520 likes | 702 Views
Medication Reconciliation. Johns Hopkins Hospital March 2006 Bob Feroli, PharmD, FASHP. Transition of Care . Patient’s previous home medications are not considered when writing discharge orders. Patient is discharged on Zocor ® (simvastatin).
E N D
Medication Reconciliation Johns Hopkins Hospital March 2006 Bob Feroli, PharmD, FASHP
Transition of Care Patient’s previous home medications are not considered when writing discharge orders. Patient is discharged on Zocor®(simvastatin). At home, patient starts Zocor® and continues to use previously prescribed Lipitor®(atorvastatin). Eleven days later, patient is admitted with severe rhabdomyolysis secondary to “statin” overdose.
Transition of Care Patient with Parkinson's disease is admitted to an ICU for an acute episode unrelated to Parkinson’s disease. Initial care is focused on the acute episode and anti-Parkinson’s drugs are not used. Patient is transferred to general care unit, “Home” therapy is not considered and anti-Parkinson’s therapy is not started. Patient develops severe Parkinsonian symptoms.
Transition of Care Discharge orders for 33 randomly selected ICU patients were reviewed by an RN in context with the patient’s home medications and ICU meds. Potential discrepancies were brought to the attending of the ordering physician. Discharge orders for 31 of 33 patients (94%) were changed. Pronovost P, et al. J Crit Care 18(4):201-205, 2003
Transition of Care • Errors can occur when a patient’s care is passed from one group to the next • Medication therapy may be inappropriately: • Continued • Omitted • Changed • Duplicated
Medication Reconciliation • Reassessment of medication therapy as a patient moves from one level of care to the next. When properly done will: • Support continuity of care • Help to avoid medication errors • JHH quality improvement priority for FY06 • Documentation is mandated by JCAHO • Effective Jan 1, 2006
Admission Transfer Discharge
Admission Transfer Discharge
Admission Transfer Discharge Eclipsys SCC?
Admission Transfer Discharge ICUs IMCs Adult Onc Nel-7 Eclipsys SCC?
Admission Transfer Discharge Eclipsys SCC? YES
Admission Transfer Discharge Eclipsys SCC? RN enters “home” medications into Eclipsys YES
Admission Transfer Discharge Home Meds Rx medications Sample medications Herbal remedies Vitamins Nutriceuticals OTC drugs Eclipsys SCC? RN enters “home” medications into Eclipsys YES
Admission Transfer Discharge Eclipsys SCC? RN enters “home” medications into Eclipsys YES
Admission Transfer Discharge Eclipsys SCC? RN enters “home” medications into Eclipsys Clerical Assoc. or RN Prints Home Medication Reconciliation form YES
Admission Transfer Discharge Eclipsys? Enter “home” medications into Eclipsys Print Home Medication Reconciliation form YES
Admission Transfer Discharge Eclipsys SCC? RN enters “home” medications into Eclipsys Clerical Assoc. or RN Prints Home Medication Reconciliation form YES
Admission Transfer Discharge Eclipsys SCC? RN enters “home” medications into Eclipsys Clerical Assoc. or RN Prints Home Medication Reconciliation form YES No Fill out Home Medication Reconciliation form
Admission Transfer Discharge Eclipsys SCC? Enter “home” medications into Eclipsys Print Home Medication Reconciliation form No Fill out Home Medication Reconciliation form
Admission Transfer Discharge Initial Med List Entered by: Patient Pt family member Nurse Physician Pharmacist other Eclipsys SCC? Enter “home” medications into Eclipsys Print Home Medication Reconciliation form No Fill out Home Medication Reconciliation form
Admission Transfer Discharge Provides one location for the home med list Initial Screening Form H&P “See home med reconciliation form” Eclipsys SCC? Enter “home” medications into Eclipsys Print Home Medication Reconciliation form No Fill out Home Medication Reconciliation form
Admission Transfer Discharge Eclipsys SCC? RN enters “home” medications into Eclipsys Clerical Assoc. or RN Prints Home Medication Reconciliation form YES No Fill out Home Medication Reconciliation form
Admission Transfer Discharge Eclipsys SCC? RN enters “home” medications into Eclipsys Clerical Assoc. or RN Prints Home Medication Reconciliation form YES No Fill out Home Medication Reconciliation form Prescriber considers home med list when developing admission orders
Admission Transfer Discharge Eclipsys SCC? RN enters “home” medications into Eclipsys Clerical Assoc. or RN Prints Home Medication Reconciliation form YES No Fill out Home Medication Reconciliation form Prescriber considers home med list when developing admission orders Prescriber signs “Home” Medication Reconciliation form
