Hi everyone, in this presentation I have shared a basic overview of Medication Reconciliation and its benefits & challenges.
However, this is for education & information purpose only.
Learn best practices based on literature and how to perform a complex and accurate medication history. Recognize gaps/inconsistencies in systems that impede medication reconciliation and identify next steps in improving current medication reconciliation within your own practice.
Speaker:
Mary Pat Friedlander, MD
Lawrenceville Family Health Center
Pittsburgh, PA
Medication Error are the most preventable events and Clinical Pharmacists can play a vital role in preventing them. in this presentation i have tried to provide maximum information regarding medication error in minimum slides.
Learn best practices based on literature and how to perform a complex and accurate medication history. Recognize gaps/inconsistencies in systems that impede medication reconciliation and identify next steps in improving current medication reconciliation within your own practice.
Speaker:
Mary Pat Friedlander, MD
Lawrenceville Family Health Center
Pittsburgh, PA
Medication Error are the most preventable events and Clinical Pharmacists can play a vital role in preventing them. in this presentation i have tried to provide maximum information regarding medication error in minimum slides.
This presentation tells us about what are the medication errors and how we differentiate between them as per the National Accreditation Board for Hospital & Healthcare Providers standard for hospitals 5th Edition.
Presentation contains detailing details of medication error.
Some GIFs may not be seen.
This is a knowledgeable and conceptual presentation which covers medication administration rights and potential risks/ errors that are very common in healthcare. We need to understand their root cause and make a medication error free environment in the healthcare.
The existence of look alike and sound alike drug names is a one of the most common causes of medication error and is of concern worldwide. As more medicines and new brands are being marketed in addition to the thousands already available. Many of these medication names may look or sound alike. Thus, the potential for error due to confusing drug names is very high. According to the survey from United States Pharmacopoeia, around commonly used medications were involved in such errors. Error prone medication pairs that can easily cause confusion while prescribing, dispensing and administration/consumption were sorted out. Also real life experiences of medication errors and near misses due to error prone drug pairs were collected from the doctors and the dispensers. It is very important that we circulate the list of confusing brand names among the practicing doctors, pharmacists and also to the drug manufacturers. Preventing confusion between already marketed products typically involves collecting voluntary reports of names involved in confusion errors, posting warnings and alerts both electronically and in areas where drugs are used. The fear of malpractice lawsuits and public embarrassment has made the physicians and nurses reluctant to report medication errors. It is more important to create the open environment that encourages the reporting of errors than to develop less meaningful comparative error rates. One possible approach to improving medical error reporting systems. This type of system should also enable internal tracking, trending and comparative analyses. We need to have such system in India.
Medications are a critical component of the care provided to patients and are used for diagnostic, symptomatic,
preventive, curative, and palliative treatment and management of diseases and conditions. A medication
system that supports optimal medication management must include processes that support safe and effective
medication use. Safe, effective medication use involves a multidisciplinary, coordinated effort of health care
practitioners applying the principles of process design, implementation, and improvement to all aspects of
the medication management process, which includes the selecting, procuring, storing, ordering/prescribing,
transcribing, distributing, preparing, dispensing, administering, documenting, and monitoring of medication
therapies
This session will introduce delegates to medicines reconciliation and its role in reducing the opportunity for error and harm to patients by making sure they are given the right medicines at every stage of their care.
This presentation tells us about what are the medication errors and how we differentiate between them as per the National Accreditation Board for Hospital & Healthcare Providers standard for hospitals 5th Edition.
Presentation contains detailing details of medication error.
Some GIFs may not be seen.
This is a knowledgeable and conceptual presentation which covers medication administration rights and potential risks/ errors that are very common in healthcare. We need to understand their root cause and make a medication error free environment in the healthcare.
The existence of look alike and sound alike drug names is a one of the most common causes of medication error and is of concern worldwide. As more medicines and new brands are being marketed in addition to the thousands already available. Many of these medication names may look or sound alike. Thus, the potential for error due to confusing drug names is very high. According to the survey from United States Pharmacopoeia, around commonly used medications were involved in such errors. Error prone medication pairs that can easily cause confusion while prescribing, dispensing and administration/consumption were sorted out. Also real life experiences of medication errors and near misses due to error prone drug pairs were collected from the doctors and the dispensers. It is very important that we circulate the list of confusing brand names among the practicing doctors, pharmacists and also to the drug manufacturers. Preventing confusion between already marketed products typically involves collecting voluntary reports of names involved in confusion errors, posting warnings and alerts both electronically and in areas where drugs are used. The fear of malpractice lawsuits and public embarrassment has made the physicians and nurses reluctant to report medication errors. It is more important to create the open environment that encourages the reporting of errors than to develop less meaningful comparative error rates. One possible approach to improving medical error reporting systems. This type of system should also enable internal tracking, trending and comparative analyses. We need to have such system in India.
