august 19 th webex. review article and discuss strategies for application of learning round table...
TRANSCRIPT
Review article and discuss strategies for application of learning
Round table discussion/question list
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
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=8
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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
https://communities.saferhealthcarenow.ca/medrec?go=1514513
Create secondary ways to capture missed meds
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=1422706
Visible medication changes throughout transitions
Patient Home Medication Record - Includes Admission, Transfer and Discharge
Ensure medications visible in one place for all transitions
https://communities.saferhealthcarenow.ca/medrec?go=1680807
Standardize training
Orientation checklist for training
Use Pharmacy Techs for obtaining BPMH
Use DVD training videos
Use prompts for different questions on BPMH forms
VIHA Picture tool with tips https://communities.saferhealthcarenow.ca/medrec?go=1829493
Use of pictures for low literacyReminders & tips for improved BPMH