Improving medicines reconciliation on discharge from surgical services at Ninewells Hospital

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1 Improving medicines reconciliation on discharge from surgical services at Ninewells Hospital Shady Botros Lead Clinical Pharmacist for Surgery John Dunn Specialist Pharmacist for Surgery Owain Prys-Jones Foundation Doctor (FY1)

2 Situation Patients with one or more drugs unintentionally omitted from their discharge summary have 2.31 times the usual risk of re-admission to hospital Stowasser D, Collins D, Stowasser M. A randomised controlled trial of medication liaison services - patient outcomes. J Pharm Pract Res 2002;32:

3 Background Local Medicines Reconciliation policy Anecdotal evidence Frustration

4 Assessment 4 week baseline data 45 % accuracy Med Rec on admission Take 5 to Ask 5 3 doctors - NO 2 doctors - YES

5 Recommendation Tackle as a Quality Improvement project Upper GI surgery ward as a pilot site Improve patient safety on transfer from secondary to primary care by improving MROD accuracy by 50% Sustained improvement in the accuracy of discharge prescriptions Promote accurate & reliable medicines reconciliation on discharge by encouraging doctors to, 1. Review the patient s reconciled list of medicines on admission and use it as a vital source when completing the discharge document 2.Clearly communicate any changes in the patient s drug history to the GP as part of the discharge document

6 Test of change On Discharge, this Med Rec form has been reviewed by DOCTOR... On... PHARMACY... On... Appropriate communication has been given to patient GP Pre test of change Test of change

7 28/10/13 04/11/13 11/11/13 18/11/13 25/11/13 02/12/13 09/12/13 16/12/13 23/12/13 30/12/13 06/01/14 13/01/14 20/01/14 27/01/14 03/02/14 10/02/14 17/02/14 24/02/14 03/03/14 10/03/14 17/03/14 24/03/14 31/03/14 07/04/14 14/04/14 21/04/14 28/04/14 05/05/14 12/05/14 19/05/14 26/05/14 02/06/14 09/06/14 16/06/14 Results pilot site % of Discharge prescription with accurate drug list & clear communication to the GP regarding any changes in drug history (prior to pharmacist verification) Median 1 (Base Line) Median 2 Median Test of change introduced Change in junior doctor rotation

8 28/10/ /11/ /11/ /12/ /12/ /01/ /01/ /02/ /02/ /03/ /03/ /03/ /04/ /04/ /05/ /05/ /06/ /06/ /07/ /07/2014 Results pilot site % of Discharge prescriptions with accurate drug list (prior to pharmacist verification) Median 1 (Base line) Median % of Discharge prescriptions with gaps in GP communication regarding changes in drug history (prior to pharmacist verification) Discontinued drug recorded Dose change recorded Drug change recorded Test of change Introduced Test of change introduced

9 SPREAD 10 wards (Surgery & Orthopaedics) SPREAD Test of change Post test of change

10 Process measure % Compliance with the new Med Rec on discharge process (Pre & Post pharmacist prompt) Green Boxes Signed Pharmacy Prompt Full Implementation

11 Outcome measure - HARM % of Discharge prescriptions with accurate drug list & clear communication to the GP regarding any changes in drug history (prior to pharmacist verification) Median 1 (base line) Median Full implementation % of Discharge prescriptions with gaps in communication regarding changes in drug history (prior to pharmacist verification) Discontinued Drug Recorded Dose Change Recorded Drug Change Recorded Full implementation

12 Outcome - WASTE 12.5 secs per Item 8.1 Items per Discharge ( secs) 5 discharges / day / Pharmacist = 8.43 mins / Day Per week = min Per Year = mins = 37 Hours SAVED 1 working WEEK of 1 WTE Pharmacist

13 My experience Current FY1 6 months working Started on Surgery where this system is used standard procedure Feel like it increased accuracy of EDDs made me remember to check and think about the initial meds rec Continued the practice into my current job

14 Patient story 82 YO Female lives alone Discharge on Friday Only time family available to pick her up Not prescribed Oramorph which she takes PRN none at home Only present in admission meds rec pharmacist had added it at admission If Meds rec not checked delay in discharge

15 Colleagues opinions All colleagues mentioned they would check TPAR and imports from ECS Most said they would check the admission document not all and some said they d skip it when busy Overwhelming majority believe doing a meds rec on discharge is important and would improve efficiency and accuracy Discharge scripts affect relationship with pharmacists

16 Issues Standardisation across the hospital Education of benefits to medical colleagues Integration with pre-assessment documentation Possibility for integration with current EDD online On going need for prompting

17 Who it benefits - EVERYONE Doctors Increased accuracy of EDDs and better communication with the GPs regarding medication changes Pharmacists Less time checking and amending EDDs and better communication with the community pharmacists for dispensing Patient Less time waiting for medication amendments and less opportunity of having medications falsely stopped, started or missed

18 NEXT STEPS... Sustainability Weekends Test / spread Oncology Links with primary care Med rec on admission Patient centred care

19 QUESTIONS? Shady Botros