Presentation on theme: "Medication Reconciliation & Presenter Name & Organization"— Presentation transcript:
1Medication Reconciliation & Presenter Name & Organization Medication SafetyThe Role ofMedication Reconciliation &Medicine ListsPresenter Name & Organization
2Objectives Be familiar with Washington Patient Safety Coalition Understand where medication reconciliation, My Medicine List, and safe transitions fit into the medication safety strategic plan.Understand the current regulatory drivers around medication reconciliation, such as The Joint Commission’s National Patient Safety Goal (NPSG)Advocate and implement medication reconciliation into workflowPromote patient awareness and utilization of My Medicine List
3Patient Case52 year old man goes to the clinic for a check-in visit with his Specialist provider.Patient’s electronic chart indicated he was to take 1 tablet of aspirin 325 daily.Patient reported taking 18 tablets of aspirin 325mg daily for shoulder pain.MEGThis patient had not had the opportunity yet to tell a healthcare professional how much aspirin he was taking until the medical assistant walked through his medication list with him.When the discrepancy was identified, it was sent to a med reconciliation pharmacist for reviewThe pharmacist called the patientThe patient did not know that it was a very dangerous daily dose of aspirin (well over the recommended maximum of 400%)The patient had never told his doctor that he was taking that muchThe pharmacist determined that acetaminophen was a safer choice for this patientThe pharmacist gave him a recommended dosing plan with acetaminophenIf this patient continued to take 6,000 mg of aspirin daily, he was great increasing his chance of bleed.The patient learned the importance of knowing his medications and following his recommended medication list.He also learned to tell his healthcare professionals exactly what he was taking.This is almost 6,000 mg of AspirinNew pain regimen was discussed
4About the WPSC www.wapatientsafety.org The Washington Patient Safety Coalition is dedicated to improving patient safety and reducing medical errors for individuals receiving health care in Washington, in all care settings.Our VisionSafe care: every patient, every time, everywhere.Our ValuesPatient-centeredSystems-oriented and sustainableEvidence-basedInclusiveResource-sensitiveOur GoalsWe will improve safety within and across all care settings by:Facilitating the exchange of information about best practices relative to patient safety.Disseminating new knowledge and new practices.Supporting coordinated/collaborative efforts and new partnerships.Raising awareness of the need for safe practices.Our ValuesPatient-centered: The methods used and promoted by the Coalition will be driven by the needs of the patient.Systems-oriented and sustainable: The Coalition will focus on system changes that create and sustain a safe environment.Evidence-based: The Coalition will strive to promote methods and activities that are evidence-based, while accommodating new research and emerging applications.Inclusive: The Coalition’s work will recognize the diversity of our community and will strive to include all populations.Resource-sensitive: The Coalition will be sensitive to the resources required to implement and sustain change.
5The Concerns Around Medication Safety 1999 IOM report: estimated that medical errors cause 44,000 to 98,000 preventable deaths and one million additional injuries each year in U.S. hospitals, and cost over $850 billion.A 2006 follow-up to the IOM study found that medication errors are among the most common medical mistakes, harming at least 1.5 million people every year. According to the study, each year…400,000 preventable drug-related injuries occur in hospitals800,000 in long-term care settings530,000 among Medicare recipients in outpatient clinics
6Improving Medication Safety: Where to begin? Drug InteractionsHigh Alert /High Risk AgentsAdherence/ Compliance BarriersPatient EducationImproved Packaging & LabelingMedication ErrorsPrescriber EducationTransitional Care ManagementTransitional Care Management
7Patients at RiskNearly 40% of patients have ≥ 1 unintended medication discrepancy at hospital admission!A similar proportion are present at transfer within a hospital and in 14% of patients at hospital discharge.A series of interventions, including medication reconciliation, introduced over a seven-month period, successfully decreased the rate of medication errors by 70% and reduced adverse drug events by over 15%. Whittington J, Cohen H. OSF Healthcare’s Journey in Patient Safety. Quality Management in Health Care. 2004;13(1):53-59.Cornish PL et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med. 2005;165:
8Medication Reconciliation: A Definition?No standard exists! The Joint Commission recommends…The process of verifying that a patient’s current list of medications (including dose, route, and frequency) is correct and that the medications are currently medically necessary and safe.Greenwald et al. Making inpatient medication reconciliation patient centered, clinically relevant, and implementable: a consensus statement on key principles and necessary first steps. Jt Comm J Qual Patient Saf Nov;36(11):504-13, 481.
