medication reconciliation: partnering with the community what worked, what didn’t ! october 2010...
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Medication Reconciliation:Partnering with the Community
What worked, what didn’t !October 2010
Ann Nickerson BSc (Pharm)Susan Crawford RN
Extra Mural Driscoll UnitMoncton New Brunswick [email protected]@horizonnb.ca
Acknowledgement
Thanks to the other Extramural Driscoll Medication Reconciliation
Team members:
Cheryl Leger, RNJoan Peddle, RN,BN;
Maura Dalton, RN, BScN; Linda Price, RN,BScN;
Margaret Meier RN,BScN
SELF ASSESMENT QUESTIONS
What are the critical steps and questions in the process of medication reconciliation and taking of the best possible medication history (BPMH)?
What key transition areas in my practice setting are problem-prone points in our medication management system?
THE RIGHT TIME
Transition PointsAdmissionTransfer to another setting, service provider or level of care within or outside the hospital settingDischarge to the community
Over half of all hospital medication errors occur at interfaces of care
Rozich, Resar (2001) J Clin Outcomes Manage.
THE RIGHT STAKEHOLDERS
“ Medication reconciliation is a shared responsibility. Communication between the various levels of care/service is vital to accurate medication reconciliation.” CCHA
Suggest: include a hospital pharmacist, a physician and home care RNS &/or those who take the medication historiesCommunity pharmacist, physicians and nurses from various levels of service in the community and hospital and risk manager
THE RIGHT STAKEHOLDERS
FORM THE TEAM-
Become champions for the patient! Result : The safety benefit of an
accurate medication history
It’s so much more than a list
Medication History“Medication-history taking is a skill” NOT a technical responsibility
Aug.1.2005 AJHP News
Remind yourself
“It’s NOT just a list”
Med Reconciliation at the time of admission is ideal.The longer you wait, may delay someone from preventing a medication error.
“I take a small white pill and a large blue pill”
Converse with patient’s community pharmacist, family member, hospital
discharge nurse and most importantly
THE PATIENT
Important Questions
PROMPT the patient to remember patches, creams, eye drops, inhalers, physician samples, shots, herbal, vitamins, minerals
Regularly used OTC products
Allergy VS side effects: Describe the reaction.
Have patients describe how and when they take their medications
Information from the patient
This is the key to a good medication history!
Dangerous practice to record a history JUST from the directions on the medication bottle or print out from the community pharmacy.
The medication history should be “as stated by the patient.” It is from here we can make modifications and actually uncover reasons for admission
E.g.. Patient taking 10mg of paroxetine(Paxil) because 20mg caused diarrhea, shakiness, unsteady on her feet. Label reads 20mg.
Improvement Model
What are we trying to accomplish?
How will we know that
change is an improvement?
What changes can we make that
will result in improvement?
Plan
Do
Act
Study
The Form - Documentation
Customization! Standardization!
Have only ONE area where a patient’s medication history can be recorded
Adopt the medication Reconciliation form as the admitting order for the patient’s home meds
Am.J.Nurs.Vol 105(3) supplement March 2005.31-36
On Action:
“There are costs and risks to a program of action, but they are far less than the long-range risks and costs of
comfortable inaction”
John F. Kennedy (1917-1963)
35th U.S. President