Medical Branch, 2012)

1. A list of the patient s current medications is obtained. The list contains the name, dose, frequency, route, purpose, date and time of last dose and compliance, and additional information as seen on the nurse medication reconciliation form. The primary means of obtaining the patient s current medication information may include: a. Patient/parent/caregiver interview b. Review of self-completed or patient provided medication list c. Great Plains Healthcare medical record d. Outside medical records The medications are documented and reviewed for duplications, omissions, and interactions. This becomes the pre-admission medication list. (University of Texas Medical Branch, 2012)

2. The medication reconciliation nurse reviews the medication list prior to physician or advanced practice professional (APP) ordering medications during the encounter. 3. In the case that the patient is admitted through the Emergency Room during the hours that the medication reconciliation nurse is not on duty, he/she will follow-up with the patient on the floor within twenty-four hours of admission. (University of Texas Medical Branch, 2012)

Promote staff buy-in Empirical-rational model Nurse manager acting as a change agent Promote acceptance to change Mandatory staff meeting Listen to suggestions Present risks and benefits Clarify misconceptions Maintain environment of trust and support (Sullivan, 2013)

January 1 st : Meet with key stake holders Resource justification February 1 st : In-service meeting with interprofessional team Implementation of pilot program March 1 st : Hiring of new staff nurses dealing with medication reconciliation process April 1 st : Review of pilot program current success Process audit evaluation

May 1 st : Utilization of focus groups Updating of EHR as needed June 1 st : Meet again with stakeholders June 30 th : Final Review of pilot program Expansion of pilot program through transitional care

Registered Nurses Annual expenditure- $117,997.20 Pharmacy Technicians Annual expenditure- $72,883.20 Pharmacists Annual expenditure- $233,294.88 (United States Department of Labor, Bureau of Labor Statistics [BLS], 2014)

25 emergency room admissions daily Potential savings/day: $11, 687 Potential annual savings: > $4.2 million (Gleason, Brake, Agramonte, & Perfetti, 2012)

Increasing patient care time Increasing patient safety

Forming Storming Norming Performing Adjourning (Sullivan, 2013)

Assessment Planning Implementation Evaluation (Sullivan, 2013)

1. Planning 2. Organizing 3. Directing 4. Controlling (ATI, 2013, p.4-5)

Link medication reconciliation with other quality initiatives being managed throughout Great Plains Healthcare Investigate and research medication reconciliation policies being implemented throughout North Dakota and nationally. Research medication reconciliation software to ensure that the programs being utilized are accurate and efficient.

Anderegg, S. V., Wilkinson, S. T., Couldry, R. J., Grauer, D. W., & Howser, E. (2014). Effects of a hospital wide pharmacy practice model change on readmission and return to emergency department rates. American Journal of Health-System Pharmacy, 71(17), 1469-1479. doi:10.2146/ajhp130686 Altru Health System. (2014). Mission, Vision & Values. Our Story. Retrieved from http://www.altru.org/aboutus/news--information/our-story/ ATI. (2013). Nursing Leadership and Management (6th Ed.). Leawood, KS: Assessment Technologies Institute, LLC. Cooper, J. B., Lilliston, M., Brooks, D., & Swords, B. (2014). Experience with a pharmacy technician medication history program. American Journal of Health-System Pharmacy, 71(18), 1567-1574. doi:10.2146/ajhp130590 Gleason K.M., Brake H., Agramonte V., & Perfetti C. (2012). Medications at transitions and clinical handoffs (MATCH) toolkit for medication reconciliation. (Prepared by the Island Peer Review Organization, Inc., under Contract No. HHSA2902009000 13C.) AHRQ Publication No. 11(12)-0059. Rockville, MD: Agency for Healthcare Research and Quality. Hakim, H. (2014). Not just for cars: Lean methodology. Nursing Management, 45(3), 39-43. doi: 10.1097/01.NUMA.0000443942.06621.6e Sullivan, E. (2013). Effective Leadership and Management in Nursing. (8 th ed.) Upper Saddle River, NJ: Pearson Prentice Hall.

Tessier, E., Henneman, E., Nathanson, B., Plotkin, K., & Heelon, M. (2010). Frontline pharmacist. Pharmacynursing intervention to improve accuracy and completeness of medication histories. American Journal of Health-System Pharmacy, 67(8), 607-611. doi:10.2146/ajhp090104 The Joint Commission. (2006). Sentinel event alert, issue 35: Using medication reconciliation to prevent errors. Retrieved from http://www.jointcommission.org/sentinel_event_alert_issue_35_using_medication_reconciliation_to_pre vent_errors/ Trinity Health. (2014). Mission, Vision & Values. About Trinity Health. Retrieved from http://www.trinityhealth.org/about_mission U.S Department of Health and Human Services, Agency for Healthcare Research and Quality. (2012). Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation. (AHRQ Publication No. 11(12)-0059). Rockville, MD: Agency for Healthcare Research and Quality. United States Department of Labor, Bureau of Labor Statistics [BLS]. (2014). May 2013 state occupational employment and wage estimates North Dakota. Retrieved from http://www.bls.gov/oes/current/oes_nd.htm#29-0000 University of Texas Medical Branch. (2012). 9.13.30 Medication reconciliation. UTMB Handbook of Operating Procedures. Retrieved from http://www.utmb.edu/policies_and_procedures/ihop/clinical/general_clinical_procedures_and_care/ih OP%20-%2009.13.30%20%20-Medication%20Reconciliation.pdf.