1. 1 Medication Reconciliation at Osborne Park Hospital Karen Chapman, Senior Pharmacist Aaron Cook, SQuIRe Project Officer

2. 2 Background State-wide SQuIRe program Why the need for a Med-Rec project? AIMS data and anecdotal evidence Medication reconciliation previously performed but poorly documented

3. 3 Target Areas Reconciliation Project on 3 aged care & rehab wards Safety initiatives across other wards Majority of patients over 65 years of age, multiple co-morbidities, visual and/or hearing impairments, fluctuating cognitive state, language barriers, multiple medications (average 15), multiple medical professionals seen prior to OPH admission = high risk patients Average length of stay on rehab wards is 19 days (reduce)

4. 4 Medication Reconciliation Process Admission: take medication history, confirm and reconcile Discharge/transfer: reconcile, liaise/communicate information to next point of care Aiming to achieve a new system which creates accountability, continuity of care and communication, saving time (overall) = safer care for patients

5. 5 My Own Medicines List Developed for maternity patients to list their medications and ADRs prior to admission

6. 6 My Medication Bags To encourage patients to bring in their own medications, assisting with reconciliation and safe medication storage during admission.

7. 7 Pharmacy Admission Data Sheet Admission data sheets are completed to list and cross check all medications and indications

8. 8 Medication Reconciliation Form Ensures admission and discharge processes have been completed correctly and details any discrepancies identified

9. 9 This is what happens when Doctors make medication errors……!

10. 10 Discharge Dispensing Checklist Discharge dispensing checklist to ensure all stages of discharge process completed

11. 11 General Practitioner and Community Pharmacy Facsimile Created to promote community liaison

12. 12 Promotion & Education Launched My Medicine bag campaign for OPH Created and launched the OPH My Own Medicine List through the antenatal clinic Provided My Medicine bags to all rehabilitation wards Local community centre posters and presentation promoting a patients own medication management Regular education sessions with medical and nursing staff Liaison with patients family, carers, GP and community pharmacist Commenced home medicines review initiative with patients GP

13. 13 Promotion Local newspaper (Stirling Times) article and picture Northern Lights (OPHs monthly newsletter/magazine) article and picture Osborne GP Network Ltd fax article Promotion of My Own Medicines on inpatient televisions OPH Internet article OPH telephone messages on hold to promote bringing own medications to hospital Liaison with OPH Community Advisory Council

14. 14 Improvements in Admission Process Pharmacists documenting and processing a complete medication history on admission, confirming and reconciling it, has risen from 0% (0/20 patients, March 2007) on 1 ward, to 100% (76/76 patients, August 2008) across 3 wards.

15. 15 Improvements in Discharge Process Similarly, documenting the reconciliation of medications and appropriate liaison/correspondence on discharge has improved from 35% (7/20 patients, March 2007) on 1 ward, to 100% (69/69 patients, August 2008) on 3 wards.

16. 16 Discrepancies Found on Admission May 2008: 56 patients (2 wards), 146 medication discrepancies/errors June 2008: 47 patients (2 wards), 88 medication discrepancies/errors July 2008: 92 patients (3 wards), 122 medication discrepancies/errors August 2008: 76 patients (3 wards), 110 medication discrepancies/errors

17. 17 Challenges Time and resources required for complete reconciliation (which is reliant upon communication with multiple sources) Reliance on Pharmacists ……. Dont worry, the Pharmacist will correct it Transient (rotational) nature of some medical staff resulting in a continuous need to retrain, up skill etc

18. 18 Future Plans – Medication Safety Initiatives Labelling, documentation size increase Continue strong engagement of medical staff Trial medication storage in centralised area Continue community promotion/awareness Investigate electronic medical record alternatives Investigate methods for preventing/reducing interruptions during Nurse medication rounds

19. 19 Questions