Session 6 Medication Reconciliation (MedRec) Rachel Pham, Hôpital Molière-Longchamps (HIS) Stephane Steurbaut, UZ Brussel
1. OBJECTIVES 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? Session Plan 4. KEY MESSAGES 5. CONTACTS
1. OBJECTIVES 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? 4. KEY MESSAGES 5. CONTACTS By the end of this session, participants will be able to: 1. Explain WHAT medication reconciliation (MEDREC) is and the IMPORTANCE of it 2. Identify KEY SUCCESS FACTORS and CHALLENGES for MEDREC implementation 3. Get INSPIRATION from other s experiences
1. OBJECTIVES I suppose this is a med wreck 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? 4. KEY MESSAGES 5. CONTACTS Med Rec Med Wreck
1. OBJECTIVES 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? Medication Reconciliation (MEDREC) WHAT it should consist of? 4. KEY MESSAGES 5. CONTACTS
1. OBJECTIVES 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? Medication Reconciliation (MEDREC) WHAT it should consist of? 4. KEY MESSAGES 5. CONTACTS
1. OBJECTIVES 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? 4. KEY MESSAGES 5. CONTACTS
«Medication review is a part of medication reconciliation.»
1. OBJECTIVES Medication reconciliation is the process of creating the most accurate 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? 4. KEY MESSAGES 5. CONTACTS list possible of all medications a patient is taking including drug name, dosage, frequency, and route and comparing that list against the physician s admission, transfer, and/or discharge orders, with the goal of providing correct medications to the patient at all transition points within the hospital. Institute for Healthcare Improvement (IHI)
WHAT it should consist of? OBTAIN CLARIFY COMPARE & COMMUNICATE BPMH BEST POSSIBLE MEDICATION HISTORY Name (galenic form) Dosage Frequency Time of administration «Discrepancies» Admission Transfer Discharge
1. OBJECTIVES 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? Medication Reconciliation (MEDREC) WHAT it should consist of? 4. KEY MESSAGES 5. CONTACTS
1. OBJECTIVES Can you give us at least 2. «MEDREC» DEFINITION 3 arguments? 3. HOW TO START A PROJECT? 4. KEY MESSAGES 5. CONTACTS
1. OBJECTIVES 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? 4. KEY MESSAGES ❶ To increase PATIENT SAFETY ACCREDITATION 5. CONTACTS
1. OBJECTIVES 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? 4. KEY MESSAGES 5. CONTACTS ca. 25% of all adverse events in healthcare are related to medications ca. 25% of all medication-related harm is due to medication errors = PREVENTABLE!!! ca. 25% of all medication errors is due to a lack of or incomplete MedRec
Medication histories: international data Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review Tam et al, CMAJ, 173, 510-15, 2005 Setting: SR involving 3755 patients (22 studies) Results: Errors in prescription medication histories occurred in up to 67% of cases 10% 61% had at least 1 omission error and 13% 22% had at least 1 commission error In 6 of the studies, the investigators estimated that 11% 59% of the medication history errors were clinically important 19% 75% of the discrepancies were unintentional
Medication histories: Belgian data (1) Pharmacist-versus physician-acquired medication history: a prospective study at the emergency department De Winter et al, Qual Saf Health Care, 19, 371-5, 2010 Setting: prospective cohort study with 3594 patients admitted at the ED Results: 2134 (59%) discrepant medication histories 5963 discrepancies most common discrepancy: drug omission (61%) 6 out of 10 medication histories are discrepant
Medication histories: Belgian data (2) Medication history verification by clinical pharmacists in elderly inpatients admitted from home or a nursing home Steurbaut et al, Ann Pharmacother, 44, 1596-603, 2010 Setting: prospective observational study with 197 patients at the geriatric department Results: clinical pharmacist identified significantly more drugs compared to physician, both in patients residing at home or in a nursing home 379 discrepancies, with 50% judged as clinically relevant 60% of patients had at least 1 discrepancy
1. OBJECTIVES ❷ 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? 4. KEY MESSAGES To increase PHARMACOTHERAPEUTIC EFFICIENCY SEAMLESS CARE 5. CONTACTS
1. OBJECTIVES 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? ❸ To avoid COSTS 4. KEY MESSAGES 5. CONTACTS
Réadmission dans les 1025% jours réadmissions = 82% = forfait mauvaise par communication admission ( ) à la sortie DOMICILE HÔPITAL
1. OBJECTIVES 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? 4. KEY MESSAGES ❶ To increase PATIENT SAFETY ❷ To increase PHARMACOTHERAPEUTIC EFFICIENCY ❸ To avoid COSTS 5. CONTACTS
Mission 1. OBJECTIVES & RULES 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? 4. KEY MESSAGES 5. CONTACTS Your hospital administration puts a lot of trust in you as a hospital/clinical pharmacist and wants you to come up with a plan for getting the hospital accredited with respect to the process of medication reconciliation. How do you proceed?
