Use of a Universal Medication List to Enhance Continuity of Care in Tennessee

Tennessee Pharmacists Association Baeteena Black, Executive Director Patient Continuum of Care Committee Jeanne Ezell, D.Ph., Chairperson Partner Organizations: Tennessee Hospital Association Tennessee Nurses Association Tennessee Medical Association Tennessee Academy of Family Practitioners Tennessee Dental Association Tennessee Poison Center Blue Cross Blue Shield of Tennessee

PROBLEMS Medication reconciliation at hospital admission is extremely difficult to accomplish when patients fail to bring an up-to-date of all their medications Past history and medication response are needed to plan patient treatment Complete medication profile is needed to screen and prevent interactions Communication of medication profile, allergy history, and vaccination history is needed to prevent discontinuity and fragmentation of care Confusion often results after hospital discharge when patients are not clear about medications and doses to be taken Community pharmacists can not adequately screen patient profiles for allergies, duplications, drug interactions and other drug-related problems if they do not have complete lists of patient medications, reasons for medication use, and allergy histories

TPA Continuum of Care Project Goal To improve medication safety in Tennessee by providing a universally consistent process for communicating vital patient information regarding medications and allergies across the continuum of care

What is Continuity of Care in Medication Management? Continuity of care is a longitudinal process that is coordinated and provided among practitioners and organizations over time, consistent with the ongoing needs of the individual patient. Medication management is an essential component of continuity of care.

Why is Medication Continuum of Care Important? Patient harm can result from inaccurate diagnosis and treatment Medication Errors can result in duplications omissions interactions

Project Objectives Until widespread electronic healthcare systems are available, all pharmacists will be urged to provide their patients with a printed medication profile; All Tennessee pharmacists will encourage patients to carry an up-to-date medication and allergy list with them at all times to be available at entry and exit from all healthcare encounters;

Initial Objective Develop and promote a common paper- based method of medication information interchange that any or all Tennesseans can use in all healthcare encounters

Methods Searched for available medication list forms Conducted a survey of over 300 health care professionals (pharmacists, nurses, physicians) to determine most important elements and formats for a universal medication list form, regardless of whether electronic or paper Graded available lists based on important elements from survey Adapted Universal Medication List (UML) from South Carolina (developed by AnMed Health and South Carolina Hospital Association 2004)

Methods Sought collaboration with other healthcare professional organizations Posted UML on TPA website for free download Translated UML into Spanish Sent out Press Releases to TPA members and partner organizations

National Issue Enhancing communication of healthcare information across the continuum of care has become a nationwide issue Many states and various organizations are promoting electronic healthcare data storage and exchange and electronic prescribing to improve continuity of care

NTOCC National Transitions of Care Coalition Formed to improve continuity of care Website has many helpful tools and information

Pilot Projects Blount Memorial Hospital, Maryville – UML adapted for use with discharge instructions UT Medical Center, Knoxville – UML included in ambulatory clinic visit patient check-in process Community pharmacies are displaying the UML in waiting areas UML provided to seniors with Vial of Life at Nashville Senior Health Expo UML forms displayed in physician offices UML used in MTM sessions

Actions Needed Healthcare providers must encourage and expect their patients to carry up-to-date medication information Tennessee e-health initiative is promoting ePrescribing and providing support for sharing medication information across the continuum of care Regional Health Information Organizations (RHIOs) need to be encouraged to include the contents of the UML in design of patient health information exchange

Conclusions Development and implementation of a Universal Medication List for use in Tennessee has been a collaborative project among healthcare professionals. The potential impact of this project and similar projects througout the U.S. on medication safety should be significant, if widespread adoption among healthcare practitioners and the public is fully achieved.

Medications play a key role in the success or failure of patient care.