Embed Size (px)
Citation preview
Medication ReconciliationMedication Reconciliation
Johns Hopkins HospitalJohns Hopkins HospitalMarch 2006March 2006
Bob Feroli, PharmD, FASHPBob Feroli, PharmD, FASHP
Transition of Care Transition of Care
Patient’s previous home medications are not Patient’s previous home medications are not considered when writing discharge orders. considered when writing discharge orders. Patient is discharged on ZocorPatient is discharged on Zocor®(simvastatin).(simvastatin).
At home, patient starts ZocorAt home, patient starts Zocor® and continues and continues to use previously prescribed Lipitorto use previously prescribed Lipitor®(atorvastatin).(atorvastatin).
Eleven days later, patient is admitted with Eleven days later, patient is admitted with severe rhabdomyolysis secondary to “statin” severe rhabdomyolysis secondary to “statin” overdose.overdose.
Transition of Care Transition of Care
Patient with Parkinson's disease is admitted to an Patient with Parkinson's disease is admitted to an ICU for an acute episode unrelated to Parkinson’s ICU for an acute episode unrelated to Parkinson’s disease.disease.
Initial care is focused on the acute episode and Initial care is focused on the acute episode and anti-Parkinson’s drugs are not used. anti-Parkinson’s drugs are not used.
Patient is transferred to general care unit, Patient is transferred to general care unit, “Home” therapy is not considered and anti-“Home” therapy is not considered and anti-Parkinson’s therapy is not started. Parkinson’s therapy is not started.
Patient develops severe Parkinsonian symptoms.Patient develops severe Parkinsonian symptoms.
Transition of Care Transition of Care
Discharge orders for 33 randomly selected Discharge orders for 33 randomly selected ICU patients were reviewed by an RN in ICU patients were reviewed by an RN in context with the patient’s home context with the patient’s home medications and ICU meds. medications and ICU meds.
Potential discrepancies were brought to Potential discrepancies were brought to the attending of the ordering physician.the attending of the ordering physician.
Discharge orders for 31 of 33 patients Discharge orders for 31 of 33 patients (94%) were changed. (94%) were changed.
Pronovost P, et al. J Crit Care 18(4):201-205, 2003 Pronovost P, et al. J Crit Care 18(4):201-205, 2003
Transition of Care Transition of Care
Errors can occur when a patient’s care Errors can occur when a patient’s care is passed from one group to the nextis passed from one group to the next
Medication therapy may be Medication therapy may be inappropriately:inappropriately: ContinuedContinued OmittedOmitted ChangedChanged DuplicatedDuplicated
Medication ReconciliationMedication Reconciliation Reassessment of medication therapy as Reassessment of medication therapy as
a patient moves from one level of care a patient moves from one level of care to the next. When properly done will:to the next. When properly done will: Support continuity of careSupport continuity of care Help to avoid medication errorsHelp to avoid medication errors
JHH quality improvement priority for JHH quality improvement priority for FY06FY06
Documentation is mandated by JCAHODocumentation is mandated by JCAHO Effective Jan 1, 2006Effective Jan 1, 2006
Admission
Transfer Discharge
Admission
Transfer Discharge
Admission
Transfer Discharge
EclipsysSCC?
Admission
Transfer Discharge
EclipsysSCC?
ICUsIMCs
Adult OncNel-7
Admission
Transfer Discharge
EclipsysSCC?
YES
Admission
Transfer Discharge
RN enters “home” medications into Eclipsys
EclipsysSCC?
YES
Admission
Transfer Discharge
RN enters “home” medications into Eclipsys
EclipsysSCC?
YES
Home Meds
Rx medicationsRx medicationsSample medications Sample medications
Herbal remediesHerbal remediesVitaminsVitamins
NutriceuticalsNutriceuticalsOTC drugsOTC drugs
Admission
Transfer Discharge
RN enters “home” medications into Eclipsys
EclipsysSCC?
YES
Admission
Transfer Discharge
RN enters “home” medications into Eclipsys
Clerical Assoc. or RN Prints
Home Medication Reconciliation form
EclipsysSCC?
YES
Admission
Transfer Discharge
Enter “home” medications into Eclipsys
Print Home Medication
Reconciliationform
Eclipsys? YES
Admission
Transfer Discharge
RN enters “home” medications into Eclipsys
Clerical Assoc. or RN Prints
Home Medication
Reconciliation form Eclipsys
SCC?YES
Admission
Transfer Discharge
RN enters “home” medications into Eclipsys
Clerical Assoc. or RN Prints
Home Medication
Reconciliation form
Fill out Home Medication
Reconciliationform
EclipsysSCC?
