Medication Reconciliation and Pharmacy Technicians:

Transcription

1 Medication Reconciliation and Pharmacy Technicians: Utilizing Pharmacy Technicians to Support the Medication Reconciliation Process Organized by the Section of Pharmacy Practice Managers ASHP Webinar Networking Session

2 Today s Presenters Janinah S. Barreto, PharmD, MS The Ohio State University Medical Center, OH Steve Ebert, Pharm.D. Drea Maier, Pharm.D Meriter Hospital, WI Teri Wooton, Pharm.D. Carolinas Medical Center Northeast, NC

3 The Joint Commission Medication reconciliation is the process of comparing a patient's medication orders to all of the medications that the patient has been taking. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. Transitions in care include changes in setting, service, practitioner or level of care. This process comprises five steps: 1) develop a list of current medications; 2) develop a list of medications to be prescribed; 3) compare the medications on the two lists; 4) make clinical decisions based on the comparison; and 5) communicate the new list to appropriate caregivers and to the patient.

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5 Role of Pharmacy Technician in Medication Reconciliation Janinah S. Barreto, PharmD, MS Medication Safety Pharmacist The Ohio State University Medical Center

6 The Ohio State University Medical Center Hospitals University Hospital Ross Heart Hospital James Cancer Center University Hospitals East Dodd Rehabilitation Facility 1,000+ beds 56,000+ patient admissions 15,700+ inpatient surgeries 1,000+ admitting physicians

7 OSUMC s Pre-Operative Assessment Center (OPAC) Simplifies the preoperative process for OSUMC patients Coordinates preoperative needs for the medically complex (ASA 3-4) Provides education for patients prior to surgery Anesthesia, sedation, risks and benefits, before the procedure (bring medications, what and not to wear the day of surgery, what meds to stop taking, diet Coordinates tests and assessments prior to surgery

8 OPAC Goals Increase patient satisfaction Decrease OR cancellations and delays 100% chart completion day of surgery

9 OPAC Staff Anesthesiologist and Residents Physician Assistants RN s Medical Assistants Pharmacy Technician

10 Typical Patient Visit Register for OPAC & Surgery Clinic Visit is ~1 hour and 15 minutes Weight and Vitals History and Physical Anesthesia Assessment & Q&A s Labs, EKG s and Type Screen/Cross Education for day of surgery... Medications, etc Medications Documented in CPOE

11 Sources of Information for Arrival Medications (i.e. home meds) Patient History Primary Care Physician Record Surgeon s H&P Internal Medicine Consult OSUMC Patient Database Other Outside Records

12 Medication List Source Documents

13 Electronic Documentation

14 Electronic Documentation

15 Single Visit Patient Home Medication List

16 Pharmacy Technician s Role 80% of time Review and document patient s arrival medication assuring appropriate dose, route, frequency and duration of therapy Review records for drug-drug interactions, duplication, drug-allergy interactions Assist with arrival medication order entry

17 Pharmacy Technician s Role 20% of time Cross-trained in IDX Medical records support Phone scheduling Participates in hospital and/or departmental committees relevant to practice area

18 Pharmacy Technician Qualifications and Role Qualifications CPht Retail Pharmacy Experience Prescription Receiver Refill Experience

19 Challenges Training/Competencies Limited Scope of Practice Staffing Level Nursing Perception

20 Future Steps Pilot Study Business Unit QA James Cancer Hospital Ambulatory Surgical Unit Data analysis pre- and post-implementation

21 Use of Technicians in the Medication Reconciliation Process Steven Ebert, PharmD, Clinical Professor of Pharmacy Clinical Supervisor Andrea Maier, PharmD Clinical Pharmacist Meriter Hospital Madison, WI

22 Meriter Hospital 448-bed non-profit community hospital Med-Surg admissions per year 16 pharmacist shifts/24 hours 11 clinical 11 central based technician shifts/24 hours 1000 RNs on staff!

23 Overview Decision process to utilize technicians Training and QA implemented Management/Road Blocks Implementation/logic Outcomes to date

24 Medication Reconciliation at Meriter, 2003 Nursing Medication History Patient Profile

25 Medication Reconciliation at Meriter, 2003 Pre-Admit Medications New Medications

26 Goals for Our Hospital Create a unified, accurate medication history Reconcile medications at transition points Provide an accurate medication list to patients on discharge

27 Med Reconciliation at Meriter Discrepancies of Various History Sources Compared to Reconciled Admission Medication List Total Discrepancies Omission Dose Frequency Formulation 350 # Discrepancies N=50 patients 0 RN History Neville M, 2005 Outpt Rxy Clinic/H&P RPh History MD Admit Orders

28 History of Pharmacy Effort in Medication Reconciliation at Meriter 2004 RN & MD driven = no pharmacy involvement min/pt 13 min/pt RN history verified & reconciled by RPh RPh enter medication histories into electronic health record min/pt Re-work of histories RPh generate discharge med list electronically 2008 More time spent on admit hx=less time downstream? Admissions Discharges Added ER & Pre-procedure patients

29 Discharge process Staffing Needs Update medications prior to admission in electronic record Benefit upon readmission, medication list would reflect changes from current admission 3000 hours = 1.5 FTE s Admission process admissions per year 30 minutes per admission 9000 hours = 4.3 FTE s additional work

30 Training Process for Technicians Developed formal training program Training sessions MR process overview & technician role Obtaining medication histories Created comprehensive training manual Provides multiple handouts for reference Mock patient interview scenarios Shadow pharmacists in ER Shadow MR technicians Lead technician is essential

31 Quality Assurance Written knowledge evaluation Multiple choice questionnaire Performance evaluation Pharmacist evaluates patient interview skills Continued evaluation & feedback Daily on-the-job feedback All work is reviewed & verified by a pharmacist

32 Roadblocks Hiring and retaining quality technicians Retraining RPhs to work with techs in clinical setting Keeping up with continued changes in responsibilities, new processes, etc.

