Medication Reconciliation MUSE 2006

1. Medication ReconciliationMUSE 2006 Markham Stouffville Hospital Alice Watt, B.Sc.Pharm 2006

2. A I M • Med Rec - What is it? • The Journey • Toolbox • Admissions • Transfers • Discharge • Reports • Lessons Learned

3. What is it? Medication Reconciliation • Process of : • Getting the Best Possible Med History • Using the BPMH to write admission orders • Identifying and reconciling discrepancies with the physician

4. Important for our patients because… • Saves lives - medication errors and adverse drug events.

5. The Journey Implementation in ER, 3E, ICU 2002 2003 2004 2005 2006 Hospital-wide implementation Getting Started Data collection Pilot project Paper Record Electronic record

6. Toolbox

7. Admissions

8. Medication Profile– Paper Record 

9. Process Interventions

10. Patient Name Synthroid 0.1 mg PO daily Metformin 500mg PO TID Medication History Synthroid 0.1mg po daily Metformin 500mg po tidcc ECASA 81 mg po daily

11. Medication Reconciliation Screen Pre-set options Patient Name Patient interview DPV Pill’s Pharmacy – (416) 333 - 9999 Synthroid 0.1mg PO DAILY N Metformin 500mg PO TIDCC U Y Called MD Order Changed EC ASA 81mgPO daily Y D Not Necessary

12. Patient Assessment Patient Name Counsel patient at discharge concerning new BP meds Speaks no english – Family to be present to help translate

13. Visual FlowSheet - Reconciliation

14. Pre-op Medication Report

15. Medication Reconciliation Record and Doctor’s order

16. Transfers

17. Transfers • Medication orders are compared by physician at transfer points. • ICU Medicine • Surgery/Short Stay Rehab

18. Transfer Order Sheet

19. Warfarin Monitoring

20. Warfarin Monitoring - VFS

21. Discharge

22. Discharge • Admission Medication reconciliation helps at discharge • Work in progress • PDRx

23. Discharge Medication List DOCTOR: LOCATION: PATIENT:

24. Reports

25. Reports • Monthly report for Safer Healthcare now • Run by date • Categories include : • Type of variances • # of medications reconciled • # of patients reconciled by ID number • Time to reconcile vs. time of admission • Time to reconcile each patient

26. Lessons Learned… • Trial and Error • Task Force • It’s a Team effort

27. Questions