Admission Transfer Discharge Eclipsys SCC? Enter “home” medications into Eclipsys Print Home Medication Reconciliation form YES No Fill out Home Medication Reconciliation form Prescriber considers home med list when developing admission orders Prescriber signs “Home” Medication Reconciliation form
Admission Transfer Discharge Eclipsys SCC? Enter “home” medications into Eclipsys Print Home Medication Reconciliation form YES No Fill out Home Medication Reconciliation form Prescriber considers home med list when developing admission orders Prescriber signs “Home” Medication Reconciliation form Place form into chart behind Med Administration tab
Admission Transfer Discharge Eclipsys SCC? Enter “home” medications into Eclipsys Print Home Medication Reconciliation form YES No Fill out Home Medication Reconciliation form Prescriber considers home med list when developing admission orders Prescriber signs “Home” Medication Reconciliation form Place form into chart behind Med Administration tab
Admission Transfer Discharge
Admission Transfer Discharge
Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys
Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form
Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form
Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form
Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Non-Eclipsys and Non-POE
Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Non-Eclipsys and Non-POE Clerical Assoc. or Nurse sends non-patient specific Transfer Reconciliation form
Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form No-Eclipsys and No-POE Clerical Assoc. or Nurse sends non-patient specific Transfer Reconciliation form
Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form No-Eclipsys and No-POE Clerical Assoc. or Nurse sends non-patient specific Transfer Reconciliation form
Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Prescriber considers “Home” Med List and Meds used just prior to transfer When developing transfer orders No-Eclipsys and No-POE Clerical Assoc. or Nurse sends non-patient specific Transfer Reconciliation form
Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Prescriber considers “Home” Med List and Meds used just prior to transfer When developing transfer orders Prescriber Signs Transfer Reconciliation form No-Eclipsys and No-POE Clerical Assoc. or Nurse sends non-patient specific Transfer Reconciliation form
Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Prescriber Signs Transfer Reconciliation form
Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Prescriber Signs Transfer Reconciliation form
Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Prescriber considers “Home” Med List and Meds used just prior to transfer When developing transfer orders Prescriber Signs Transfer Reconciliation form No-Eclipsys and No-POE Clerical Assoc. or Nurse sends non-patient specific Transfer Reconciliation form
Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Prescriber considers “Home” Med List and Meds used just prior to transfer When developing transfer orders Prescriber Signs Transfer Reconciliation form No-Eclipsys and No-POE Clerical Assoc. or Nurse sends non-patient specific Transfer Reconciliation form Place form into chart behind Med Administration tab
Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Prescriber considers “Home” Med List and Meds used just prior to transfer When developing transfer orders Prescriber Signs Transfer Reconciliation form No-Eclipsys and No-POE Clerical Assoc. or Nurse sends non-patient specific Transfer Reconciliation form Place form into chart behind Med Administration tab
Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Prescriber considers “Home” Med List and Meds used just prior to discharge When developing discharge orders Prescriber Signs Transfer Reconciliation form No-Eclipsys and No-POE Clerical Assoc. or Nurse sends non-patient specific Transfer Reconciliation form Place form into chart behind Med Administration tab
Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Prescriber Signs Transfer Reconciliation form
Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Prescriber Signs Transfer Reconciliation form
Admission Transfer Discharge Sending Unit Receiving Unit POE and/or Eclipsys Clerical Assoc. or Nurse sends patient specific Transfer Reconciliation form Prescriber considers “Home” Med List and Meds used just prior to discharge When developing discharge orders Prescriber Signs Transfer Reconciliation form No-Eclipsys and No-POE Clerical Assoc. or Nurse sends non-patient specific Transfer Reconciliation form Place form into chart behind Med Administration tab
Medication ReconciliationNext Steps • Improve compliance with current system • Automate reconciliation process • Improve reconciliation in outpatient sector