SlideShare a Scribd company logo
Spotlight Case November 2005 Reconciling Doses
Source and Credits This presentation is based on the November 2005 Spotlight Case in Emergency Medicine  See the full article at  http://webmm.ahrq.gov   CME credit is available through the Web site Commentary by:  Frank Federico ,  RPh , Director, Institute for Healthcare Improvement Editor, AHRQ WebM&M: Robert Wachter, MD Spotlight Editor: Tracy Minichiello, MD Managing Editor: Erin Hartman, MS
Objectives At the conclusion of this educational activity, participants should be able to: List the steps involved in medication reconciliation Describe the role of each of the stakeholders in medication reconciliation Discuss how medication reconciliation decreases the opportunity for medication errors and harm
Case: Reconciling Doses A 68-year-old man with a history of diabetes and atrial fibrillation (maintained on warfarin) presented to the emergency department (ED) with fever and mental status change. Lumbar puncture was attempted three times without success; empiric treatment for meningitis was started. Further examination revealed an area of cellulitis, and intravenous antibiotic therapy was changed accordingly.
Case (cont.): Reconciling Doses At the time of admission, the patient was unable to recite his medication list, and his wife was unclear about the doses. However, the EMS run-sheet had a list of the patient’s medication and doses. The patient was started on the medication regimen per the EMS report.
Medication Reconciliation The process of collecting the best medication history possible, verifying that list, and comparing it with orders written at admission, transfer, and discharge Ensures each member of health care team has access to a list of home medications and what was ordered at transitions in levels of care Provides a method to communicate when an intentional medication change is made
Medication Reconciliation: The Data More than one half of medication errors occur at the interfaces of care  Up to 67% of cases had errors in prescription medication histories An average of 10 prescriptions needed to be changed weekly in the ICU as a result of implementing a reconciliation process Rozich JD, Resar RK. JCOM. 2001;8(10):27-34. Tam VC, et al. CMAJ 2005;173:510-515. Pronovost P. J Crit Care. 2003;18:201-205.
Medication Reconciliation Recommended change for teams participating in IHI collaboratives to reduce adverse drug events One of six changes chosen by the 100,000 Lives Campaign to improve patient care and prevent avoidable deaths JCAHO selected medication reconciliation as one of the National Patient Safety Goals 100K Lives Campaign. IHI Web site.  National Patient Safety Goals for 2006 and 2005. JCAHO Web site.
Case (cont.): Reconciling Doses After 2 days, the patient was transitioned to Augmentin. While in hospital, the patient had been receiving 5 mg of warfarin at bedtime, which, according to the EMS intake sheet, was his usual outpatient dose. The team did not confirm this dose with the patient’s family, primary physician, or pharmacy.
Case (cont.): Reconciling Doses At the time of discharge, the patient’s INR was noted to be 4.   Realizing the warfarin dose was too high, the team instructed him to decrease his dose to 3 mg at bedtime and to have his INR rechecked in 3 days. After 3 days, his INR was 10. He was treated with vitamin K.
Case (cont.): Reconciling Doses Two days later, the patient returned to the ED with back pain, lower extremity weakness, and incontinence. He was found to have an epidural hematoma. The hematoma was emergently evacuated. One week post-operatively, the patient still had neurologic deficit.
Starting a Medication Reconciliation Program Identify a champion and a multidisciplinary team to work on testing changes that will lead to the desired system Ensure senior leadership support  Secure commitment for resources for the project during its development Start with a small sample of the hospital population
Recruiting Medication Reconciling Team Multidisciplinary team should include:  Executive sponsor Physician champion Nursing leader, staff nurse Pharmacy leader, pharmacy support Patient safety/QI representative Staff education representative Other group representatives  (see form) Team planning form available  here Massachusetts Coalition for the Prevention of Medical Errors.
Examine the system currently in place Use high-level flow  diagram  to determine the different entry points into the hospital  Use similar diagram for transfers and discharges Use a proven improvement methodology (eg, Model for Improvement) to test and implement changes Developing a Medication Reconciliation Program Plsek PE. Pediatrics. 1999;103 (suppl):203-214. Model for Improvement. IHI Web site.
Developing the Reconciliation Process Identify who should participate in each step and define the responsibility of each position Medication history can be completed by a physician, nurse, pharmacist, or pharmacy technician  Base decision on available resources Pharmacists found to be more effective in taking medication history but may train others to do so Michels RD, Meisel SB. Am J Health Syst Pharm. 2003;60:1982-1986. Nester TM, Hale LS. Am J Health Syst Pharm. 2002;59:2221-2225.
Potential Reconciliation Model RN collects medication history Pharmacist verifies information Physicians use the list to aid in decisions about drug therapy  and document reasons to discontinue, change, or hold medications
Medication Reconciliation Forms Most organizations use forms  Often adapted to serve as order form Columns can indicate whether medication should be continued, discontinued, or placed on hold  Place the list prominently in the chart or use colored paper to facilitate access to information Hospitals must determine if these changes introduce new opportunities for errors
Example Reconciliation Form http://www.macoalition.org/Initiatives/RecMeds/CooleyDickinsonReconcilForm.doc
Example Form (cont.) http://www.macoalition.org/Initiatives/RecMeds/CooleyDickinsonReconcilForm.doc
Another Reconciliation Form http://www.macoalition.org/Initiatives/RecMeds/CaritasNorwoodReconcilForm.doc
Another Form (cont.) http://www.macoalition.org/Initiatives/RecMeds/CaritasNorwoodReconcilForm.doc
More Example Forms and Tools Massachusetts Coalition for the Prevention of Medical Errors Reconciling medication toolkit Institute for Healthcare Improvement Medication reconciliation tools
Medication Reconciliation: Technology Linking electronic medical records to download medication histories onto a form reduces the number of steps and the need to manually complete form At discharge, reformatting the medication profile from the pharmacy system onto a prescription form can efficiently generate discharge prescriptions
Evaluate Reconciliation Success Use a measurement strategy to determine program’s effectiveness Assessment form available  here Collecting data per admission or chart may help determine if reconciliation is occurring Information about the percent of unreconciled medications at different transfer points can identify how well the process is working
Medication Reconciliation: Role of the Patient Patients can be active participants in medication reconciliation Organizational level: One health system has engaged patients in developing a statewide universal medication form Individual level: Carry up-to-date medication list and present it at each health care visit  Patient medication card available  here Medication Reconciliation can Save Your Life. McLeod Health Web site.
How to Perform Medication Reconciliation Collect the best medication list possible  If patient is unable to provide list, interview family members and contact primary physician or local pharmacy Complete medication reconciliation at each transition of care At discharge, reconcile prescriptions with most recent inpatient orders and patient medication list prepared at admission
Take-Home Points Medication reconciliation is an effective process to reduce errors and harm associated with loss of medication information at transitions in care Collect the 'best' medication history possible; use open-ended questions when taking a medication history Patients can play a vital role in this process by carrying up-to-date medication list
Take-Home Points Hospitals should develop medication reconciliation processes based on patient entry points and available resources Medication reconciliation should be applied whenever medication orders are rewritten or whenever there is a change in treatment plan or level of care For medication reconciliation to be successful, all stakeholders must be involved

