1

Marie BarnicoatBradley FigginsAli Gortemoller

UF Health 2015 APPE Block Students

Transitions in Care:April 2015 Results

2Overview Data collection methods Adult ED Data Pediatric ED Data Suggestions for Improvement

3Data Collection Who: ED patients planned for admission What: Medication Reconciliation When: 3/30/15 - 4/21/15 (23 days) Where: Adult and Pediatric EDs

4Adult ED Data

Total Number of Interviews Completed: 175 patients

Percentage of Patients with a PTA Error: 85.7%

Total PTA Errors Identified: 686 errors

Average number of PTA errors per patient: 3.97 errors/pt

Average Time Spent per Med Rec: 27 minutes

5Adult PTA Medication List Errors

42%

34%

11%

9%

2%1%0%

Patient no longer taking

Omissions

Wrong Dose

Wrong Frequency

Therapeutic Duplications

Wrong Route

Other

6Pediatric ED Data

Total Number of Interviews Completed: 62 patients

Percentage of Patients with a PTA Error: 70.91%Total PTA Errors Identified: 114 errorsAverage number of PTA errors per patient: 1.74 errors

Average Time Spent per Med Rec: 18 minutes

7Pediatric PTA Medication List Errors

34%

27%

21%

12%

3% 3%

OmissionsPatient no longer takingWrong DoseWrong frequencyTherapeutic DuplicationsWrong RouteOther

8Core Measures 115 opportunities identified

107 VTE prophylaxis (93%) 2 VTE treatment (1.7%) 5 HF (4.3%) 1 AMI (1.0%)

9Good Catch (1) MA 66 y/o Female

CC: Back pain

PMH: HTN, PVD, Hep C, Breast Cancer, Recurrent DVT

PTA Medications: Warfarin 10mg tab. Take one tab po 5x weekly (Tuesday, Wednesday, Thursday,

Saturday, Sunday) Warfarin 15mg tab. Take one tab po 2x weekly (Monday and Friday)

Corrections: Warfarin 10mg tab. Take one tab po 5x weekly (Tuesday, Wednesday,

Thursday, Saturday, Sunday) Warfarin 5mg tab. Take one tab po 2x weekly (Monday and Friday)

10Good Catch (2)IM 78 y/o AAF

CC: vaginal bleeding

PMH: dementia, HTN, DMII, obesity, prior CVA, aphagia

Modified Divalproex DR 500 mg tablet ordered

Divalproex DR 250 mg tablet

Added Duloxetine ER 30 mg tablet: 1 tab PO every morning Cilostazol 100 mg tablet: 1 tab PO BID Ferrex 150 mg capsule: 1 cap daily Tramadol 50 mg tablet: 1 tab PO BID Multivitamin: 1 tab PO daily

11Good Catch (3) LC & CC, 4 month-old twins

CC: Wheezing, increasing home O2 demands (Dx of bronchiolitis)

PMH: Prematurity at 30 wks gestation, pulmonary HTN, O2 and G-tube dependence, ASDs, MBD, hypercarbia 2/2 chronic hypoventilation

PTA Medications: Sildenafil oral liquid 30 mg (10 mg/mL x 3 mL) via G-tube q6h Acetazolamide oral liquid (compounded) 62.5 mg (50 mg/mL x 1.25 mL) via G-tube Furosemide oral solution 12 mg (10 mg/mL x 1.2 mL) daily via G-tube Albuterol 0.083% nebulizer q6h prn

Modification:Acetazolamide oral liquid: concentration reported by mother as 50

mg/mL; was actually 30 mg/mL (37.5 mg)

12Suggestions for Improvement Standardization of documentation

Peds vs. Adults Discontinuation vs. Comments sections

Peds ED Later shift? Peds-specific progress note template Peds med rec example

AOD Recommendations More frequent “check-ins” Verifying correct home meds

13Suggestions for Improvement (2) Potential areas for expansion

Elective day surgery pts

Refresher email for ED personnel

Opportunities for enhanced student learning Topic discussions for common ED CCs

e.g., SOB, chest pain, sickle cell pain crisis…

14Acknowledgements Kyle Koenig, Pharm.D., BCPS Stacey Moultrie, Pharm.D. Yan Zhang, Pharm.D. Alex Ebied, Pharm.D.