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VA Medication Reconciliation Initiative

Pharmacy Informatics: “There’s a VA App for That!” Pleasanton, CA. August 2 – 5, 2011 VA MedRecon Share point VA MedRecon Yammer Group Maureen.Layden@VA.gov Rosemary.Grealish@VA.gov. VA Medication Reconciliation Initiative.

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VA Medication Reconciliation Initiative

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  1. Pharmacy Informatics: “There’s a VA App for That!” Pleasanton, CA.August 2 – 5, 2011VA MedRecon Share pointVA MedRecon Yammer GroupMaureen.Layden@VA.govRosemary.Grealish@VA.gov VA Medication Reconciliation Initiative

  2. MedRecon Journal Club: Adams, Shawn M (Portland); Amarshi, Rahemat; Ashworth, Joann Y.; Bockhold, Colleen R.; Church, Victoria L (Portland); Davis, Lisa G; Doten, Amy E; Ducharme, Elizabeth A.; Golterman, Lori (VHACO); Hoeksema, Laura J. (NCPS); Kazi, Salahuddin; Kinnaird, Daniel E. ASHVAMC; Layden, Maureen Q.; Lesselroth, Blake J (Portland); Lyle, Diane M.; Ondeck, Deborah A.; Perry, Arlene A.; Rayburn, Larry D.; Rayburn, Virginia (Columbus); Reiss, Alexander I.; Rogers, Delories Jean (ATG); Stainbrook, Renotta G.; Toy, Shawn; vhapbh Burke-Bebee, Suzie MedRecon Documentation and Monitoring Group: Adames, Irene; Adams, Shawn M (Portland); Amarshi, Rahemat; Anderson, Jacquelyn D.; Baruch-Bienen, Deborah L; Bockhold, Colleen R.; Boockvar, Kenneth S.; Cagle, Stephen W.; Chavalitanonda, Nann N.; Cho, Richard; Cohen, Emily; Conrad, Chester; Curtis, Van; Cusack, Caitlin M. (BITS); Davila, Yvonne B.; Davis, Lisa G; Delgado, Ailsa M.; Deltoro-Borrero, Yolanda; Dierker, Susan E; Doten, Amy E; Durkin, Rob; Farrell-Holtan, Jean M.; Gillon, Joseph; Grealish, Rosemary; Group Review VHAMASTER; Heitman, Edgar R.; Hughes, Lina R (SPO); Kaboli, Peter J.; Kazi, Salahuddin; Khan, Shaiza FHCC Lovell; Layden, Maureen Q.; Lesselroth, Blake J (Portland); Lin, David; McConnell, Mark E.; Mewton, Joel; Michaud, Dana L. VHAIRO; Ochs, Leslie A.; Ondeck, Deborah A.; Pickard, Marcia (Ann Arbor); Plourd, Kimberly M.; Profit, Lori; Reiss, Alexander I.; Silverman, Robert; Stadler, John B.; Stein-Gocken, Julie; Stimson, Jean M.; Taylor, Suzanne; Toy, Shawn; Tubbs, Traviss A.; VHASYRBROWND3; Washington, Myron J.; Wittenberg, Geri FHCC Lovell MedRecon Staff and PatientEducation: Amarshi, Rahemat; Bockhold, Colleen R.; Charters, Kathleen (CCSI); Chavalitanonda, Nann N.; Echt, Katharina; Gill, Rosemary; Gill, Rosemary (Palo Alto); Golterman, Lori (VHACO); Grealish, Rosemary; Heitman, Edgar R.; Hoeksema, Laura J. (NCPS); Horvath, Kathy; Kazi, Salahuddin; Layden, Maureen Q.; Lyle, Diane M.; McConnell, Mark E.; Mehta, Sima N.; Ondeck, Deborah A.; Painter, Kathleen; Plourd, Kimberly M.; Pries, Rose Mary NCP; Probst, Maria (White City/VISN20/); Rayburn, Virginia (Columbus); Rayford-Outsey, Faye L CAVHCS; Trudeau, Paulette; Trudeau, Scott; vhapbh Burke-Bebee, Suzie MedRecon Task Force:Adams, Shawn M (Portland); Connolly, Karin S.; Connolly; Cusack, Caitlin M. (BITS); Ducharme, Elizabeth A.; Grealish, Rosemary; Heller, Thomas; Layden, Maureen Q.; Lesselroth, Blake J (Portland); Lin, David; Lucas, Joe (VHA OHI); Ondeck, Deborah A.; Pickard, Marcia (Ann Arbor); Rayford-Outsey, Faye L CAVHCS; Silverman, Robert; Vasquez, Luz; Watson, Kimberly R. First, Thank you!

