Acute Care Med Rec Connection Call

1. Acute Care Med Rec Connection Call August 19th Webex

2. Agenda • Review article and discuss strategies for application of learning • Round table discussion/question list

3. Article Jennifer R. Pippins, Tejal K. Gandhi et al, Classifying and Predicting Errors of Inpatient Medication Reconciliation, Journal of General Internal Medicine, Springer New York, Vol. 23, No. 9, 1414-1422, September 2008. Objective: To determine the reasons, timing and predictors of potentially harmful medication discrepancies Design: Prospective observational study Patients: Brigham and Women’s Hospital admitted general medical patients Measurements: Study pharmacists took gold-standard medication histories and compared them with medical team’s medication histories, admission and discharge orders. Blinded teams of physicians adjudicated on all unexplained discrepancies

4. Results : • Among 180 patients, 2066 medication discrepancies were identified, and 257 (12%) were unintentional and had potential for harm (1.4 per patient). • Of these, 186 (72%) were due to errors taking the preadmission medication history, while 68 (26%) were due to errors reconciling the medication history with discharge orders. • Most PADEs occurred at discharge (75%). • In multivariable analyses, low patient understanding of preadmission medications, number of medication changes from preadmission to discharge, and medication history taken by an intern were associated with PADEs. Conclusions : Unintentional medication discrepancies are common and more often due to errors taking an accurate medication history than errors reconciling this history with patient orders. Focusing on accurate medication histories, on potential medication errors at discharge, and on identifying high-risk patients for more intensive interventions may improve medication safety during and after hospitalization. Journal Link: • http://psnet.ahrq.gov/resource.aspx?resourceID=7896&sourceID=1&emailID=8405

5. How can we apply these results? • Training for medication history taking • Get it right at admission reliably • Do you have a check system to determine if BPMH’s are gold standard? • Develop ways to illicit all medications. • Incorporate strategies for low literacy patients • Make medication changes visible throughout various transitions

6. Discussion Poll Share comments, Your experience with BPMH training

7. Learning from Canadian Teams • Addendum History Form (used for medications left off BPMH) • Redundancy provision to ensure all medications are captured on BPMH https://communities.saferhealthcarenow.ca/medrec?go=1514513 Create secondary ways to capture missed meds

8. Learning from Canadian Teams • Patient Home Medication Record - Includes Admission, Transfer and Discharge • Ensure medications visible in one place for all transitions https://communities.saferhealthcarenow.ca/medrec?go=1422706 Visible medication changes throughout transitions

9. Learning from Canadian Teams https://communities.saferhealthcarenow.ca/medrec?go=z1110065 Create tools for patients

10. Learning from Canadian Teams • Orientation checklist for training • Use Pharmacy Techs for obtaining BPMH • Use DVD training videos • Use prompts for different questions on BPMH forms https://communities.saferhealthcarenow.ca/medrec?go=1680807 Standardize training

11. Learning from Canadian Teams VIHA Picture tool with tipshttps://communities.saferhealthcarenow.ca/medrec?go=1829493 Use of pictures for low literacy Reminders & tips for improved BPMH

12. Round Table Your questions & comments