33 Residency Project 2007 To evaluate whether the use of trained pharmacy technicians to assist pharmacists with MR tasks can: Increase efficiency with the MR process Decrease pharmacist workload Main endpoints Pharmacist time spent on MR tasks Pharmacist satisfaction with the process Measured by pharmacist surveys

34 Results: RPh Time Spent on Medication Reconciliation Baseline Post-Implementation Time (min) Exclusions: ER Shift ICU Shift Central Shift 0 Per Discharge Per Admission

35 Results: RPh Time Spent on Medication Reconciliation Time (min) MR per shift baseline Projected Admission MR per shift Postimplementation Discharge Average admits per shift reported Baseline: 3.9 Post: 3.6 Average discharges per shift reported Baseline: 3.3 Post: 5.8

36 Survey Results Percent of RPhs that Agree or Strongly Agree Baseline Post-implementation Percent MR allows time for other tasks MR is efficient MR done in timely manner Comfort with tech on admission Comfort with D/C tech

37 Results of Post-Implementation Survey "Amount of time spent by RPh on MR activities has decreased" Agree Strongly Agree 27% "Efficiency of MR process has improved" Agree Strongly Agree 73% 18% 100% either agree or strongly agree to both statements 82%

38 Progress to Date 4 FTE s 3 technician shifts M-F, 2 shifts Sat-Sun Duties: Discharge medication lists Medication histories Update medication allergies Manage medications brought in by patient and stored in pharmacy

39 Daily Pharmacy Workload Related to Med Reconciliation Obtain Hx Verify Hx PTA in Elect Record Tech Disch List RPh Check Disch List Minutes/Day Pre-2005 Enter Inpt Med Hx into Epic Admit and Discharge- Inpt/Cath/Amb Surg- 2008? Hx, Admit, Disch- Inpt/Cath/Amb Surg/OB/ER- 2009

40 Conclusion Incorporation of pharmacy technicians into MR process: Increases pharmacist satisfaction Pharmacists feel process is more efficient Decreases average pharmacist time spent per admission and discharge Allows for expanded pharmacy involvement in MR on a greater number of patients

41 Pharmacy Technicians in the Emergency Care Center Carolinas Medical Center Teri Wooton, PharmD, CDE Director of Pharmacy Services

42 Background Feb 07 JC Mock Survey with RFI for Med Rec & Pharmacy review of orders Mar 07 need for FTEs presented to Sr. Administration Apr 07 8 unbudgeted FTEs approved to fill for Pharmacy Services in ECC Jun 07 3 Pharmacists hired Sep 07 Technician selection begins

43 Technician Selection Formal interview process 1-2 days shadowing ECC Pharmacist Good communication skills Experience in pharmacy Good problem solving skills Able to withstand the environment

44 Background reading Technician Training 3 page competency checklist Observe pharmacist x 10 interviews Perform supervised interviews x 10 patients Pharmacist signs off competency

45 A day in the life Current hours 12:30PM 9:00PM 7 days/week Check status board for admission icon Collect med lists from various sources Perform patient interview Document current med list in computer Print out med rec list Review with Pharmacist Put list on chart for admitting MD to sign

46 A day in the life - continued Repeat x patients Continue til 6:30PM 30 minute dinner break 7PM review the board with pharmacist 1-3 more patient interviews Retrieve Omnicell replenishment from Central Pharmacy Restock Omnicell cabinets Go Home

47 Overall Success Pharmacists couldn t do their job without them Review of orders Code participation C&S review MD Consults Tech career ladder, increased job satisfaction Positive feedback from MDs/RNs Minimized workload for admitting RN Assist with retrieval of stats

48 Lessons Learned Involve ECC staff in design of program Cross-train techs with central staff but maintain consistent core Must have a People person Constant opportunity to evaluate techs performance Standardized documentation methods Manage expectations

49 Future Plans Nov 08 expanded hours Tech: 7AM to 11PM Pharmacist: 7AM to 1AM Dec 08 Pilot PreOp interview OR Pharmacy Techs to perform Med Rec

50 Today s Presenters Janinah S. Barreto, PharmD, MS The Ohio State University Medical Center, OH Steve Ebert, Pharm.D. Drea Maier, Pharm.D Meriter Hospital, WI Teri Wooton, Pharm.D. Carolinas Medical Center Northeast, NC

51 Medication Reconciliation and Pharmacy Technicians: Utilizing Pharmacy Technicians to Support the Medication Reconciliation Process Janinah S. Barreto, PharmD, MS The Ohio State University Medical Center, OH Steve Ebert, Pharm.D. Drea Maier, Pharm.D Meriter Hospital, WI Teri Wooton, Pharm.D. Carolinas Medical Center Northeast, NC