Medication Reconciliation at Osborne Park Hospital

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Medication Reconciliation at Osborne Park Hospital Powered By Docstoc
					Medication Reconciliation
at Osborne Park Hospital




•Karen Chapman, Senior Pharmacist
•Aaron Cook, SQuIRe Project Officer
                                      1
                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




                                            2
                      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)




                                                                        3
  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




                                                          4
‘My Own Medicines’ List



              Developed for maternity
              patients to list their
              medications and ADRs
              prior to admission




                                        5
            ‘My Medication’ Bags

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




                                    6
Pharmacy Admission Data Sheet

                  Admission data sheets are
                  completed to list and cross
                  check all medications and
                  indications




                                                7
Medication Reconciliation Form


                    Ensures admission and
                    discharge processes have
                    been completed correctly
                    and details any
                    discrepancies identified




                                               8
This is what happens
when Doctors make
medication
errors……!




                       9
Discharge Dispensing Checklist

                    Discharge dispensing
                    checklist to ensure all
                    stages of discharge process
                    completed




                                                  10
General Practitioner and Community
Pharmacy Facsimile



                     Created to promote
                     community liaison




                                          11
           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
  patient’s own medication management
• Regular education sessions with medical and nursing staff
• Liaison with patient’s family, carers, GP and community pharmacist
• Commenced home medicines review initiative with patient’s GP




                                                                       12
                         Promotion
• Local newspaper (Stirling Times) article and picture
• Northern Lights (OPH’s 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




                                                                    13
      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.

    100

      80

      60

      40

      20

       0
           Mar May   Jul   Sep Nov Jan Mar May    Jul


                                                                         14
        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.

      100

       80

       60

       40

       20

         0
             Mar May Jul   Sep Nov Jan Mar May Jul


                                                                      15
     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

     160
     140
     120
     100
                                                   Patients
      80
                                                   Discrep/Errors
      60                                           Omissions
      40
      20
        0
            May      Jun       Jul     Aug


                                                                            16
                     Challenges
• Time and resources required for complete reconciliation
  (which is reliant upon communication with multiple
  sources)
• Reliance on Pharmacists …….
             ‘Don’t worry, the Pharmacist will correct it’
• Transient (rotational) nature of some medical staff
  resulting in a continuous need to retrain, up skill etc




                                                             17
     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




                                                 18
Questions




            19

				
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posted:2/24/2012
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