Medications are a critical component of the care provided to patients and are used for diagnostic, symptomatic,
preventive, curative, and palliative treatment and management of diseases and conditions. A medication
system that supports optimal medication management must include processes that support safe and effective
medication use. Safe, effective medication use involves a multidisciplinary, coordinated effort of health care
practitioners applying the principles of process design, implementation, and improvement to all aspects of
the medication management process, which includes the selecting, procuring, storing, ordering/prescribing,
transcribing, distributing, preparing, dispensing, administering, documenting, and monitoring of medication
therapies
This session will introduce delegates to medicines reconciliation and its role in reducing the opportunity for error and harm to patients by making sure they are given the right medicines at every stage of their care.
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EVIDENCE BASED PROJECTRECOMMENDING AN EVIDENCE-BASED PRA.docxelbanglis
EVIDENCE BASED PROJECT
RECOMMENDING AN EVIDENCE-BASED PRACTICE CHANGE
HEALTH CARE ORGANIZATION
JOHN HOPKINS HOSPITAL TO PROVIDE QUALITY HEALTHCARE SERVICES TO THE PATIENTSHAS THE CULTURE FOR EMBRACING THE DESIRED CHANGE FOR THE LONGTERM PROSPERITYHAS THE CULTURE FOR IMPROVING THE HEALTH AND SAFETY OF THE PATIENTS
John Hopkins hospital has always been focused to provide quality healthcare services to the patients and the hospital has the culture for embracing the desired change for the long term prosperity. John Hopkins hospital has the culture for improving the health and safety of the patients and in any case if there is need to embrace change for the achievement of this objective, the management of the hospital cannot delay.
*
CURRENT PROBLEM
INCREASED CASES OF MEDICATION ERRORS AMONG THE HEALTH PRACTITIONERS.
OCCUR DUE TO INCREASED FATIGUE AMONG THE NURSES
ALSO CAUSED BY POOR COMMUNICATION BETWEEN THE PHYSICIAN AND THE PHARMACIST
ALSO CAUSED BY LIMITED INFORMATION AMONG THE PATIENTS ON THE RIGHT DOSAGE
Recently there have been increased cases of medication errors among the health practitioners (Institute for Healthcare Improvement, 2017). This has resulted in adverse effects to the patients ranging from increased hospitalization due to health complications and even death. Medical errors may occur due to increased fatigue among the nurses, where long working hours with limited shifts may result in the administration of the wrong medication to the patients. Medical errors are also caused by poor communication between the physician and the pharmacist resulting in the administration of the wrong dosage to the patient. Medical errors are also caused by limited information among the patients on the right dosage resulting in an overdose or under dose.
*
DESCRIPTION OF THE CIRCUMSTANCE
ROBERTSON, AN EIGHTEEN-MONTH-OLD LITTLE BOY, WAS ADMITTED TO JOHN HOPKINS HOSPITAL. HAD SUFFERED FROM BURNS WAS DENIED A DRINK DESPITE HIS REQUEST FROM THE MOTHERTHE NURSE INSTRUCTED THAT THE CHILD SHOULD NOT DRINK ANYTHING. WHEN THE MOTHER WAS BATHING HIM, THE CHILD APPEARED TO SUCK THE WASHCLOTH IMMENSELYTHE DOCTOR ASSURED THE MOTHER THAT EVERYTHING WAS OKAY.THE DOCTOR INSTRUCTED THAT NO NARCOTICS WERE SUPPOSED TO BE ADMINISTERED TO THE CHILDTHE NURSE DECIDED TO ADMINISTER METHADONE TO THE CHILD AT AROUND ONE O'CLOCK DESPITE BEING AWARE THAT THE DOCTOR HAD INSTRUCTED NO NARCOTICS WAS TO BE ADMINISTEREDDOLPHIN SUCCUMBED TO SEVERE DEHYDRATION AND MISUSED NARCOTICS.
Robertson, an eighteen-month-old little boy, was admitted to John Hopkins Hospital in February 2003 after suffering from first and second-degree burns. The injury was caused by his act of climbing in a hot bathtub. The child did spend over ten days in the intensive care unit, after which he was referred to the step-down unit to commence the discharging process. The child was denied a drink despite his request from the mother, and the nurse instructed that the child should not drink an ...
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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2. BACKGROUND
Patients often receive new medications or have changes made to
their existing medications at times of transitions in care upon
hospital admission, transfer from one department/unit to another
during hospitalization, or discharge from the hospital to home or
another facility.
