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Improving medication management in the emergency department at Royal Perth Hospital

Improving medication management in the emergency department at Royal Perth Hospital. Lea Dias - ED Pharmacist Barry Jenkins, Chief Pharmacist Dr Frank Sanfilippo, Population Health, UWA Stephen Witney - ED Technician. Background. ED is under-serviced by pharmacy at RPH

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Improving medication management in the emergency department at Royal Perth Hospital

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  1. Improving medication management in the emergency department at Royal Perth Hospital Lea Dias - ED Pharmacist Barry Jenkins, Chief Pharmacist Dr Frank Sanfilippo, Population Health, UWA Stephen Witney - ED Technician

  2. Background • ED is under-serviced by pharmacy at RPH • Significant medication safety concerns • Significant continuity of care issues • Funding obtained for a pharmacist and technician from Oct 05 - June 06

  3. Aim • Introduce a comprehensive service • patient own medication bags • frequent stock checks and analysis • access to a clinical pharmacist during business hrs • introduce an electronic drug formulary • investigate the role of the pharmacist & technician • Conduct a Pilot study • assess the accuracy of medication history taking • assess the impact of pharmacy involvement

  4. Achievements • Patient Own Medication Bags (POMBs) introduced and written into hospital policy • Drug protocols and administration guidelines on ED intranet • Service to nursing & medical staff improved • Pilot study completed and analysed

  5. Pilot study summary • Primary objective: • To compare the accuracy of medications recorded on the medication chart against a validated medication history taken by the pharmacist for high-risk patients. • Secondary objective • Assess the utility of the pharmacy service in reviewing high risk patients and resolving medication related problems.

  6. Method • Service • 1FTE clinical pharmacist, 1FTE Technician • Mon-Fri 8:00am-4:30pm • Sample - high risk patients • Inclusion criteria • admitted patients with a completed drug chart •  65 years old or  5 medications • Exclusion criteria • nil medications pre-admission • Recruitment • once or twice daily ward rounds in all ED areas • 9th April - 30th May 06 (period of 7 weeks)

  7. Method • Role of the technician • Record pre-admission medication information • patient’s own medications/list or WebsterPak® • GP letters • nursing home/pharmacy medication list • previous admission at RPH • discharge letters • Record medications charted on admission

  8. Method • Role of the pharmacist • Validate history with at least two sources • Reconcile pre-admission medication history with charted medications • Classify discrepancy as; • intentional (deliberate changes) eg. withheld, new or cease drug, OR • unintentional (errors) eg. drug omission, drug commission, or incorrect dose. • Communicate discrepancies • written in blue notes • verbally with team or ward pharmacist • attach Medication Action Plan to chart

  9. Method

  10. Method • Introduced towards the end of the study.

  11. Analysis • Data analysed using SPSS • Lost to follow up • subjects that satisfied the selection criteria but were lost to the ward/discharged before being seen by the ED Pharmacist • these subjects were not included in the results • Patients not screened • lack of resources did not permit all high-risk pts to be reviewed and included in the results. • sub-sample of these patients to test for selection bias

  12. Results

  13. Results 2

  14. Distribution of unintentional errors Patients Unintentional errors

  15. Discussion • Unintentional discrepancies (errors) • mean of 2.1 per patient • Intentional (deliberate) changes • mean of 0.9 per patient • On discharge must account for:- • all errors not corrected in ED and • all deliberate changes initiated in ED and • all other discrepancies arising from the ward

  16. Conclusion • Primary objective[To compare the accuracy of medications recorded on the medication chart against a validated medication history taken by the pharmacist for high-risk patients.] • there is a high incidence of unintentional error in admission medication histories for high-risk patients • Secondary Objective[Assess the utility of the pharmacy service in reviewing high risk patients and resolving medication related problems] • a pharmacist/technician based pharmacy service identified, and in a third of cases, corrected, unintentional medication errors

  17. Key messages • Don’t rely on old information - validate it • Accurate discharge letter is vital • Undetected errors made on admission may go uncorrected at discharge • Medical and nursing staff benefit from clinical pharmacy services • A dedicated ED pharmacy service improves the medication management of admitted patients

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