  3. Goals Understand Medication Reconciliation In the VA In your facility And your important role

  4. First Thanks!! VA Pharmacy Informatics Taking the Lead

  5. Conservative Estimations, compliments of Dr. Lesselroth • Estimate 4.5 discrepancies per patient encounter, 30% clinically relevant1-3 • Each discrepancy has a positive predictive value for an ADE of 0.0234 • 4.5 x 0.023 = 0.1 ADE/Encounter • If we conservatively estimate that 13% of those ADEs result in temporary disability, hospitalization, or death4 • O.1 X 0.13 = 0.013 Events/Encounter • If we estimate a facility manages 415,000 encounters per year • 415,000 X 0.013 X 5, 395 Events every year Kaboli et al., Am J Mgd Care, 2004 ; 2.Lesselroth et al., JC Qual Pt Saf, 2009; 3.Pippins et al., JGIM, 20084. Boockvar et al., Qual Saf Heath Car, 2009

  6. Medication ReconciliationWhat it is NOT • Just about a list • Pharmacy’s problem, alone • Useless • Being phased out in Joint Commission • Impossible, BUT • IT IS: • Hard to do

  7. The Joint Commission Reconciliation Revised Patient Safety Goals* • NPSG.03.06.01 EP1: Obtain information on the medications the patient is currently taking. • NPSG.03.06.01EP3: Compare the medication information. • NPSG.03.06.01EP4: Provide the patient (or family as needed) with written information. • PC.04.02.01: Information about treatment is provided to other service providers VA Medication Reconciliation Directive Definition • Obtaining medication information from patient, caregiver, and/family. • Comparing this to the medication information available • Communicating with and providing education to patient, caregiver, and/or family regarding this information. • Communicating this with the healthcare team(s).

  8. Minimum MedRecon Documentation Requirements • Patient provided medication information obtained at the episode of care must be represented in the electronic medical record (EMR) • Comparison of this to the medication information available on the EMR* • Final updated medication list highlights the added, changed, and discontinued medications • Discharge instructions = discharge medication information in the EMR

  9. MedRecon Documentation: Lessons Learned • Avoid Duplicate Documentation • Make your templates consistent with workflow in the clinical setting • Consider that all the minimum documentation requirements do not have to be captured in the template but must exist somewhere in the note • Engage the end-users in developing tools • Must essentially help us help the patient, “What did the patient come in on, what did she leave with, and why • Don’t put Remote Meds in Non VA Meds-Use the Software

  10. VA MedRecon Directive • Assign a VISN and Facility MedRecon Point of Contact to disseminate timely info • Update your facility MedRecon policy, if necessary • Establish MedRecon processes • Assign roles and responsibilities • Measure the effectiveness of your facilities MedRecon • Participate in the MedRecon EPRP & Discharge Call Monitor or PACT equivalent

  11. VA MedRecon Directive • In the MedRecon Goody Bag (Toolkit) regarding the MedRecon Directive • MedRecon FAQs • Directive and Facility MedRecon Policy Gaps Analysis Tool • Please email us if you have questions • Directive and Joint Commission Crosswalk

  12. Metrics Post-Discharge Call Monitor (Voluntary) ExternalPeer Review Process (Pilot)*: • Discharge patients to home • Did you get an updated Medication List? • FY2010 Quarter 4, Average 95% Yes! • 183, 182 Veterans were called *Guidance Deb Ondeck, RN, OQP 1 & 2 Review the patient’s list of medications • Identify medication discrepancies • Address medication discrepancies • Provide a written list • Refer to or follow-up medication management?

  13. MedRecon Metrics: Local • Patient Activation: “Did you bring your medications or your med list to this appointment?” • Terminal Process Metric: “Did you receive an updated med list at the end of the encounter? • Outcome: • Discrepancy Rates • ADEs • ED/Urgent Care visits • Re-admission

  14. MedRecon Software • Let’s get to work • Where are you doing “MedRecon”? • Who is doing what tasks? • How are you measuring the process? • Are there opportunities for change?

  15. Patient Centered Medication Information Management • Completion of the MedRecon/PCMIM NSR • Focus on existing projects • Take into account organizational history • PBM Patient Centered Care Liaison • Support Shared Decision Making • Medication Use Crisis • Standardizing Medication Information • Display • Content • Continue to promote pharmacy as key player in this multidisciplinary process

  16. Patient Centered Medication Information Management Ultimately, Medication Reconciliation will be so imbedded in our daily routine and consistent with the expectations of our patients that the campaign will become obsolete and the terms forgotten.

  17. VA Medication Reconciliation: and Patient Centered Med Info Mgt • MedRecon NSR, in collaboration with: • VPS Kiosk • MHV • The Daily Plan • Ask a Pharmacist • Greenfields • Health Risk Assessment • Local Innovations • New Functionalities !

  18. The Top 3 VA MedRecon Barriers • MedRecon software works only if clinicians update the Medication Orders in pharmacy package Vulnerabilities: • Co-pays are generated • Patients are dispensed extra or excess medication [a safety and financial liability] • Our Medication Lists are generated from many sources with variable/inconsistent output display • Active & Expired • Outpatient & Inpatient • Local & Remote (Other VAMCs & DoD) • Remote med conflicts have caused sentinel events • VA & non VA • It is difficult to obtain, document, and store in the chart patient-derived medication information [the Veteran’s voice]

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