Learning Objectives. Introduction to Reconciling Medication Information. Background. Elements of Performance NPSG

Transcription

1 Pharmacy Evaluation of Medication Reconciliation Initiated in the Emergency Department Manuel A. Calvin, Pharm.D. PGY1 Pharmacy Resident Saint Francis Hospital, Tulsa, OK OSHP Annual Meeting Residency Project Pearls March 27, 2015 Learning Objectives Recall Elements of Performance associated with The Joint Commission s National Patient Safety Goal Identify common types of medication reconciliation errors at Saint Francis Hospital Describe study results The speaker has no actual or potential conflict of interest in relation to this presentation. 2 Background Introduction to Reconciling Medication Information Medication errors harm an estimated 1.5 million people and kill several thousand each year in the United States Important safety issue Organizations face challenges Cost of at least $3.5 billion annually Medication reconciliation is designed to prevent medication errors at patient transition points Process to create complete and accurate medication list upon admission Reduce negative patient outcomes associated with medication discrepancies Clinician awareness Patient s role in medication safety Bootman J, et al. Institute of Medicine Classen DC et al. JAMA. 1997;277: Steeb D. J Am Pharm Assoc. 2011; 52(4): e The Joint Commission NPSG Elements of Performance NPSG Maintain and communicate accurate patient medication information Obtain medication information when the patient is admitted to the hospital Document medication information in an accessible list 5 6

2 Elements of Performance NPSG Compare medication information from before admission to hospital medications to identify and resolve discrepancies. Assessment Question According to The Joint Commission, the intent of National Patient Safety Goal is to: A. help organizations reduce negative patient outcomes associated with medication discrepancies B. evaluate the accuracy of medication reconciliation practices C. decrease a pharmacist s workload by prospectively identifying medication errors D. help patients avoid unnecessary health care costs 7 8 Saint Francis Hospital Current Practice Occurs via electronic medical record (EMR) Performed primarily by nursing staff Pharmacist involvement in certain instances Study Pharmacy Evaluation of Medication Reconciliation Initiated in the Emergency Department 9 10 Study Design Prospective, randomized study n = 100 Medication reconciliations completed between 11/14/ /28/2015 Institutional Research Ethics Board (IREB) expedited review - approved 11 Study Setting Saint Francis Hospital Current staffed beds: 825 Adult beds: 663 Children s Hospital: 162 Trauma Emergency Center: 85 beds FY 2014 admissions: 41,898 FY 2014 emergency visits: 98,272 12

3 Study Purpose To examine the potential role of pharmacy personnel in the prevention of medication errors in the medication reconciliation process Primary Objective: To determine the extent to which medication reconciliation is performed accurately for patients admitted to the hospital via the emergency department 13 Inclusion Criteria Age 18 years or older Admitted within previous 24 hours 10 or more medications prior to admission English-speaking 14 Exclusion Criteria Admitted for observation only Prisoner or inmate Transferred from another healthcare facility Non-communicative or altered mental status with no family members present Study Methods Identify patient via Electronic Medical Record Evaluate inclusion and exclusion criteria Visit patient and provide handouts Clarify discrepancies Progress note Patient Data Collected Error Classifications Patient Name Outpatient pharmacy Omissions Additions Date of birth Medication allergies Duplications Wrong drug Patient location Medications Wrong route Wrong directions Information source Time elapsed Physician or pharmacy contacted Wrong strength or dose Wrong dosage form 17 18

4 Demographics Total Patients n = 100 Age (years) Mean 65 Range Gender (n) Female 60 Male 40 Medications Reviewed (n) 1525 Mean Range Total Errors (n) 224 Mean 2.24 Range Patient Distribution n = Average Time To Complete Medication Reconciliation n = 91 Primary Information Source n = Results Total Errors by Type (n = 224) Omissions 81 Wrong Sig 51 Average Time Based on Number Of Home Medications Additions 35 Wrong strength/dose 33 Duplications 10 Wrong dosage form 7 Wrong Drug 7 Wrong Route 0 Incomplete Documentation (n = 43) Allergy Clarification 28 Missing Information

5 Average Number Of Errors Effect Of Phone Calls On Completion Time Haven t taken in years Patient Case Examples 17 medications on home medication list Upon admission, restarted on: Tramadol Singulair Prednisone None were currently prescribed Truthfully the only thing I take everyday is my Cymbalta. 10 medications on home medication list Notified attending physician I ll tell you something I haven t told anyone else yet. Patient getting Seroquel from neighbor Psychiatrist notified 29 Heart Transplant Patient Tacrolimus 1mg Capsule Take 4mg every morning and 3mg every night Nurse entered: Drug: Tacrolimus Strength: 1mg Frequency: BID With comment: Take 4 caps in the AM and 3 at night Physician reordered: Tacrolimus 1mg BID 30

6 Study Limitations Small sample size No evaluation of nursing shifts No comparison to nursing medication reconciliation completion times Excluded patients with 9 medications Unable to compare error rates prior to change in electronic medical record Setbacks 31 Conclusions Room for improvement Average of 2.24 errors in patients with 10 or more medications Results are consistent with published evidence Errors are common Preventable Medication reconciliation barriers Bates DW, et al. JAMA ;274(1): Bates DW, et al. J Gen Intern Med. 1995;10: Summary Acknowledgements The Elements of Performance for the Joint Commission specifically include medication reconciliation activities Our current practice has the potential to cause significant patient harm More study is needed to establish the most beneficial intervention Whitney C. Williams, Pharm.D. Clinical Pharmacist Internal Medicine, University of Kentucky, Lexington, KY Jacyntha Sterling, Pharm.D. Clinical Pharmacy Drug Information Specialist, Saint Francis Hospital, Tulsa, OK Kaili Melton, Pharm.D., BCPS Clinical Pharmacy Emergency Medicine Specialist, Saint Francis Hospital, Tulsa, OK Pharmacy Evaluation of Medication Reconciliation Initiated in the Emergency Department Manuel A. Calvin, Pharm.D. PGY1 Pharmacy Resident Saint Francis Hospital, Tulsa, OK OSHP Annual Meeting Residency Project Pearls March 27, 2015 The speaker has no actual or potential conflict of interest in relation to this presentation. 35 References 1. Bootman J, Cronenwett L. Preventing medication errors: quality chasm series. Institute of Medicine, Steeb D, Webster L. Improving care transitions: optimizing medication reconciliation. J Am Pharm Assoc 2011; 52(4): e National Patient Safety Goals. The Joint Commission. 4. Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA. 274(1):29-34, 1995 Jul Bates DW, Boyle DL, Vander Vliet MB, Schneider J, Leape L. Relationship between medication errors and adverse drug events. J Gen Intern Med 1995;10: Classen DC, Pestotnik SL, Evans RS, et al. Adverse drug events in hospitalized patients: excess length of stay, extra costs, and attributable mortality. JAMA 1997;277: