WHY?

1. LinkingMedsCheck and Hospital Medication Reconciliation Improving Patient Safety Building the Community Pharmacy and Hospital PartnershipAlice Watt ISMP Canadaawatt@ismp-canada.org

2. WHY?

3. Computer Profile Discontinue

4. Linking MedRec to MedsCheck The Pilot

5. Overview of MedsCheck/Medication Reconciliation Pilot - 2008 To facilitate the linkage of the MedsCheck program in community pharmacies with the medication reconciliation process in hospitals across Ontario.

6. Pilot Objectives To Improve : • Communication of medication information • Continuity of care for the patient/client at transitions of care. • Accuracy of medication ordering • Efficiency by reducing re-work For elective surgical patients with pre-planned surgical admission to hospital and at discharge.

7. LINKING Med Rec to MedsCheck 5. Patient returns to community pharmacy for a MedsCheck Follow-up within 2 weeks of discharge • Patient asked to obtain a MedsCheck from community pharmacy 2 weeks prior to pre-admission appointment 2. Pre-admission Clinician uses MedsCheck to create medication history (BPMH) 4. Patient discharged from Hospital with a comprehensive medication discharge list and prescriptions 3. BPMH used to write medication orders at admission

8. Community PharmacistsRole • Book MedsCheck for pre-admission clinic patients when they ask or if contacted by the hospital • Perform MedsCheck using a systematic approach • Record all the medications the patient is actually taking. If it differs from the prescribed instructions then document the discrepancy in comments section. • Include all current prescription and over-the-counter medications. (aspirin, iron, potassium, eyedrops, creams, puffers) • Ask about medications dispensed from other pharmacies. • Perform MedsCheck Follow-up at Discharge from hospital within 2 weeks

9. Supports for Community “Enhancing MedsCheck” Presentation to help community pharmacists learn a systematic and standardized approach medication history taking that is accurate and reliable.

10. Innovations to accommodate requests for MedsCheck • Designated MedsCheck day each week - considered a viable business plan that pays for itself • SPEP Students - good educational experience • Scheduling daily time for MedsCheck • Accommodating patients who cannot get a MedsCheck from their own pharmacy • A ‘MedsCheck’ Pharmacist

11. Innovations - Performing MedsCheck Using a MedsCheck form that has special area for OTCs/Herbals Using a MedsCheck form in the same format as the hospital BPMH form for patients going to surgery. MedsCheck written in the patient’s native language

12. Pilot Results

13. Results – Quality of MedsCheck 113 MedsChecks collected 180 discrepancies were identified between the BPMH and the MedsCheck Average of 1.6 discrepancies per MedsCheck Average time to complete the BPMH was not reduced ~ 12 minutes Average of 8 prescriptions per patient Limitations to this pilot

14. Types of Discrepancies

15. Comments from Hospitals • The word “MedsCheck” should be on the profile • Printed computer medication profiles that include repeated/refill medications are confusing and time consuming for the health care professional and/or patient to read and interpret.

16. Comments from the hospitals • The variable quality of the MedsCheck makes it difficult for hospital staff to rely on them to create a BPMH

17. However……. • When the MedsCheck was complete, community pharmacies provided a lot of useful information to hospitals, especially when patients forget to bring in their medications.

18. Coordinating MedsCheck and Medication Reconciliation in Ontario will: Encourage hospital and community pharmacies to work more closely together to improve communication and patient care.