1. 1 DISCLAIMER We are speaking today in an individual capacity and not as employees of Alberta Health Services. The views and opinions presented are entirely our own. They do no necessarily reflect the views of Alberta Health Services; Nor should they be construed as an official explanation or interpretation.

2. 2 Expanding Scope of Practice Technicians Performing BPMH Foothills Hospital Calgary, AB Hospitalist and Primary Care Network (PCN) Patients

3. 3 Introduction Kristi Fauth – Started at FMC in July of 2006 Mindy Kohar– Started at FMC in December of 2003 The Expanded Role in ED Two technicians and two pharmacists were chosen to pilot this new role and it has been ongoing since October of 2009.

4. 4 General Info About Our Site  933 beds currently at FMC.  There is a new tower being built that includes an ICU expansion. Upon Completion, there will be 1026 beds. Following this there will also be a pharmacy expansion.

5. 5 General info about our pharmacy department  Within our department we have a large team of pharmacists, technicians and assistants. All of which perform duties in/out of the main pharmacy providing service to the entire site  Clinical Pharmacist Activities include: ED, Palliative, Oncology, ICU, CV-ICU, Cardiology, Nephrology/transplant, Med Teaching Unit and Hospitalists

6. 6 General info about our pharmacy department  Technician Responsibilities Order EntryUnit Dose delivery system OncologyFill patient specific orders Non sterile & sterile manufacturing Tech Check Tech is in place at our site when filling refills, delivering unit dose and in sterile & non sterile manufacturing  Assistant Responsibilities Narcotics, Deliveries, Packaging, Re-stock Code Trays, Wardstock and Inventory management

7. 7 Data from research show that 53% of patients have at least ONE medication discrepancy upon admission. 3 22-27% of those medication discrepancies had potential for harm. 3 Best Possible Medication History (BPMH) is a process where steps are taken to retrieve the most current, accurate information of the patients home medications. Including what medications they have taken in the recent past BPMH

8. 8 Because one source of information may not be completely up to date we consult as many sources as possible We have learned how to use Netcare however it may not list all current meds and may not include any OTC products Sources of Medication Information -Netcare- Community Pharmacy -Chart - SCM/Prev. Hosp Recs -Centricity- Blister Packs/Vials -Nursing Home MAR -Interview -MD Office

9. 9 Why BPMH? Physicians are usually not familiar with the patient and often do not have access to the complete medical record. As a result, they are not familiar with the patient’s medications, medical history, or allergies The ED is known to be a particularly high-risk environment with frequent medication errors 1 Ultimate Goal of BPMH: To compile the most accurate up to date pt medication list

10. 10 BEST POSSIBLE MEDICATION HISTORY Date:______________________________________ Name:_________________________________ PHN/ULI:________________________ FMC Loc:___________________ Pharmacy:_____________________ Phone:________________ Health Issue:_________________________________________ MedicationStrengthFrequencyHold/dcSCMComments Metoprolol 25mg50mgBidXPt stopped taking last wk Eye/ear drops: Y/NCold/Flu/Allergies: Y/NBowels: Y/N Pain: Y/NTopical: Y/NSleep: Y/N Vitamins: Y/NHerbals: Y/NHeartburn: Y/N Information sources: _X_ EMS records_X_ Hospital records_X_ Netcare _X_ Pharmacy list___ MAR from a facility_X_ Patient recall ___ Family recall___ Vials___ Blister pack ___ Family Physician___ Other:___________________

11. 11 Medication Reconciliation What is Med Rec? A process of identifying the most accurate list of all medications a patient is taking, including: Name – Dose – Frequency – Route. Identifying any discrepancies and reporting them to a pharmacist. Med Rec Involves: Start - Performing a BPMH Comparing the BPMH to a patient’s current medication orders in hospital. In the hospital we have Computer Prescriber Order Entry with a program called Sunrise Clinical Manager (SCM) for all physicians orders To finish - Reconciling discrepancies with the medical team

12. 12 MED REC Primary goals of Med Rec process; To prevent/recognize/manage medication discrepancies. To Provide seamless care, from admission to discharge.The ED lacks the ability for direct follow-up, and thus adverse interactions between medications prescribed in the ED may go unnoticed by the providers 2