9ASHP-APhA Medication Reconciliation Goals Medication reconciliation should be a patient-centered process, taking into account the patient’s level of health literacy and willingness to engage in his or /her personal health care.Target improvement in patient well-being through education, empowerment, and active involvementAchieve by promoting communication among patients and healthcare providersASHP – APhA Medication Reconciliation Initiative Workgroup Meeting . February 12, 2007
10Achieving Medication Safety Goals via Medication Reconciliation Drive Systems (Re)Designand Process ImprovementDrive Systems (Re)Designand Process ImprovementCatalyst Driving ChangeWPSCRegulatory OrganizationsReimbursement ModelsMaximize Use of TechnologyFacilitate Cultural Change
11Healthcare Systems Design: Must Support the Med Rec Process CollectClarifyChange in…Care SettingMedicationsVerifyReconcileCommunicateEducate
12Medication Reconciliation: Not So Simple! DISCHARGE PROCESSHOSPITAL ADMISSION PROCESSCOMMUNITY PROCESSMedicationInfo SourcesPt & FamilyClarification/VerificationPhysiciansPharmaciesPre-Admit Outpt Medication ListPre-Admit Outpt Medication ListPre-Admit Outpt Medication ListPt & FamilyCare FacilitiesPhysiciansOutpatient Medication ListPharmaciesMedical RecordsInpatient Med ListInpatient Med ListCare Facilities3rd Party VendorsPatient condition & diagnosisDischarge Medication Reconciliation
13Real Life Example: Inpatient Admission Patient admitted through EDED Not a good setting for collecting informationTriage, stabilize, transfer or dischargeSolution: ED Med Rec TechsComplete when admitted on unit?Nurses busy admitting patientMed Rec challenging and time consumingUse what was collected in ED? Verify but not thoroughly?Provider prints off what is in systemUnverified, from last admissionErrors perpetuated on Transfer and at DischargeGarbage In = Garbage OutExample of process at Franciscan Health System
14Real Life Example: Franciscan Health System Patient Arrives at EDED Med Rec TechInterviews patient or caregiversRecords medication information from patient medication bottlesCalls outpatient pharmacies, queries available sources, GH Epic, FMG Elysium, etc., contacts patient’s PCPsClarifies information with family or caregiverGenerates a complete and accurate home med list that is reviewed by a pharmacistList provided to ED or admitting provider to complete medication reconciliation.Accurate home medication improves transitions in careProvides a good foundation for Discharge Med RecExample of improved process from Franciscan Health System
15Real Life Example: Group Health Post-Discharge Medication ReconciliationDischargeHomePrimary CareExample provided by Group HealthPatients identified who are high risk for readmitInformation sent to Clinical Pharmacists for follow upPharmacist calls patient days post-dischargeMed recon and comprehensive medication reviewPharmacist updates patient’s physicianMakes medicationrecommendations80% of patients have at leastone discrepancy resolved.
16Safe Transitions Involve Many! Safe transitions are best when we maximize amulti-disciplinary approachGroup Health: Specialty Medication Reconciliation involves a variety of disciplinesMedical Assistant: medication verificationSpecialist: medication review and hand-off to pharmacistPharmacist: comprehensive medication reconciliation and communication to patient and appropriate physiciansPrimary Care Provider: authorize prescriptions and carry out ongoing care of patient’s therapyGroup Health’s Multidisciplinary approach to specialty medication reconciliation
17Incentivizing Change via Regulatory Process Mandating change and prioritizationTechnology Adoption
18Medication Reconciliation Requirements The Joint CommissionMedication Reconciliation RequirementsA 6-year journey to improve patient safety2005200620072008200920102012TJCintroducesNPSG 8“Med Rec” required for accreditationNPSGminor revisionsNPSG major revisions plannedScoring suspended and some simplificationNew standards created & releasedImplementation of new standard
19Medication Reconciliation TJC 2011Medication ReconciliationNational Patient Safety Goal #3: “Improve the safety of using medications”NPSG : “Maintain and communicate accurate patient medication information”Applies to:Hospitals, including Critical Access HospitalsAmbulatory CareOffice (Ambulatory) SurgeryHome CareLong-term CareBehavioral HealthTIM
20The Patient Protection and Affordable Care Act (H.R. 3590) Value-Based Purchasing (VBP)Hospital ConsumerAssessment of HealthcareProviders and Systems (HCAHPS)(Section 3001)Core Measures(Section 3001)Healthcare-AssociatedInfections (HAI)(Section 3001)At Risk: 1% in FY2013 growing annually to 2% in FY2017(70% Core Measures + HAI and 30% HCAHPS)Medicare ReimbursementTIMEffective Oct. 1, 2012Reduces Medicare inpatient payments for hospitals with higher than expected risk-adjusted readmission rates for certain conditions.Reduced Medicare payments for every discharge.At Risk: 1% reductionbeginning FY2015At Risk: 1% reduction in FY2013 and willRise to 3% by FY2015Hospital AcquiredConditions (HAC)(Section 3008)Readmission Rates(Section 3025)AMI, PNE, HFCOPD, CABG,PTCA, etc.5
