Medication Error. Medication Errors. Transitions in Care: Optimizing Intern Resources

Transcription

1 Transitions in Care: Optimizing Intern Resources DeeDee Hu PharmD, MBA Clinical Specialist Critical Care and Cardiology PGY1 Program Director Memorial Hermann Memorial City Medical Center Medication Error any preventable event that may cause or lead to inappropriate medication use or patient harm, while the medication is in the control of the healthcare professional, patient, or consumer. Such events may be related to professional practice, healthcare products, procedures, and systems.. National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP), Medication Errors Harms 1.5 million patients per year $3.5 billion per year Severe harm potential 6% Moderate harm potential 33% 61% No harm potential Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med. 2005;165:

2 Adverse Events After Discharge Permanent Disabilities (3%) 30% Nonpermanent disability 64% Several days of symptoms Forster AJ, Harvey JM, Peterson JF, et al. The Incidence and Severity of Adverse Events Affecting Patients after Discharge from the Hospital. Ann IntMed. 2003;138; Regulations National Patient Safety Goal #8: to accurately and completely reconcile medications across the continuum of care requirements Admission reconciliation process Communication to next level of care The Joint Commission. Issue 35: Using medication Reconciliation to Prevent Errors. Jan Pharmacists and Medication Reconciliation 600 interventions Cost savings averaged $700/intervention Total savings = $420,155 Lee AJ, Boro MS, Knapp KK, et al. Clinical and Economic Outcomes of Pharmacist Recommendations in a Veterans Affairs Medical Center. Am J Health-SystPharm; 2002; 59:

3 Memorial Hermann Memorial City Medical Center 443 licensed beds Located at I-10 & Beltway 8 the geographic epicenter of Houston s growth Destination Tertiary Care Hospital Specialties Heart and Vascular Stroke Bariatric Surgery Orthopedic Surgery TRANSITIONS IN CARE PROGRAM (TIC) Pre-TIC Process Implementation Nurses perform medication history upon admission Physicians perform discharge reconciliation Nurses perform medication discharge counseling. Process Review Compared nursing driven medication history versus IPPE history Nursing group had 18 errors/patient 3

4 Program Design Fourth year pharmacy interns Complete a series of 1-2 clinical rotations prior to TIC TIC rotation constitutes Advanced Institutional Medicine Rotation Interns are provided workstations, office supplies and SprectreLink phones Orientation starts the last week of the rotation prior TIC functions Medication Reconciliation Telemetry rounds Discharge Counseling Anticoagulation Heart Failure Discharge Reconciliation Medication Reconciliation Medication history via thorough interview of the patient and/or family members Information could be gained from contacting physician offices and/or outpatient pharmacies Reconciliation included clinical corellation of medication history to inpatient medications Any interventions were presented to clinical specialist for review and changes. 4

5 Telemetry rounds Improvement of HCAHP scores Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand? Never, Sometimes, Usually, Always Communication of new medications started and any relevant side effects Discharge Counseling High risk medications Warfarin Anti-Xa medications Dabigitran Lovenox CHF patients Lifestyle Medications Follow up Discharge Reconciliation Communication with unit discharge nurse Reconcile inpatient medications with discharge prescription list Communicate any interventions or hanges to clinical specialist 5

6 Intervention Documentation Intervention Approach Medication Reconciliation Discharge Counseling Intervention Category Inpatient Therapeutic Outpatient Therapeutic Documentation Counseling Intervention Type Commission Omission Duplicates Adverse Effect Allergy Drug Interaction Therapeutic Duplication Wrong Drug Wrong Dose Wrong frequency Wrong formulation TIC PROGRAM RESULTS 6

7 Intervention Approach Began April 2013 Data collection through October patients excluded OVERVIEW Patients 669 Interventions 1318 Intervention Approach Medication Reconciliation 1129 Discharge Counseling 189 Primary Admission Diagnosis Admission Reason Cardiac 181 Endocrine 28 Gastrointestinal 41 Genitourinary 8 Hematology 37 Hepatic 12 Infection 205 Musculoskeletal 10 Neurologic 42 Oncology 34 Pulmonary 29 Renal 42 Intervention Category Intervention Category Documentation 730 Inpatient Therapeutic 54 Outpatient Therapeutic 183 Counseling 351 7

8 Intervention Type Intervention Type Adverse effect 3 Allergy 15 Commission 68 Counseling 168 DDI 4 Duplicate 59 Counseling 351 Omission 333 Therapeutic Duplication 9 Wrong Dose 105 Wrong Drug 21 Wrong Formulation 6 Wrong Frequency 164 Wrong Route 12 Outcomes Medicine Med/Onc Telemetry LOS CHF Readmissions HCAHPS Pre TIC Post TIC Pre TIC Post TIC Pre TIC Post TIC NC NC NC NC Cost Savings Calculation Cost Savings ($) = harm score X LOS X ICD-9 avg bed cost/day Harm Score 0 = harm is unlikely 0.5 = harm is neither likely nor unlikely 1 = harm is likely Lee AJ, Boro MS, Knapp KK, et al. Clinical and Economic Outcomes of Pharmacist Recommendations in a Veterans Affairs Medical Center. Am J Health-SystPharm; 2002; 59:

9 Cost Savings Score PharmD MD counseling Harm Score 0.58 Length of Stay Actual = 4.83 days Median Model = 2.99 days Cost Savings Intervention Number Total Cost Savings 1318 $ 9