3. WHAT IS MEDICATION RECONCILIATION
■ Medication reconciliation is a formal process or technique used by
clinical personnel (e.g. doctors, nursing staff and pharmacists) to
gather a complete and accurate list of a patient's prescribed and
home medications to identify discrepancies in drug regimens in
different levels of care, healthcare settings, or points in time and to
use that information to inform prescribing decisions and identify and
prevent medication errors.
■ In short, it is a Process of identifying the most accurate list of all
medications a patient is taking including name, dosage, frequency &
route and to use this list to provide correct medications for patients
anywhere within the health care system and most importantly,
compare the patient's current medication list against the admission,
transfer or discharge orders
4. GOALS OF MEDICATION RECONCILIATION
■ To prevent adverse drug events (ADEs) at all interfaces of care (admission, transfer and
discharge), for all patients.
■ To improve the safety of using medications.
■ To ensure the safety of all patients against medication error.
■ To eliminate undocumented intentional discrepancies and unintentional discrepancies by
reconciling all medications, at all interfaces of care.
An undocumented intentional discrepancy occurs when the Physician intentionally adds, changes or
discontinues a medication the patient was taking prior to admission but this is not clearly
documented in the patient’s medical record.
An unintentional discrepancy occurs when the physician unintentionally changes, adds or omits a
medication the patient was taking prior to admission.
5. EXAMPLES OF MEDICAL RECONCILIATION
Example of an Undocumented Intentional Discrepancy
A patient receiving atenolol for hypertension was admitted for surgery. The admitting
resident did not order atenolol on admission due to concerns about perioperative
hypotension. The reason for not ordering atenolol was not documented in the medical
record. The patient was discharged on the third postoperative day and was given a
discharge prescription that did not include atenolol. The patient was unsure whether
to resume treatment with atenolol at home and called her family doctor for advice.
The family doctor called the patient’s surgeon to clarify the discrepancy. The surgeon
did not know why the atenolol was stopped while in hospital and called the hospital
pharmacy. The pharmacy did not have a record of the change so the pharmacist on
the surgical unit tried to contact the admitting resident but the resident was no longer
on the service.
6. EXAMPLES OF MEDICAL RECONCILIATION
Examples of an Unintentional Discrepancy
An elderly woman was admitted to a general medicine unit with a diagnosis of
community-acquired pneumonia. Antibiotics and symptom management were ordered
and started. Two days later the patient had a myocardial infarction and it was found
that a beta-blocker (cardiac medication) had been unintentionally omitted on
admission.
A patient was admitted for total knee replacement surgery. After four or five days the
patient was not motivated and refused to get out of bed. The family mentioned to the
nurse that the patient had been on an antidepressant medication prior to admission
and it had not been ordered while in hospital. The medication was ordered. It took
approximately one week for the medication to work again, resulting in a prolonged
hospital stay.
7. STEPS OF MEDICATION RECONCILIATION
There are following basic, but very important steps of Medication
Reconciliation.
■ Verification: Collection of complete and accurate medication list ( including
current & past medication) of patient and other medication information.
■ Clarification: Ensuring the dosage and medications are appropriate for the
patient.
■ Reconciliation: Resolving discrepancies and documenting changes and new
orders.
Although the required steps seem basic, the logistics behind when, where, how, and by whom this is done can be difficult.
8. BENEFITS OF MEDICATION RECONCILIATION
■ Obtain and maintain a complete list of medications
the patient is regularly taking.
■ Reduction in medication error and adverse drug
events.
■ Patients receive appropriate medication.
■ Improve effective communication between clinical
personnel and patients & their family members.
9. CHALLENGES OF MEDICAL RECONCILIATION
■ TIME TIME TIME..!! – Biggest Challenge.
■ Patient’s inability to recall medications, its dosage and
frequency.
■ Unreliable sources of medication information
■ Skill level of interviewer of patients.
10. CONCLUSION
Medication Reconciliation has been increasing,
more studies are needed on the implementation and
adoption of effective medication reconciliation
processes, with emphasis on the identification of
current best practices for medication reconciliation.
11. REFERENCES
■ Approach to Improving Safety: Medication Reconciliation (Agency for
Healthcare Research & Quality)
■ Medication Reconciliation According to the Joint Commission, S.
Michael Ross, MD, MHA
■ Medication Reconciliation: A Learning Guide, Queen’s University –
Office of interpersonal Education & Practice
■ Ensuring Medication Reconciliation, By Kristen Georgia, BS; Kristin
Kinney, RN, MSN; Angela Pace, RN, MSN; and Kim Helton, RN, BSN
■ Improving Care Transitions: Optimizing Medication Reconciliation,
Developed by: American Pharmacists Association, American Society
of Health-System Pharmacists