1 / 49

Medication Reconciliation

Medication Reconciliation. Johns Hopkins Hospital March 2006 Bob Feroli, PharmD, FASHP. Transition of Care . Patient’s previous home medications are not considered when writing discharge orders. Patient is discharged on Zocor ® (simvastatin).

vivek
Download Presentation

Medication Reconciliation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Medication Reconciliation Johns Hopkins Hospital March 2006 Bob Feroli, PharmD, FASHP

  2. Transition of Care Patient’s previous home medications are not considered when writing discharge orders. Patient is discharged on Zocor®(simvastatin). At home, patient starts Zocor® and continues to use previously prescribed Lipitor®(atorvastatin). Eleven days later, patient is admitted with severe rhabdomyolysis secondary to “statin” overdose.

  3. Transition of Care Patient with Parkinson's disease is admitted to an ICU for an acute episode unrelated to Parkinson’s disease. Initial care is focused on the acute episode and anti-Parkinson’s drugs are not used. Patient is transferred to general care unit, “Home” therapy is not considered and anti-Parkinson’s therapy is not started. Patient develops severe Parkinsonian symptoms.

  4. Transition of Care Discharge orders for 33 randomly selected ICU patients were reviewed by an RN in context with the patient’s home medications and ICU meds. Potential discrepancies were brought to the attending of the ordering physician. Discharge orders for 31 of 33 patients (94%) were changed. Pronovost P, et al. J Crit Care 18(4):201-205, 2003

  5. Transition of Care • Errors can occur when a patient’s care is passed from one group to the next • Medication therapy may be inappropriately: • Continued • Omitted • Changed • Duplicated

  6. Medication Reconciliation • Reassessment of medication therapy as a patient moves from one level of care to the next. When properly done will: • Support continuity of care • Help to avoid medication errors • JHH quality improvement priority for FY06 • Documentation is mandated by JCAHO • Effective Jan 1, 2006

  7. Admission Transfer Discharge

  8. Admission Transfer Discharge

  9. Admission Transfer Discharge Eclipsys SCC?

  10. Admission Transfer Discharge ICUs IMCs Adult Onc Nel-7 Eclipsys SCC?

  11. Admission Transfer Discharge Eclipsys SCC? YES

  12. Admission Transfer Discharge Eclipsys SCC? RN enters “home” medications into Eclipsys YES

  13. Admission Transfer Discharge Home Meds Rx medications Sample medications Herbal remedies Vitamins Nutriceuticals OTC drugs Eclipsys SCC? RN enters “home” medications into Eclipsys YES

  14. Admission Transfer Discharge Eclipsys SCC? RN enters “home” medications into Eclipsys YES

  15. Admission Transfer Discharge Eclipsys SCC? RN enters “home” medications into Eclipsys Clerical Assoc. or RN Prints Home Medication Reconciliation form YES

  16. Admission Transfer Discharge Eclipsys? Enter “home” medications into Eclipsys Print Home Medication Reconciliation form YES

  17. Admission Transfer Discharge Eclipsys SCC? RN enters “home” medications into Eclipsys Clerical Assoc. or RN Prints Home Medication Reconciliation form YES

  18. Admission Transfer Discharge Eclipsys SCC? RN enters “home” medications into Eclipsys Clerical Assoc. or RN Prints Home Medication Reconciliation form YES No Fill out Home Medication Reconciliation form

  19. Admission Transfer Discharge Eclipsys SCC? Enter “home” medications into Eclipsys Print Home Medication Reconciliation form No Fill out Home Medication Reconciliation form

  20. Admission Transfer Discharge Initial Med List Entered by: Patient Pt family member Nurse Physician Pharmacist other Eclipsys SCC? Enter “home” medications into Eclipsys Print Home Medication Reconciliation form No Fill out Home Medication Reconciliation form

  21. Admission Transfer Discharge Provides one location for the home med list Initial Screening Form H&P “See home med reconciliation form” Eclipsys SCC? Enter “home” medications into Eclipsys Print Home Medication Reconciliation form No Fill out Home Medication Reconciliation form

  22. Admission Transfer Discharge Eclipsys SCC? RN enters “home” medications into Eclipsys Clerical Assoc. or RN Prints Home Medication Reconciliation form YES No Fill out Home Medication Reconciliation form

