The Impact of a Formalized Medication Reconciliation Process in the Emergency Department

1. The Impact of a Formalized Medication Reconciliation Process in the Emergency Department Hilary Rowe BSc(Pharm) VIHA Pharmacy Resident 2009-10

2. Question • Prompted by • Required Organization Practice (ROP) of Accreditation Canada • Recommendations of Safer Healthcare Now! • Determine potential impact of a medication reconciliation process at the Royal Jubilee Hospital Emergency Department (RJH ED)

3. Medication Reconciliation Documenting a complete and accurate list of home medications called a Best Possible Medication History (BPMH) Resolution of discrepancies between BPMH and home medication admission orders

4. Study Design • Prospective • Phase I- Baseline Study • Phase II- Pilot Study • Sample size calculation • 28 patients required to show a 75% decrease in discrepancies compared to baseline

5. Baseline Study Phase I • Primary Objective • Quantify home medication discrepancies without proactive reconciliation by 2400hrs one day post presentation to the ED • Secondary Objectives • Characterize the severity of home medication discrepancies (Drug Related Problems [DRP] and medications involved) • Determine if the discrepancies were undocumented intentional or unintentional

6. Inclusion Criteria • Patients admitted to RJH ED • Patient signed consent form • Required admission medication orders written in ED • Orders written in chart by 2400hrs one day post presentation to the ED

7. Exclusion Criteria Clinical Teaching Unit (CTU) patients Patients going directly to procedural locations Patients under 18 years old Patients in Psychiatric Emergency Services, who were violent or in isolation

8. Baseline Data Collection • BPMH-after admission orders • Asked about OTC & Rx therapy • Looked at medication bottles & lists • Checked PharmaNet • Talked to family as needed • Compared home medication admission orders to BPMH by 2400hrs one day post presentation to the ED • Documented discrepancies identified

9. Discrepancy Type 0= No discrepancy 1= Intentional discrepancy- physician made intentional choice to add, change or discontinue a medication and it was clearly documented 2=Undocumented intentional discrepancy- physician made intentional choice to add, change or discontinue a medication but it was not clearly documented 3=Unintentional discrepancy- physician added, changed or discontinued a medication unintentionally 4=OTC discrepancy (this type of discrepancy was added by the investigative pharmacists to describe natural health products and vitamins that were not prescribed)

10. Results Mean number of medications per patient=9.7

11. Pilot Study Phase II • Primary Objective • Quantify the change in discrepancies when comparing the number of baseline discrepancies to the number of discrepancies found after a medication reconciliation intervention • Secondary Objectives • Characterize the severity of home medication discrepancies (DRP’s and medications involved) • Determine if the discrepancies were undocumented intentional or unintentional

12. Pilot Study Data Collection • BPMH -within 24hrs of presentation • Same interview process as Baseline Study • BPMH left in chart • Clinical pharmacy note outlining discrepancies was left in chart • Compared home medication admission orders to BPMH by 2400hrs one day post Medication Reconciliation intervention • Documented discrepancies found

13. Results *64% decrease Mean number of medications per patient=8.23 Mean time required per patient = 32 min (15-65 min)

14. Thank You Come see my poster for more information…

15. Reference Safer Healthcare Now!. Medication reconciliation (acute care) getting started kit. [Internet]. Canadian Patient Safety Institute; [updated 2009 Jan 19; cited 2009 Nov]. Available from:http://www.saferhealthcarenow.ca/EN/Interventions/medrec_acute/Documents/Med%20Rec%20(Acute%20Care)%20Getting%20Started%20Kit.pdf