Strategies for Medication Nomenclature Standardization at Multi-Organ Transplant Program

1. Dr. Helen Chen1, Kevin Quach1,2, Dr. Ian MacKillop1, Dr. Joseph Kim2 1 University of Waterloo 2 University Health Network Strategies for Medication Nomenclature Standardization at Multi-Organ Transplant Program

2. Faculty/Presenter Disclosure • Faculty: Dr. Helen Chen, PhD • Relationships with commercial interests: • None

3. Outline • Challenges of patient drug management in transplantation • Drug standardization strategies • Lessons learned and continuous discovery

4. Challenges

5. Five Rights for Drug Administration Practices • Standard for safe medication practices • Five rights: Patient, drug, time, dose, and route • Patient safety • Incomplete information about patient’s medications • Knowledge deficit leading to administration of wrong dose or use of wrong route • Serious drug interaction unknown or overlooked Source: Medication Errors, Cohen, 2006

6. Challenges in Organ Transplant Programs • Need to precisely manage patient medications in the continuum of care • Lack of standard drug nomenclature • Lack of information management process • Interoperability of multiple drug information systems • Fast evolving of drug products and variations of nomenclature

7. Desired State

8. Methodology/Approach • Recognized and took action to resolve a medication information problem • Established a working committee (physicians, nurses, pharmacists, IT specialists, IT admin) • Consulted with standardized drug databases (e.g. Health Canada, SNOMED, RxNorm) • Established medication standardization strategies • Developed a data governance policy for future maintenance of drug database

9. Drug Standardization Strategies

10. Standardization Strategies

11. Mapping drug name with drug formula and strength Solution Drug formula and dosage information will be retained in separate tables from medication name

12. Distinguishing between brand name and generic name medications Solution • Merging brand name information to the corresponding generic name

13. Correcting Combination Drug Nomenclature Other problems Specifying doses of each drug ingredient in combination drugs Solution Using a dash (-) to separate drug ingredients in combination medications

14. Limited Use (LU) Medications • Problem • Limited use medications are offered under the Ontario Drug Benefit Program for specific situations as for a particular medical condition and/or for a limited period of time (Source: Ontario Ministry of Health and Long-Term Care) • Physicians are required to review the criteria before writing the three-digit code • Solution • Removing LU codes from medication names • Implementing an alert system to notify physicians when LU medications are being added to patient chart

15. Very Important Drug (VID) List • VID list • List of medications to import all updated brand name medication information • Medications included • Frequently recorded medications (e.g. acetaminophen) • Immunosuppressants (e.g. cyclosporine, MMF) • Synchronization tool with Health Canada

16. Results

17. Results

18. Lessons learned and continuous discovery

19. Lessons learned and continuous discovery • Aforementioned challenges continue to exist • Solutions • Understand importance of drug nomenclature standardization and adhere to strategies • Develop robust processes to regulate changes • Construct technological tools to perform updates

20. Thank you!