21Readmissions are…Frequent18% of all Medicare hospitalizations are 30-day re-hospitalizationsAverage rates are >20% for certain patient populationsPotentially avoidable76% of Medicare re-hospitalizations were “potentially preventable”Costly$15B annually in Medicare of which $13B may be unnecessaryActionable for improvementResearch and quality improvement initiatives have demonstrated >30% reduction of 30-day readmission rates for a variety of populationsMedications and medication use are often implicated in unexpected readmissions!MedPAC 2007 Report to Congress; Promoting Greater Efficiency in Medicare
22Med Reconciliation & Readmissions How much does ahospital readmit cost?$14,500Our analysis showsthat for every 25patients that receivesmed recon post-discharge, 1 hospitalreadmit is prevented.Group Health data. The $14,500 is the approximate cost of a readmission (or an admission).For the 2012 calendaryear, the program willsave an estimated1 million dollars14 day30 DayKilcup M, Schultz D, et al. Post-discharge pharmacist medication reconciliation: Impact on readmission rates and financial savings. J Am Pharm Assoc. 2013: Jan/Feb, 53:1.
23Opportunities for Pharmacy: Readmissions Preventing Interventions Phase of CareAdmissionInpatient StayDischargeHomePharmacy Service ProvidedPerform Admission AssessmentDetermine factors in admission/readmissionMedication historyMedication reconciliationErrors of omission (EBM)Adverse drug events (ADE)Medication adherenceMedication accessDetermine post-hospital needsWhere will patient likely receive care?Who are caregivers?Barriers to care?Care OptimizationProvide effective teaching & enhanced learningIdentify barriers to learningMedication managementDisease self-managementMedication adherenceUse “Teach Back” methodProvide toolsOptimize the medication regimenInitiate indicated medicationsDiscontinue unnecessary or unsafe medicationsSimplify the medication regimenPrepare for Transition in CareMedication regimen reviewMedication reconciliationProvide medication list and related information to:Patient/caregiverPhysician/medical teamPharmacy/pharmacistVerify appropriate post-discharge care planMatch discharge follow-up to need (readmission risk stratification)Ensure proper information is provided regarding contact information, action plan for care and symptom or AE managementProvide Appropriate Post-Discharge CareContact patient/caregiverLive or virtual visitPatient status and medication reviewMedication reconciliationMedication adherenceADE surveillanceMedication accessMed management/ Disease managementCommunicate to other providers any pertinent medical information or findings
24Achieving Medication Safety Goals via Medication Reconciliation Drive Systems (Re)Designand Process ImprovementCatalyst Driving ChangeWPSCRegulatory OrganizationsReimbursement ModelsMaximize Use of TechnologyMaximize Use of TechnologyFacilitate Cultural Change
25Achieving Medication Safety Goals via Medication Reconciliation Drive Systems (Re)Designand Process ImprovementCatalyst Driving ChangeWPSCRegulatory OrganizationsReimbursement ModelsMaximize Use of TechnologyFacilitate Cultural ChangeFacilitate Cultural Change
27My Medicine List Heighten Public Awareness Emphasize the need for patients to take an active role in managing their medicines.The initiative’s goal is for every person to maintain an up-to-date list and to share it with his/her health care provider.TIMA campaign intended to build public awareness of the need for patients to take an active role in managing their medicines.Sponsored by the Washington Patient Safety Coalition (WPSC)The initiative’s goal is for every person to maintain an up-to-date list of every medicine he or she is using and to share it with his or her health care provider during each and every visit.
28My Medicine ListA sample of resources available on the My Medicine List pages of the WPSC web site.
29What's in a “Medicines” List Prescription medicationsSample medicationsVitaminsHerbal & Alternative MedsNutriceuticals & Dietary SupplementsOver-the-counter drugsVaccinesRespiratory therapy-related medicationsParenteral nutritionBlood derivativesIntravenous solutions (plain or with additives)Diagnostic and contrast agentsRadioactive medicationsAny product designated by the FDA as a drug!
30How Can You Help? Remember the 3 As ASK every patient about his or her medicine list at each encounter.ADVISE your patients to carry a listASSIST your patients with resources & toolsRefer your patients to mymedicinelist.orgfor information and resourcesWhat you don’t know about your patients could harm them!