1. OBJECTIVES & RULES Workshop rules 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? 4. KEY MESSAGES 5. CONTACTS 1. Be fully present. No phone calls are allowed during the session. 2. Be constructive: criticize ideas, not people. 3. No comment or question is stupid. Ask for clarification when you need it. 4. Don't interrupt someone is talking. Be respectful of other participants and the facilitators. 5. Participate!
1. OBJECTIVES 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? 4. KEY MESSAGES 5. CONTACTS By the end of this session, participants will be able to: 1. Explain WHAT medication reconciliation (MEDREC) is and the IMPORTANCE of it 2. Identify KEY SUCCESS FACTORS and CHALLENGES for MEDREC implementation 3. Get INSPIRATION from other s experiences
https://www.youtube.com/watch?v=spqrcu4wspc
1. OBJECTIVES & RULES 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? Medication Reconciliation (MEDREC) WHAT it should consist of? 4. KEY MESSAGES 5. CONTACTS
«The hospital pharmacist is the best placed healthcare professional to perform medication reconciliation.»
Proven amelioration of the quality of the medication history Restricted human resources Non-disponibility 24h/24h, 7/7 «The focus on the pharmacists/pharmacy technicians risks losing sight of medication reconciliation as a shared inter-professional accountability» (Fernandes, 2012)
«Hospitals should focus medication reconciliation on aged polymedicated patients.»
Targeting ALL PEOPLE may save TIME, but If limited resources: Beter to target patients who will derive the most benefit
Patients most at risk of medicines- related problems include those who: have medication misadventure as the known or suspected reason for their presentation or admission to the health service organisation are aged 65 years or older take 5 or more medicines take more than 12 doses of medicines per day take a medicine that requires therapeutic monitoring or is a high-risk medicine have clinically significant changes to their medicines or treatment plan within the last 3 months have suboptimal response to treatment with medicines have difficulty managing their medicines because of literacy or language diffi culties, dexterity problems, impaired sight, confusion/dementia or other cognitive diffi culties have impaired renal or hepatic function have problems using medication delivery devices or require an adherence aid are suspected or known to be non-adherent with their medicines have multiple prescribers for their medicines have been discharged within the last 4 weeks from or have had multiple admissions to a health service organisation
1. OBJECTIVES & RULES 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? Medication Reconciliation (MEDREC) WHAT it should consist of? 4. KEY MESSAGES 5. CONTACTS
«Medication Reconciliation only makes sense when performed at hospital admission.»
ON TRANSFER ON ADMISSION ON DISCHARGE Prevent discrepancies in hospital May reduce readmissions Save time «La sortie se prépare à l admission»
24 H OBTENIR CLARIFIER COMPARER BPMH BEST POSSIBLE MEDICATION HISTORY Nom (forme) Dosage Fréquence Moment d adm. «DISCORDANCE» Admission Transfert Sortie
«The Emergency Department is the best place to perform Medication Reconciliation.»
ON TRANSFER Emergency Dep. Other The most common gateway for admissions Surgical preadmission clinics for elective surgery patients Service with a high rate of medicationrelated readmissions
1. OBJECTIVES & RULES 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? Medication Reconciliation (MEDREC) WHAT it should consist of? 4. KEY MESSAGES 5. CONTACTS
Level: BRONZE BPMH Admission (A) Reconciliation
Level: DIAMOND BPMH Admission (A) Reconciliation Discharge (DC) Reconciliation Inter-professional Electronically generated DC prescription Attention to broader medication management issues Medication counselling prior to discharge Post-discharge follow-up phone call Communication of medication changes
1. OBJECTIVES 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? 4. KEY MESSAGES 5. CONTACTS By the end of this session, participants will be able to: 1. Explain WHAT medication reconciliation (MEDREC) is and the IMPORTANCE of it 2. Identify KEY SUCCESS FACTORS and CHALLENGES for MEDREC implementation 3. Get INSPIRATION from other s experiences
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SENSIBILISATION CLINICAMP 2016 29/04/2016
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OUTIL Patients most at risk of medicines- related problems include those who: Bureau d admission hospitalisation
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PROJET BELGE
PROJET BELGE CLINICAMP 2016 29/04/2016
1. OBJECTIVES & RULES 1. Leadership support Hospital administration must be actively engaged & facilitate an environment for removing barriers. 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? 4. KEY MESSAGES 5. CONTACTS
1. OBJECTIVES & RULES 2. «MEDREC» DEFINITION Why Should We Do This? It s Cost Effective! High Diagnosis Specific Order Sets Do First Medication Reconciliation Dedicated Unit Pharmacist Pharmacist Patient Interview Investing In Safety Bar Code Reconciliation CPOE Automated ADE Monitoring 3. HOW TO START A PROJECT? Impact on ADE Pharmacy Managed Protocols Zero Tolerance Ordering Standards Pharmacist Order Entry 4. KEY MESSAGES Preprinted Order Forms Pocket Formulary Intervention Database Don t Bother 5. CONTACTS Low Medication Competency Testing Low Cost To Implement High Uit presentatie G. Billman: Children s Hospitals and Clinics (Minnesota, USA)
