From Nexus project showcase. Presented by Nazanin Falconer, Pharmacy service, Middlemore Hospital, at HINZ 2014, 11 November 2014, 1.45pm, Plenary Room

1. Assessment of Risk Tool (ART)
Prioritisation of Inpatients for Clinical
Pharmacy Services
Falconer N, Nand S, Liow D.
Pharmacy Service
Middlemore Hospital
Counties Manukau Health

2. Harm from medicines
“… come at a high personal
cost to individuals who are
entrusted to our care.”
Dr. Mary Seddon (HQSC)1

3. Pharmacist Intervention
• Medication Reconciliation (MR) and pharmacist
review reduce adverse drug events (ADEs)2
• But resource intensive
• So need to consider;
– Which patient is likely to benefit most?
– How can high risk patients be identified quickly and
consistently?
– How can contributions to patient care be measured and
evaluated?

4. ART
• Electronic, dynamic, predictive risk tool³
• 37 flags
• Each flag has a score
• Patient is categorised as high, medium or low
risk

5. e- Medication Reconciliation Prioritisation Tool – concept draft only.
Business System Process Flow
ART Database
Source Data Processing Care Provider
Éclair
CCM
Pharmacist
UI
Change
Criteria
e- Medication Reconciliation Concerto
Secondary Care
Clinician
Patient demographic
& admission details
PiMS
MediConnec
t
SMT
New e-MED Data
Repository
Patient laboratory
results
Patient enrolment
& clinical details
Assign
weighed
scores based
on predefined
criteria
Read
Only
Prioritisation Tool
Reports
Patient medication
Prescribing & transaction
details
Patient clinical
details
Manage
Patient
ACCESS
e- Medication
Parameter
Tool
VIEW

6. Flag Groups

7. ART home screen

8. The Flags
• To determine the effectiveness of the ART for
identifying patients at high risk of ADE’s for
MR and clinical pharmacist review.

9. Reports

10. Validation Study
• Validated for use in pharmacy
– Prospective observational study (n= 247)
– high risk patients 3 x unintentional medication
discrepancies compared with low risk patients
(p<0.0001)
– Flags associated with Unintentional medication
discrepancies e.g. multiple medication flag

11. In the (near) Future…
• Make ART real-time
• Potential for negative scoring
• Tailor flags for other services to identify their
high risk patients

12. Special thanks to…
• Clinical Pharmacists at Middlemore Hospital
Pharmacy Department
• Health Quality and Safety Commission of New
Zealand (HQSC)
• Aaron Jackson – Orion Health
• Mary Seddon – HQSC
• Irene Zheng – Counties Manukau Health
• Health Alliance ART Project team

13. References
1. Health Quality and Safety Commission New Zealand. Making health and disability
services safer - serious adverse events report 2012/2013. Nov 2013 [p26].
Available from: http://www.hqsc.govt.nz/assets/Reportable-
Events/Publications/Making-health-and-disability-services-safer-Serious-Adverse-
Events-Nov-2013.pdf
2. Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL. Clinical pharmacists and inpatient
medical care: a systematic review. Arch Intern Med. 2006;166(9):955.
3. Falconer, N. Nand, S. Liow, D. Jackson, A. Seddon, M. Development of an electronic
patient prioritisation tool for clinical pharmacist interventions. AJHP., 2014. 71:
p.4311-320
Questions
Nazanin.falconer@middlemore.co.nz