  23. Admission Transfer Discharge Eclipsys SCC? RN enters “home” medications into Eclipsys Clerical Assoc. or RN Prints Home Medication Reconciliation form YES No Fill out Home Medication Reconciliation form Prescriber considers home med list when developing admission orders

  24. Admission Transfer Discharge Eclipsys SCC? RN enters “home” medications into Eclipsys Clerical Assoc. or RN Prints Home Medication Reconciliation form YES No Fill out Home Medication Reconciliation form Prescriber considers home med list when developing admission orders Prescriber signs “Home” Medication Reconciliation form

  25. Admission Transfer Discharge Eclipsys SCC? Enter “home” medications into Eclipsys Print Home Medication Reconciliation form YES No Fill out Home Medication Reconciliation form Prescriber considers home med list when developing admission orders Prescriber signs “Home” Medication Reconciliation form

  26. Admission Transfer Discharge Eclipsys SCC? Enter “home” medications into Eclipsys Print Home Medication Reconciliation form YES No Fill out Home Medication Reconciliation form Prescriber considers home med list when developing admission orders Prescriber signs “Home” Medication Reconciliation form Place form into chart behind Med Administration tab

  27. Admission Transfer Discharge Eclipsys SCC? Enter “home” medications into Eclipsys Print Home Medication Reconciliation form YES No Fill out Home Medication Reconciliation form Prescriber considers home med list when developing admission orders Prescriber signs “Home” Medication Reconciliation form Place form into chart behind Med Administration tab

  28. Admission Transfer Discharge

  29. Admission Transfer Discharge

  30. Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys

  31. Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form

  32. Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form

  33. Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form

  34. Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Non-Eclipsys and Non-POE

  35. Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Non-Eclipsys and Non-POE Clerical Assoc. or Nurse sends non-patient specific Transfer Reconciliation form

  36. Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form No-Eclipsys and No-POE Clerical Assoc. or Nurse sends non-patient specific Transfer Reconciliation form

  37. Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form No-Eclipsys and No-POE Clerical Assoc. or Nurse sends non-patient specific Transfer Reconciliation form

  38. Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Prescriber considers “Home” Med List and Meds used just prior to transfer When developing transfer orders No-Eclipsys and No-POE Clerical Assoc. or Nurse sends non-patient specific Transfer Reconciliation form

  39. Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Prescriber considers “Home” Med List and Meds used just prior to transfer When developing transfer orders Prescriber Signs Transfer Reconciliation form No-Eclipsys and No-POE Clerical Assoc. or Nurse sends non-patient specific Transfer Reconciliation form

  40. Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Prescriber Signs Transfer Reconciliation form

  41. Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Prescriber Signs Transfer Reconciliation form

  42. Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Prescriber considers “Home” Med List and Meds used just prior to transfer When developing transfer orders Prescriber Signs Transfer Reconciliation form No-Eclipsys and No-POE Clerical Assoc. or Nurse sends non-patient specific Transfer Reconciliation form

  43. Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Prescriber considers “Home” Med List and Meds used just prior to transfer When developing transfer orders Prescriber Signs Transfer Reconciliation form No-Eclipsys and No-POE Clerical Assoc. or Nurse sends non-patient specific Transfer Reconciliation form Place form into chart behind Med Administration tab

  44. Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Prescriber considers “Home” Med List and Meds used just prior to transfer When developing transfer orders Prescriber Signs Transfer Reconciliation form No-Eclipsys and No-POE Clerical Assoc. or Nurse sends non-patient specific Transfer Reconciliation form Place form into chart behind Med Administration tab

  45. Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Prescriber considers “Home” Med List and Meds used just prior to discharge When developing discharge orders Prescriber Signs Transfer Reconciliation form No-Eclipsys and No-POE Clerical Assoc. or Nurse sends non-patient specific Transfer Reconciliation form Place form into chart behind Med Administration tab

  46. Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Prescriber Signs Transfer Reconciliation form

  47. Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Prescriber Signs Transfer Reconciliation form

  48. Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Prescriber considers “Home” Med List and Meds used just prior to discharge When developing discharge orders Prescriber Signs Transfer Reconciliation form No-Eclipsys and No-POE Clerical Assoc. or Nurse sends non-patient specific Transfer Reconciliation form Place form into chart behind Med Administration tab

  49. Medication ReconciliationNext Steps • Improve compliance with current system • Automate reconciliation process • Improve reconciliation in outpatient sector

More Related