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Using Key Performance Indicators (KPIs) from Medication Reconciliation (MR) to Quantify and Prevent Future Adverse Drug Events (ADEs) Stephen Lim, TT Chih, E Fong Pharmacy, Armadale Health Service. Delivering a Healthy WA. Armadale Health Service (AHS). Overview:. Med Rec (MR) in AHS
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Using Key Performance Indicators (KPIs) from Medication Reconciliation (MR) to Quantify and Prevent Future Adverse Drug Events (ADEs)Stephen Lim, TT Chih, E FongPharmacy,Armadale Health Service Delivering a Healthy WA
Overview: • Med Rec (MR) in AHS • Aim and Method to quantify MR • Definition of: • Adverse Drug Events (ADEs) • Key Performance Indicators (KPIs) • Achievements of KPIs • Prevention of future ADEs • Lesson learnt
Med Rec (MR) in AHS Since 2007 SQuIRe funded project Marketed as Med Matching (M+M) program 70-90% M+M for all admitted patients Sustainable program Common errors in MR
Common Drug Errors in MR Exclude ADR documentation
Aims and Method to Quantify MR: Aims: To quantify success or failure in MR Use KPIs to or prevent ADEs Method: Daily data collection from MR activities Analyse data monthly using 4 KPIs
Definition of ADEs: (Adverse Drug Events ΞActual Drug Errors) • Potential Drug Errors: • MR < End of Next Calendar Day (ENCD) • near misses (rectified before drug admin) • Not counted as ADEs • Actual Drug Errors: • MR > ENCD • Counted as ADEs due to: • Med not admin (Rx omission) • Wrong drug/dose admin (incorrect Rx)
Case study (patient AO, 70y, ♀)ADE ΞAdverse Drug Events ΞActual Drug Errors
Definition of 4 KPIs: • KPI1 = ADEs per 1000 doses administered Number ADEs ÷ Number med doses admin (30 random patients/month) X 1000 • KPI2 = ADEs per 100 med written (Rx) Number ADEs ÷ total med written X 100 • KPI3 = Pharmacy Interventions per 100 patients Total pharmacist clinical interventions ÷ total MR patients X100 • KPI4 = ADEs per 100 patients seen >ENCD Number ADEs ÷ total MR patients X 100
ACHIEVEMENT : KPI1 ADEs per 1000 doses Average 4.7 ADEs per 1000 doses = 1 ADE per 200 doses • Trendline • ADEs
ACHIEVEMENT: KPI2 ADEs per 100 med Rx 17 drug errors for every 100 meds written 13 ADEs prevented due to MR 4 ADEs for every 100 meds written • Trendline • ADEs
ACHIEVEMENT: KPI3 Pharmacy Interventions per 100 patients 122 clinical interventions per 100 patients 64 MR activities per 100 patients Trendline MR
KPI4: ADEs per 100 admissions(Do Nothing KPI!) 83 ADEs per 100 patients (MR > ENCD) Flat trendline: Error when no MR
Prevent Future ADEs: • Goal: • ADEs to harm: • KPI1 • KPI2 • ↑ KPI3 • KPI4
Lesson learnt: • KPI1 and KPI2 (≠ 0 ADE): • timely Med Rec (within ENCD) • involve all clinicians in MR • ↑ KPI3: • 50% clinical pharmacist workload is MR related • KPI4 remains constant if no MR • 0.8 ADE per patient
Conclusion: • To ADEs: • Timely Med Rec within ENCD • Involve all clinicians in MR