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Medication Reconciliation in Continuing Care

Medication Reconciliation in Continuing Care. Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric Medicine Specialist Cape Breton District Health Authority. Outline. Understand why Medication Reconciliation

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Medication Reconciliation in Continuing Care

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  1. Medication Reconciliation in Continuing Care Getting It Right Together Creating a Culture of Safety September 8, 2008 Dr. Paula Creighton MD, FRCP(C) Geriatric Medicine Specialist Cape Breton District Health Authority

  2. Outline Understand why Medication Reconciliation is getting so much attention through: • Understanding how adverse drug events (ADEs) commonly occur • Identify practical steps that can reduce the risk of ADEs in practice • Identify key features of a safer system Dr. Paula Creighton

  3. Dr. Paula Creighton

  4. Dr. Paula Creighton

  5. Definition Adverse Event • UNINTENDED act or event during care • May result in potential harm • Harm = increase length of stay = temporary/permanent disability = death Dr. Paula Creighton

  6. Dr. Paula Creighton

  7. How ADEs occur? • Increase range of medicines to treat or prevent disease • Multiple co-morbid conditions • Age-related changes physiology Tsilimingras, Rosen, &. Berlowitz 2003. Canadian Patient Safety (CPSI) Institute 2006 Dr. Paula Creighton

  8. How ADEs occur? • Multiple health care practitioners • Frequent visit to hospital setting (hospitalization, procedures, tests) • Adherence problems Tsilimingras, Rosen, &. Berlowitz 2003. Canadian Patient Safety (CPSI) Institute 2006 Dr. Paula Creighton

  9. How ADEs occur? • OTC medication use • Impaired vision, dexterity, literacy Tsilimingras, Rosen, &. Berlowitz 2003. Canadian Patient Safety (CPSI) Institute 2006 Dr. Paula Creighton

  10. When ADEs occur? • Entry and exit points of clinical encounters Cornish P. et al Arch Intern Med 2005:165; 424-429 Dr. Paula Creighton

  11. Traditional Medication History • Labels • Lists • Verbal (open ended inquiry) • Someone else has/will complete Dr. Paula Creighton

  12. Limitations toTraditional Medication History Discrepancies: • Unintentional • Undocumented Intentional Dr. Paula Creighton

  13. Unintentional Discrepancies • Over-the-counter medications • Shared prescriptions • Labels “as directed” • Prescription change without script • Samples Dr. Paula Creighton

  14. Undocumented Intentional Discrepancies • What changed and why? • Convey a clear understanding of desired outcomes to therapy. • Written communication with patient/family and pharmacist Dr. Paula Creighton

  15. Get Involved safer healthcare Now! Dr. Paula Creighton

  16. Key Features toward a Safer System Change Dr. Paula Creighton

  17. Key for a Safer System • Doing our jobs differently… …If you always do what you have always done; You always will get what you always got Dr. Paula Creighton

  18. Practical steps to reduce risk of ADEs • “To prescribe according to best evidence from scientific research and to be mindful of the precepts of patient autonomy” Holland R, Wright D. Medication Review for Older Adults. Geriatrics and Aging March 2006, Vol 9. No.3. Dr. Paula Creighton

  19. Practical steps to reduce risk of ADEs • When might it be best to withhold or discontinue medications that are otherwise appropriate on the basis of guidelines? Dr. Paula Creighton

  20. Practical steps to reduce risk of ADEs • Consider life expectancy • Goals of care and quality of life defined by patient/family • Potential benefit & risk of medications Dr. Paula Creighton

  21. Practical steps to reduce risk of ADEs Start low, Go slow, Or don’t start at all! Dr. Paula Creighton

  22. Practical steps to reduce risk of ADEs Partnering with Patients “Nothing about me, without me” (author unknown) Dr. Paula Creighton

  23. Medication Reconciliation Partnering with Patients • patient/family interview Dr. Paula Creighton

  24. Practical steps to reduce risk of ADEs • Humans require formal cues/processes to stay on track reliably • Reliable work processes account for the known imperfections of humans Adapted from PSO Training Course (IHI) 2004 Dr. Paula Creighton

  25. Medication Reconciliation MEDICATION RECONCILIATION: include on list below Over the counter products, Samples, Shared pills Dr. Paula Creighton

  26. Threats for Change toward a Safer System • Power Gradient • Fear • (Mis)-Perception “touchy, feely” initiatives Dr. Paula Creighton

  27. Key for Change toward a Safer System Self audit: • More mirrors and fewer windows Dr. Paula Creighton

  28. Self Audit • "One of the major impediments to convincing people of the prevalence and seriousness of cognitive error is the faith they have in their own thinking abilities" Croskerry, P. The Science of Human Factors in Healthcare, QHN, October 2003 Dr. Paula Creighton

  29. Key for Change toward a Safer System “ Many little people Doing many little things In many little places Can change the world.” (Chinese Proverb; author unknown) Susan Sheridan, Chair, Patients for Patient Safety Strand, WHO World Alliance for Patient Safety; Co-Founder, Consumers Advancing Patient Safety, Eagle, Idaho Dr. Paula Creighton

  30. Get Involved safer healthcare Now! Dr. Paula Creighton

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