13. 13 Valuable Skills for this Role  Knowledge and Experience with medications  Independence within the workplace  Professional Confidence as a Technician  Communication / Conversation Skills  Organizational Skills  Multi Tasking  Ability to learn: data retrieval skills, resource searching, computer programs

14. 14 Training  Our Clinical Practice leader supplied us with a Med Rec training Manual that is currently being used to train Residents and Pharmacists  Literature Searches - research into other hospitals who have implemented med rec.  Week 1 – Observed our CPL & Pharmacist  Week 2 & 3 - We were performing the duties while being supervised by our CPL & Pharmacist  Week 4 – Fully trained and comfortable performing the necessary duties

15. 15 Technicians in ED  We were fortunate enough to receive an office in the Emergency department. Two technicians and two pharmacists rotate through shifts, currently Mon-Fri. This office makes us easily accessible for any staff members on the unit to find us with any concerns regarding patients, missing medications or stock  Professional Interactions Physicians, Nurses, Respiratory Therapists, Echo Cardiologists, and Porters

16. 16 Technicians in ED  Patient Selection – New admissions and admitted Hospitalist and Primary Care Network (PCN) patients  We have the ability to look at all new pts first thing in the morning to prioritize our day. We work on the newest admits first - it is beneficial for the Nurses and physicians if we can provide the current med list ASAP  We see and average of 8 pts per day

17. 17 Technicians in ED Hospitalist pts are decided by the complexity of their health conditions and medication history. Usually COPD, CHF, falls, UTI, pneumonia etc. PCN pts have community physicians that are part of a PCN group. They will flag on admittance and be assigned to this service Hospitalist patients total approx 160 - PCN patients total approx 40 Physicians and Nurses also make requests for pts outside these groups depending on the circumstance

18. 18 A Day In The Life Of A Med Rec Tech  START Log on to SCM and prioritize our patients in the list and print off their current admission orders Print out NETCARE for the patient medication profile Contact Community Pharmacy and have them fax the medication profile for the last 6 months Access patient chart for any medication information

19. 19 A Day In The Life Of … Write up the BPMH form with all of the collected patient information Patient Interview is then performed. The patient is asked about their prescription medications and any OTC products they take. If family is present they can be interviewed as well Contact other sources of information if needed - Ex: Eye Clinic, Southern Alberta Clinic (SAC), other hospitals, family members

20. 20 A Day In The Life Of … Med Rec - Compare the medication information between home medications and what is currently ordered in the hospital. Consult with Pharmacist  FINISH The pharmacist will make their recommendation to the physician on any changes if needed The time it takes to see a single patient varies, on average it will take approximately ½hr to 1hr per pt

21. 21 Other Duties  Liaison between main Pharmacy and ED  Inventory Control  Suggestions on Increases and Decreases in floorstock quota, additions and deletions of floorstock meds  H1N1 Pandemic Planning Support, stocked antivirals.  Issues regarding medications for patients – missing / delayed meds  Modified Narcotic / Floorstock Order Forms

22. 22 NEW Duties As of the end of April we have started preparing discharge printouts for our specific group of pts From ED the patient is transferred to a unit. When they are ready for discharge they will receive a printout of their scheduled meds If we are not busy in ED we will call the pharmacists on the unit to see if we can assist them Also started scanning and saving all our BPMH info onto a protected drive for any repeat patients

23. 23 The Experience Positive feedback from staff and patients Beneficial for both departments Job satisfaction Providing seamless care Future possibilities……..

24. 24 REFERENCES 1.Croskerry P, Sinclair D. Emergency Medicine: A practice prone to error? Canadian J of Emerg Med; 2001: 3(4) 2.Heininger-Rothbucher D, Bischinger S, Ulmer H, et al. Incidence and risk of potential adverse drug interactions in the emergency room. Resuscitation. 2001;49:283-288 3.Lizer et al, Gleason et al, Lubowski et al. Medication history reconciliation by pharmacists in an inpatient behavioural health unit. AM J Health-Syst Pharm. 2007;64:1087 – 1091.