YES
No
Admission
Transfer Discharge
Enter “home” medications into Eclipsys
Print Home Medication
Reconciliationform
Fill out Home Medication
Reconciliationform
EclipsysSCC?
No
Admission
Transfer Discharge
Enter “home” medications into Eclipsys
Print Home Medication
Reconciliationform
Fill out Home Medication
Reconciliationform
EclipsysSCC?
No
Initial Med ListEntered by:
PatientPt family member
NursePhysician
Pharmacistother
Admission
Transfer Discharge
Enter “home” medications into Eclipsys
Print Home Medication
Reconciliationform
Fill out Home Medication
Reconciliationform
EclipsysSCC?
No
Provides onelocation for thehome med list
Initial Screening FormH&P
“See home med reconciliation form”
Admission
Transfer Discharge
RN enters “home” medications into Eclipsys
Clerical Assoc. or RN Prints
Home Medication Reconciliation form
Fill out Home Medication
Reconciliationform
EclipsysSCC?
YES
No
Admission
Transfer Discharge
RN enters “home” medications into Eclipsys
Prescriber considershome med list when developing admission
orders
Clerical Assoc. or RN Prints
Home Medication Reconciliation form
Fill out Home Medication
Reconciliationform
EclipsysSCC?
YES
No
Admission
Transfer Discharge
RN enters “home” medications into Eclipsys
Prescriber considershome med list when developing admission
orders
Prescriber signs“Home” MedicationReconciliation form
Clerical Assoc. or RN Prints
Home Medication Reconciliation form
Fill out Home Medication
Reconciliationform
EclipsysSCC?
YES
No
Admission
Transfer Discharge
Enter “home” medications into Eclipsys
Prescriber considershome med list when developing admission
orders
Prescriber signs“Home” MedicationReconciliation form
Print Home Medication
Reconciliationform
Fill out Home Medication
Reconciliationform
EclipsysSCC?
YES
No
Admission
Transfer Discharge
Enter “home” medications into Eclipsys
Prescriber considershome med list when developing admission
orders
Prescriber signs“Home” MedicationReconciliation form
Print Home Medication
Reconciliationform
Fill out Home Medication
Reconciliationform
EclipsysSCC?
YES
No
Place form intochart behind
Med Administration tab
Admission
Transfer Discharge
Enter “home” medications into Eclipsys
Prescriber considershome med list when developing admission
orders
Prescriber signs“Home” MedicationReconciliation form
Print Home Medication
Reconciliationform
Fill out Home Medication
Reconciliationform
EclipsysSCC?
YES
No
Place form intochart behind
Med Administration tab
Admission
Transfer Discharge
Admission
Transfer Discharge
Admission
Transfer Discharge
Sending Unit
POEand/or
Eclipsys
Receiving Unit
Admission
Transfer Discharge
Clerical Assoc. or Nurse sends patient specificpatient specific
Transfer Reconciliation form
Sending Unit
POEand/or
Eclipsys
Receiving Unit
Admission
Transfer Discharge
Sending Unit
POEand/or
Eclipsys
Receiving Unit
Clerical Assoc. or Nurse sends patient specificpatient specific
Transfer Reconciliation form
Admission
Transfer Discharge
Clerical Assoc. or Nurse sends patient specificpatient specific
Transfer Reconciliation form
Sending Unit
POEand/or
Eclipsys
Receiving Unit
Admission
Transfer Discharge
Non-Eclipsysand
Non-POE
Clerical Assoc. or Nurse sends patient specificpatient specific
Transfer Reconciliation form
Sending Unit
POEand/or
Eclipsys
Receiving Unit
Admission
Transfer Discharge
Non-Eclipsysand
Non-POE
Clerical Assoc. or Nurse sends patient specificpatient specific
Transfer Reconciliation form
Sending Unit
POEand/or
Eclipsys
Clerical Assoc. or Nurse sends non-patient specificnon-patient specificTransfer Reconciliation form
Receiving Unit
Admission
Transfer Discharge
No-Eclipsysand
No-POE
Clerical Assoc. or Nurse sends patient specificpatient specific
Transfer Reconciliation form
Sending Unit
POEand/or
Eclipsys
Receiving Unit
Clerical Assoc. or Nurse sends non-patient specificnon-patient specificTransfer Reconciliation form
Admission
Transfer Discharge
No-Eclipsysand
No-POE
Clerical Assoc. or Nurse sends patient specificpatient specific
Transfer Reconciliation form
Sending Unit
POEand/or
Eclipsys
Clerical Assoc. or Nurse sends non-patient specificnon-patient specificTransfer Reconciliation form
Receiving Unit
Admission
Transfer Discharge
Prescriber considers
“Home” Med List and
Meds used just prior to transfer
