Bridging Medication Across Settings of Care

1. Bridging Medication Across Settings of Care Richard Ricker, RPH, MBA Sparrow Hospital Barbara J. Smith, LBSW, MS, CHC, NHA Burcham Hills DATE: May 29, 2013

2. We have no conflict of interest to declare. We do not have any relevant financial relationships with any commercial interests.

3. OBJECTIVES • Define the focus of medication reconciliation • Describe the process and outcomes of the Sparrow, Burcham Hills “Bridging Medications Project”

4. Medication Reconciliation Medication errors are perhaps the most common patient safety errors. Unintended medication discrepancies occur in nearly one-third of patients at admission. Unintended medication discrepancies occur in 14% of patients at hospital discharge. Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med. 2005;165:424-429

5. Focus of Medication Reconciliation: • The Focus is on global patient safety and improved patient outcomes. • Is composed of multiple processes that: • reduce medication errors • support safe medication use by patients • encourages community-based providers and those practicing in health systems to collaborate • promotes overall continuity of patient care.

6. The Sparrow/Burcham Project Both organizations are members of the Community Collaborative “Capital Area Collaborative for Care Transitions” Burcham participates on the Sparrow Hospital sponsored “Skilled Nursing Facility Readmissions” group Richard and Barbara identified a common interest and began work to design a pilot to address medication reconciliation at transition

7. Motivating Factors for Burcham Hills • Time spent by admissions nurse to reconcile medications • 3 different documents sent from hospital with conflicting medication lists • Limited access to a contact at hospital to verify medication orders • Client dissatisfaction with medication availability at admission to Burcham • Missing C-II scripts resulting in inability to provide timely pain medication administration

8. Motivating Factors for Sparrow Improve discharge medication reconciliation process Provide 48-hour medication “bridge” to allow for smoother transition of patients from hospital to skilled nursing facility Reduce 30-day readmissions

9. Our Planning Process Agreement that there was improvement opportunity Agreement that patient outcomes were each setting’s responsibility during transition Identified a “One Source of Truth” both settings would acknowledge Agreed upon process and outcome measures

10. Sparrow’s Process When discharge to Burcham Hills is confirmed: • Pharmacy Technician prints “After Visit Summary” (AVS) • Reconciles Discharge Medication List. • Contacts MD for Controlled Substance (i.e. C-II) Prescriptions for Burcham Hills and Sparrow Hospital. • Fills 48-hour supply of medication(unit-dose) not stocked in automated dispensing cabinets (ADCs) at Burcham Hills. • Notes on Discharge Medication List amount of medication being dispensed for patient. • Places any prescriptions, medications, and Discharge Medication List in “tamper-proof” bag for transport with patient.

11. Burcham’s Process • Admission Coordinator informs medication technician of “bed offer” for a Sparrow Client activating the Sparrow process • Upon client arrival to Burcham Hills Center for Health and Rehabilitation admission nurse: • Verifies content of medication packet sent with client • Reviews “One source of truth” document • Conducts medication reconciliation with client/family • Assesses pain

12. Burcham’s Process Continued Medication Administration Record is developed that includes medications listed on after visit summary and patient home medication list. Medications are ordered from Burcham Pharmacy for later delivery Medications not provided by Sparrow are obtained from Pyxis system until pharmacy delivery

13. Interim Status Review • Initial audit of 20 charts of clients transitioned between March 15 and March 31streveals great improvement: • 20 included the After visit summary(one source of truth) • 11 had all medications reconciled including home medications • 11 medication reconciliations had complete dose and frequency information and no duplicate orders

14. Status Review Continued: • Initial audit of 20 charts of clients admitted between March 15 and March 31st: • 8 had either duplication of orders or inadequate instructions for administration • These were charts early in new process inception • 1 had handwritten notes by an unidentified source that changed medication orders after technician did reconciliation

15. Burcham Reactions • Admission nurses are very pleased: • Agree that admission process has been decreased 30-60 minutes per client • Nurses report greater job satisfaction, lower stress • There have been zero client complaints since starting the project • Pain issues upon admission are addressed immediately

17. QUESTIONS