1. OBJECTIVES & RULES 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? 4. KEY MESSAGES 5. CONTACTS 1. Leadership support Hospital administration must be actively engaged & facilitate an environment for removing barriers. 2. Multidisciplinary team Obtain strong representation from the leadership of the 3 key stakeholders: physicians, nursing, and pharmacy. 3. Data feedback Use data and examples of errors to motivate change and to measure whether changes are leading to improvement. 4. Start small Stay focused, use small tests of the reconciling process to identify what strategies work best at your organization. 5. Embed into existing workflow
1. OBJECTIVES & RULES 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? 4. KEY MESSAGES 5. CONTACTS 1. Leadership support Hospital administration must be actively engaged & facilitate an environment for removing barriers. 2. Multidisciplinary team Obtain strong representation from the leadership of the 3 key stakeholders: physicians, nursing, and pharmacy. 3. Data feedback Use data and examples of errors to motivate change and to measure whether changes are leading to improvement. 4. Start small Stay focused, use small tests of the reconciling process to identify what strategies work best at your organization. 5. Embed into existing workflow
1. OBJECTIVES & RULES 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? 4. KEY MESSAGES 5. CONTACTS 1. Leadership support Hospital administration must be actively engaged & facilitate an environment for removing barriers. 2. Multidisciplinary team Obtain strong representation from the leadership of the 3 key stakeholders: physicians, nursing, and pharmacy. 3. Data feedback Use data and examples of errors to motivate change and to measure whether changes are leading to improvement. 4. Start small Stay focused, use small tests of the reconciling process to identify what strategies work best at your organization. 5. Embed into existing workflow
1. OBJECTIVES & RULES 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? 4. KEY MESSAGES 5. CONTACTS 1. Leadership support Hospital administration must be actively engaged & facilitate an environment for removing barriers. 2. Multidisciplinary team Obtain strong representation from the leadership of the 3 key stakeholders: physicians, nursing, and pharmacy. 3. Data feedback Use data and examples of errors to motivate change and to measure whether changes are leading to improvement. 4. Start small Stay focused, use small tests of the reconciling process to identify what strategies work best at your organization. 5. Embed into existing workflow
1. OBJECTIVES & RULES 2. «MEDREC» DEFINITION 3. HOW TO START A PROJECT? 4. KEY MESSAGES Rachel Pham rachel@pham-contact.net Hôpital Molière-Longchamps Rue Marconi, 142 1190 Bruxelles Stephane Steurbaut Stephane.steurbaut@uzbrussel.be UZ Brussel Laarbeeklaan 101 1090 Brussel 5. CONTACTS 5. CONTACTS
References 1/3 Fernandes, O. (2012). "Medication reconciliation in the hospital: what, why, where, when, who and how?" Healthc Q 15 Spec No: 42-49. Gleason, K. M., et al. (2010). "Results of the Medications at Transitions and Clinical Handoffs (MATCH) study: an analysis of medication reconciliation errors and risk factors at hospital admission." J Gen Intern Med 25(5): 441-447. Tam, V. C., et al. (2005). "Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review." CMAJ 173(5): 510-515. MedRec (2009). "High 5s Project: Action on Patient Safety. Assuring Medication Accuracy at Transitions in care : Medication Reconciliation. Mueller, S. K., et al. (2012). "Hospital-based medication reconciliation practices: a systematic review." Arch Intern Med 172(14): 1057-1069.
References 2/3 Marc Vanmeerbeek, Christiane Duchesnes, Valérie Massart, Jean-Luc Belche, Philippe Denoël et Didier Giet. (2008). «Pluridisciplinarité, continuité et qualité des soins en 1ère ligne : quelles attentes des professionnels?» Dobranski S & al, «The nature of hospital prescribing errors,» British Journal of Clinical Governance, pp. 187-193, 2002. Cornish P.L & al., «Unintended medication discrepancies at the time of hospital admission,» Arch Intern Med 165, pp. 424-429, Feb 2005. White, C. M., et al. (2011). "Utilising improvement science methods to optimise medication reconciliation." BMJ Qual Saf 20(4): 372-380. Etchells, E., et al. (2012). "Comparative economic analyses of patient safety improvement strategies in acute care: a systematic review." BMJ Qual Saf 21(6): 448-456.
Vidéo «Get it right». Consulté sur http://www.youtube.com/watch?v=dc5jfuba6ci l «Reconciling medications at admissions: safe practice recommendations and implementation strategies», G Rogers & al, Jounral on Quality and patient safety, Jan 2006, Vol 32 n 1 References 3/3 Karnon J, Campbell F, Czoski-Murray C. Model-based costeffectivness analysis of interventions aimed at preventing medication error at hospital admission (medicines reconciliation). J Eval Clin Pract 2009;15:299e306. Simoens, S., et al. (2011). "Review of the cost-effectiveness of interventions to improve seamless care focusing on medication." Int J Clin Pharm 33(6): 909-917 Alemayehu B. Mekonnen & al, Pharmacy-led medication reconciliation program at hospital transitions: a systematic review and meta-analysis. Journal of clinical pharmacy and therapeutics, 2016, 41, 128-144 Alemayehu B Mekonnen & al., Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: a systematic reviex and meta-analysis, BMJ open 2016