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Exploring the Roles in Medication Management Provider, Nurse, Pharmacist and Patient. Salahuddin Kazi, MD Eric Spahn, Pharm D Tammy Rosenberger BSN, RN Michael Bingham, CPhT. The Role of Nurses in Medication Management. Tammy Rosenberger BSN, RN. Nursing’s role.

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exploring the roles in medication management provider nurse pharmacist and patient

Exploring the Roles in Medication ManagementProvider, Nurse, Pharmacist and Patient

Salahuddin Kazi, MD Eric Spahn, Pharm D

Tammy Rosenberger BSN, RN Michael Bingham, CPhT

nursing s role
Nursing’s role
  • Nurses have played a major role in patient safety for years.
    • Florence Nightingale
    • Clara Barton
    • Linda Richards
nursing and medication safety
Nursing and medication safety
  • Nurses have the opportunity to keep the patient safe from harm when it comes to their medication.
    • Before the pt is seen by the provider, during prevention and completion of clinical reminders, ask if there are any additions or changes in medication
      • If the pt has reminders re: chronic disease, this can alert the nurse to discuss current medications for these conditions.
      • Include asking about non-va meds (herbals, OTC, prescribed meds by other providers outside the VA system)
        • Nurses have the ability to enter and remove them.
      • Can also document changes on check in sheet to alert provider.
    • When a patient is calling for changes or new meds from outside provider.
    • Discharge f/u calls
    • Seeing patient after visit to offer education
nursing and medication safety1
Nursing and medication safety

Is the pt taking b/p meds; when was last dose; taking regularly;

nursing and medication safety2
Nursing and medication safety
  • BCMA – Bar Code Medication Administration
    • Idea of Sue Kinnick, RN -1994 –Eastern Kansas Health Care System
nursing and medication safety3
Nursing and medication safety
  • Case manager – 1200 patients
  • PACT model: High risk registry
  • Visit includes medication reconciliation
    • Med list
      • Active meds, any non va meds,
      • Encourage patient to bring in prescription bottles
      • Alert provider to discrepancies
    • Allergies
      • Review and document, alert provider
upcoming med safety project
Upcoming Med safety project
  • Pilot project at Pittsburgh
    • Medication review will be available for the pt on the Kiosks.
      • Pictures of the pills will be shown, pt will be able to choice which pill they have if manufactures are changed
      • Staff will be available to assist patients with this process.

Improves the process for patients to be better prepared to see their provider.

the physician visit
The Physician Visit
  • Embed medication reconciliation within the workflow of the visit and NOT as a separate process
    • Discuss medications as part of disease management
  • View remote meds
  • Review Allergies
  • Review pharmacist flags
  • Confirm indications, strength and indications
  • Review interactions
  • Assess appropriateness of therapy
  • Educate the patient and provide a written list of medications
after visit summary
After Visit Summary

http://ixblog.wordpress.com/ix-reports/the-after-visit-summary-avs/

after visit summary1
After Visit Summary

LOCAL TITLE: RHEUMATOLOGY AFTERVISIT SUMMARY

STANDARD TITLE: MEDICATION MGT NOTE

DATE OF NOTE: APR 25, 2012@09:07 ENTRY DATE: APR 25, 2012@09:07:53

AUTHOR: Provider #1 EXP COSIGNER:

URGENCY: STATUS: COMPLETED

***CLINIC AFTERVISIT SUMMARY***

XXXXXXXXXXXXXXXX DOB: XXXXXXXXXXX

APR 25, 2012

Thank you for allowing us to participate in your healthcare. Please

review and retain this document. It may contain additional information or

instructions from your care provider.

________________________________________________________________________

Today your provider was: Provider #1

Primary Care Team: Blue Team #1

Primary Care Doctor: Provider A

after visit summary2
After Visit Summary

Future Appointments:

5/5/12 11:30 am GI LAB SATURDAY 5TH FLOO ext.71590

5/7/12 1:00 pm DIABETES INTRODUCTION ext.74270

7/9/12 1:00 pm XLAB CLINIC-X ext.70678

7/9/12 3:00 pm DALLAS PC CL10 ext.78914

Labs that were ordered today: No pending labs.

Imaging studies that were ordered today: NO recent pending Radiology

found.

Consults or procedures that were ordered today:

NO recent pending Consults found.

after visit summary3
After Visit Summary

Your vitals for today are:

Blood Pressure - 140/66 (04/25/2012 08:25)

Weight - 254 lb [115.5 kg] (04/25/2012 08:25)

Pain Level - 5 (04/25/2012 08:25)

Allergies:

Patient has answered NKA

after visit summary4
After Visit Summary

These are the MEDICATIONS we show you should continue taking:

Active Medications

============================================================

1) Acetaminophen 500Mg Tab

Take one tablet by mouth twice a day as needed for pain.

Maximum of 3000mg of acetaminophen per day from all sources

2) Allopurinol 100Mg Tab

Take one tablet by mouth every day for gout

3) Gemfibrozil 600Mg Tab

Take one-half tablet by mouth twice a day for cholesterol

4) Magnesium Citrate 300Ml Bt

Take 2 bottles by mouth once drink 2 bottles as directed

By gi lab instructions.

5) Polyethylene Glycol,(golyte/colyte) 4L

Take 4 liters (1 bottle) by mouth once

6) Prednisone 20Mg Tab

Take one tablet by mouth every day for inflammation

You have 6 active medications

______________________________________________________________________

Your provider has NOT prescribed any new medications today.

_______________________________________________________________________

These are DISCONTINUED medications that you should NO LONGER TAKE:

Indomethacin 25Mg Cap

Take Two Capsules By Mouth Three Times A Day For Pain

after visit summary5
After Visit Summary

Additional provider instructions: If you get a gout flare, please call

clinic.

a. Please give a list of these medications to each provider you see.

b. You can use this list of medications to update the information

when any of these medications are discontinued, doses are changed,

or new medications (including over the counter products, herbals

and supplements) are added.

c. Please carry medication information at all times in the event of

emergency situations.

_______________________________________________________________________

If you have any questions, please notify an assistant before you leave.

If you have questions or concerns after today, please contact the clinic.

Please leave a message for the rheumatology nurse at 1-800-849-3597

extension 72105. Your call will be returned in 1 business day.

For medication refills please call 1-800-849-3597 extension 79000.

After hours and weekends: Registered nurses are available 24 hours, 7 days

a week and on holidays to answer medical advice questions by calling

800-677-8289.

/es/ Provider #1, RN, MSN, FNP-c

RHEUMATOLOGY NP

Signed: 04/25/2012 09:09

access to care
Access to Care

“Pharmacists are the most accessible health care professionals in the United States and have always been one of the most trusted professions.”

-2011 USPHS Report to USSG

part of a team
Part of a Team

COMMUNICATION

slide33

Part of Our Job

  • Interpretation and verification of physician’s orders, patient medication profile review (allergy, drug interaction screens, etc.) providing drug and policy information to patients and medical center staff.
  • Direct and Indirect patient care, drug therapy monitoring, formulary management, staff education, prescription inputting, patient counseling, and cost containment
  • Recommend, implement, monitor, and modify patient-specific pharmacotherapy in collaboration with patients and other health care professionals to optimize drug therapy.
  • Notification of safety and drug alerts (CMOP delays, shortages, recalls, etc.) to patients and providers
  • Assignment to specific clinical areas including discharge pharmacy, anticoagulation, geriatric medicine, home-based primary care, antibiotic stewardship, behavioral medicine, and other clinical areas.
questions
Questions?
  • Use the Q&A on Live Meeting to ask Questions

OR

Email: Rosemary.Grealish@VA.gov