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Medication Reconciliation at a Psychiatric Hospital

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Medication Reconciliation at a Psychiatric Hospital

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    1. Medication Reconciliation at a Psychiatric Hospital Raymond Lorenz, PharmD Psychiatric Pharmacy Practice Resident Medical University of South Carolina Institute of Psychiatry and South Carolina College of Pharmacy April 26, 2007

    3. Background According to Joint Commission: “Accurately and completely reconcile patient medications across the continuum of care” Medication reconciliation (med rec) Prevent medication misadventures Decrease rates of adverse events Minimal literature of med rec in a psychiatric hospital

    4. Background Med rec at the Institute of Psychiatry Admitting practitioner completes medication history Pharmacist reviews medication history against medications ordered on inpatient profile Any discrepancies are discussed with patient’s treatment team Pharmacist documents med rec performed List can be updated

    5. Methods Med rec defined as: Matching the patient’s admission medications to their inpatient medication profile Coordination with outside facility Medication history, if needed Perform med rec on 300 charts in a 2 month period (Sept – Oct 2006)

    6. Methods Following data was collected: Patient demographics Number of medication histories completed by admitting practitioner Number of reconciliations performed by pharmacists Number of home medications Number and type of interventions made by pharmacists Omissions, commissions, clarifications Time for med rec to occur and length of time from admission to reconciliation

    9. Objectives What is our rate of compliance with the Joint Commission goal of medication reconciliation on admission? How long does it take to perform medication reconciliation at IOP? What are the most common interventions pharmacists are making?

    10. Results – Demographics Total of 316 reconciliations performed over 46.7 hours 49.4% of admissions (316/640) 52.8% within 24 hours 70% within 48 hours Gender, race, age indicative of patient population Diagnoses 48% mood disorders 20% psychotic disorders 14% childhood disorders 8% substance use disorders 9% other

    11. Results – Interventions

    12. Results – Interventions

    13. Results – Interventions Type of intervention 85% clarifications 14% omissions 1% commissions Medication history done by admitting team 99.97% compliance Medication history complete and accurate 76.3% compliance Documentation of continue on admission 69% compliance

    14. Limitations Did not collect data regarding disparate pharmacist coverage Time for medication reconciliation may be longer Lack of medication histories collected by pharmacists Did not reach 100% medication reconciliation rate Transfer and discharge aspects of medication reconciliation not assessed

    15. Conclusions About 50% of medication reconciliation was completed When pharmacists perform medication reconciliation, on average about one intervention is made per patient Interventions are clarifications to current therapy About 9 minutes per patient Admitting team should document if medications should be continued on admit More pharmacy staff is needed to meet the JCAHO goal of 100% medication reconciliation

    16. Acknowledgements Amy VandenBerg, PharmD, BCPP Shannon Drayton, PharmD, BCPP Elisabeth Mouw, PharmD Lizbeth Hansen, PharmD

    17. References 1. Joint Commission on Health Care Accreditation. National Patient Safety Goals. Accessed from: http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/06_npsg_facts.htm. Accessed on 7/28/06 2. Vira T, Colquhoun M, Etchells E. Reconcilable differences: correcting medication errors at hospital admission and discharge. Qual Saf Health Care 2006;15(2):122-6 3. Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepencies at the time of hospital admission. Arch Intern Med 2005;165(4):424-9 4. Tam VC, Knowles SR, Cornish PL, et al. Frequency, type, and clinical importance of medication histpry errors at admission to hospital: a systematic review. CMAJ 2005;173(5):510-5 5. Nickerson A, MacKinnon NJ, Roberts N, Saulnier L. Drug therapy problems, inconsistencies, and omissions identified during a medication reconciliation and seamless care services. Healthc. Q. 2005;8 Spec No:65-72 6. Rodehaver C, Fearing D. Medication reconciliation in acute care: ensuring an accurate drug regimen on admission and discharge. Jt Comm J Qual Saf 2005;31(7):406-13

    18. Questions?

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