When developing transfer orders
No-Eclipsysand
No-POE
Clerical Assoc. or Nurse sends patient specificpatient specific
Transfer Reconciliation form
Sending Unit
POEand/or
Eclipsys
Clerical Assoc. or Nurse sends non-patient specificnon-patient specificTransfer Reconciliation form
Receiving Unit
Admission
Transfer Discharge
Prescriber considers
“Home” Med List and
Meds used just prior to transfer
When developing transfer orders
No-Eclipsysand
No-POE
PrescriberSigns
Transfer Reconciliationform
Clerical Assoc. or Nurse sends patient specificpatient specific
Transfer Reconciliation form
Sending Unit
POEand/or
Eclipsys
Clerical Assoc. or Nurse sends non-patient specificnon-patient specificTransfer Reconciliation form
Receiving Unit
Admission
Transfer Discharge
PrescriberSigns
Transfer Reconciliationform
Clerical Assoc. or Nurse sends patient specificpatient specific
Transfer Reconciliation form
Sending Unit
POEand/or
Eclipsys
Receiving Unit
Admission
Transfer Discharge
PrescriberSigns
Transfer Reconciliationform
Clerical Assoc. or Nurse sends patient specificpatient specific
Transfer Reconciliation form
Sending Unit
POEand/or
Eclipsys
Receiving Unit
Admission
Transfer Discharge
Prescriber considers
“Home” Med List and
Meds used just prior to transfer
When developing transfer orders
No-Eclipsysand
No-POE
PrescriberSigns
Transfer Reconciliationform
Clerical Assoc. or Nurse sends patient specificpatient specific
Transfer Reconciliation form
Sending Unit
POEand/or
Eclipsys
Clerical Assoc. or Nurse sends non-patient specificnon-patient specificTransfer Reconciliation form
Receiving Unit
Admission
Transfer Discharge
Place form intochart behind
Med Administration tab
Prescriber considers
“Home” Med List and
Meds used just prior to transfer
When developing transfer orders
No-Eclipsysand
No-POE
PrescriberSigns
Transfer Reconciliationform
Clerical Assoc. or Nurse sends patient specificpatient specific
Transfer Reconciliation form
Sending Unit
POEand/or
Eclipsys
Clerical Assoc. or Nurse sends non-patient specificnon-patient specificTransfer Reconciliation form
Receiving Unit
Admission
Transfer Discharge
Place form intochart behind
Med Administration tab
Prescriber considers
“Home” Med List and
Meds used just prior to transfer
When developing transfer orders
No-Eclipsysand
No-POE
PrescriberSigns
Transfer Reconciliationform
Clerical Assoc. or Nurse sends patient specificpatient specific
Transfer Reconciliation form
Sending Unit
POEand/or
Eclipsys
Clerical Assoc. or Nurse sends non-patient specificnon-patient specificTransfer Reconciliation form
Receiving Unit
Admission
Transfer Discharge
Place form intochart behind
Med Administration tab
Prescriber considers
“Home” Med List and
Meds used just prior to discharge
When developing discharge orders
No-Eclipsysand
No-POE
PrescriberSigns
Transfer Reconciliationform
Clerical Assoc. or Nurse sends patient specificpatient specific
Transfer Reconciliation form
Sending Unit
POEand/or
Eclipsys
Clerical Assoc. or Nurse sends non-patient specificnon-patient specificTransfer Reconciliation form
Receiving Unit
Admission
Transfer Discharge
PrescriberSigns
Transfer Reconciliationform
Clerical Assoc. or Nurse sends patient specificpatient specific
Transfer Reconciliation form
Sending Unit
POEand/or
Eclipsys
Receiving Unit
Admission
Transfer Discharge
PrescriberSigns
Transfer Reconciliationform
Clerical Assoc. or Nurse sends patient specificpatient specific
Transfer Reconciliation form
Sending Unit
POEand/or
Eclipsys
Receiving Unit
Admission
Transfer Discharge
Place form intochart behind
Med Administration tab
Prescriber considers
“Home” Med List and
Meds used just prior to discharge
When developing discharge orders
No-Eclipsysand
No-POE
PrescriberSigns
Transfer Reconciliationform
Clerical Assoc. or Nurse sends patient specificpatient specific
Transfer Reconciliation form
Sending Unit
POEand/or
Eclipsys
Clerical Assoc. or Nurse sends non-patient specificnon-patient specificTransfer Reconciliation form
Receiving Unit
Medication ReconciliationMedication ReconciliationNext Steps Next Steps
Improve compliance with current Improve compliance with current systemsystem
Automate reconciliation processAutomate reconciliation process Improve reconciliation in outpatient Improve reconciliation in outpatient
sectorsector
