presentation on implementing medrec in non-inpatient settings
TRANSCRIPT
Medication Reconciliation Networking Session
Steve Rough, MS., RPh.Director of Pharmacy
University of Wisconsin Hospital and Clinics
Objectives
Provide a return on investment (ROI) framework for cost-justifying additional pharmacist resources for medication reconciliation
Review a strategy for implementing medication reconciliation in non-inpatient care areas (clinics, procedure areas, emergency department, etc)
ROI Framework
ROI Framework
ROI Framework
Approach for implementing medication reconciliation in
non-inpatient areas
Key stakeholders identified– Medical staff, pharmacists, nurses, and representation from
the OR, radiology, cath lab, medical records, quality, risk management, public affairs, and IT
Establishment of Medication Reconciliation Steering Committee– Charged with leading the implementation process– Pharmacy and Nurse Managers serve as co-chairs– Membership from each key stakeholder group
Resident major project
Step 1: Prepare
Step 1: Prepare
Charge of the Medication Reconciliation Steering Committee – Developing standardized medication reconciliation
processes and workflows– Developing training materials, tools and resources– Outlining specific accountabilities for staff training
and implementation– Develop auditing mechanisms to ensure
compliance and measure sustained compliance
Step 2: Assess the current system
Identify all impacted areas and the manager of each area (91 areas)
Gap analysis to determine levels of performance in clinics, procedure areas, emergency department– Identify all access points for patients within the
organization– For each element of performance, determine
areas where not fully compliant with standards
Essentially 100% non-compliance!
Example of Accountabilities
Step 3: Analyze
Meet with leaders/managers from four major areas– Clinics (2 nursing directors over all 80 clinics)– Procedure areas (Radiology, Cath Lab, Infusion
Center, Peds Sedation, GI, etc, etc)– Perioperative areas (Inpatient and ambulatory
surgery, recovery)– Emergency Department
Educate them on the required elements of NPSG 8a & 8b
Step 3: Analyze
Workflows documented for each area to fit with patient flow– Four workflows established:
• Paper• Traditional electronic medical record (WISCR/ADS)• Health Link (Epic) – new electronic health record• Transplant database
Example of workflow diagram
Workflow for WISCR/ADS Clinics
Dis
char
ge P
lann
erM
DM
A or
Aut
horiz
ed P
erso
nnel
Patie
nt
DP prints medication list with
changes and provides to patient
MD gives visit data form to patient to
take to Disch. Planner
Print a master problem list and visit data sheet
Patient stops at discharge planner
desk
MD documents changes on visit data form and
writes new prescriptions
DP transcribes changes into ADS
Medication changes?
Patient education on medication
changes
Patient arrives in clinic
Patient leaves clinic
Verifies patient allergies
NoMA takes patient to exam room
Yes MD conducts patient visit
Allergy changes?
MA notifies MD that patient is ready for visit
Medication changes?
MA opens ADS in the exam room and completes
standard question list
DP obtains visit data form and
reviews changes to medication list
No
Yes
MD reviews patient medication list and problem
list
Visit Data Form is returned for filing
in the Medical Record
MA verifies current medication list with
patient
Updates patient allergies in ADS
Patient schedules appointment and is given
reminder to bring in medication list
No
MA updates ADS med list
Yes
DP schedules return appt or diagnostics &
gives medication list to patient
Step 4: Plan
Identify responsible person for implementation in each clinic site– Documentation of medication history,
reconciliation, updates, providing list to patient and next provider of care
Quantify resources needed by area– Computers– Access to information– Education– Personnel
Step 4: Plan
Develop education materials– Include the case for medication reconciliation- it’s
the right thing to do for our patients!– Steps for obtaining a complete medication list
• Include name, dose, route, frequency, last dose taken, indication
– How to perform reconciliation– Policy expectations
• documentation of history and allergies on every patient• providing every patient with discharge medication list• send list to next provider if medication changes
Step 4: Plan
Development of documentation tools– Paper documentation form for areas without
electronic documentation – Modifications to electronic tools already available
to include patient friendly terms, easier to read information
• provider-entered information prints out in patient-friendly format
Example of Paper Documentation
Step 4: Plan
Development of auditing tools that are sustainable– Include questions on all five elements of
performance on Joint Commission tracer• History documented• Reconciliation• Clarification of discrepancies• List to patient• List to next provider of care
Step 5 & 6: Execute and Measure
Educational road shows and web casts for managers and front line staff
Rolling implementation, not pilots– Start with high risk area: ED, Radiology, Cath lab, surgery
clinics
Pharmacy resident and students audit compliance for 6 months
Implement changes and improvements on the fly as needed
Step 7&8: Communicate & Replicate
Communicate audit results to key stakeholders
Big bang go-live in all remaining areas over 2 month timeframe
Poster showcase for Joint Commission surveyors
Optimize processes in Health Link
Tools Available on ASHP Website
Policy and Procedure Workflows Forms Training materials ROI spreadsheet
http://www.ashp.org/s_ashp/cat1c.asp?CID=489&DID=7607
Questions