More Related Content

What's hot

Medication error
Medication errorMedication error
Medication error
DR RAMSHA TAREEN
 
Medication error
Medication errorMedication error
Medication error
Krishna Kalikivaya
 
Medication safety and administration
Medication safety and administrationMedication safety and administration
Medication safety and administration
Nursing Hi Nursing
 
Medication safety
Medication safetyMedication safety
Medication safety
Usharani Ramamoorthy
 
Medication errors
Medication errorsMedication errors
Medication errors
serag35
 
Medication safety 2011
Medication safety 2011Medication safety 2011
Medication safety 2011
Rashid Abuelhassan
 
Medication errors
Medication errorsMedication errors
Medication errors
jjoneslocklear
 
CLINICAL PHARMACY MANUAL
CLINICAL PHARMACY MANUALCLINICAL PHARMACY MANUAL
CLINICAL PHARMACY MANUAL
anamsohail29
 
Medication errors and safety
Medication errors and safetyMedication errors and safety
Medication errors and safety
O0793347636M
 
Medication Errors Presentation
Medication Errors PresentationMedication Errors Presentation
Medication Errors Presentation
Yara Mohamed
 
Medication error
Medication errorMedication error
Medication error
Nikita Patel
 
Medication error
Medication errorMedication error
Medication error
Sarah Pulackal
 
Medication Errors M Pharm
Medication Errors M PharmMedication Errors M Pharm
Medication Errors M Pharm
SohelNadaf3
 
Medication error
Medication errorMedication error
Medication error
maryline1979
 
Medication error
Medication errorMedication error
Medication error
Dr. Ramesh Bhandari
 
MOM-NABH 5TH STANDARD
MOM-NABH 5TH STANDARDMOM-NABH 5TH STANDARD
MOM-NABH 5TH STANDARD
Dr.Jeena Salim
 
MEDICATION ERRORS
MEDICATION ERRORSMEDICATION ERRORS
MEDICATION ERRORS
MAHIRA MAIDEEN
 
Medication errors
Medication errorsMedication errors
Medication errors
Dr Arpan Dutta Roy
 
MMU Chapter - JCIA 2013
MMU Chapter - JCIA  2013MMU Chapter - JCIA  2013
MMU Chapter - JCIA 2013
Mouad Hourani
 
Medication Safety
Medication Safety  Medication Safety

What's hot (20)

Medication error
Medication errorMedication error
Medication error
 
Medication error
Medication errorMedication error
Medication error
 
Medication safety and administration
Medication safety and administrationMedication safety and administration
Medication safety and administration
 
Medication safety
Medication safetyMedication safety
Medication safety
 
Medication errors
Medication errorsMedication errors
Medication errors
 
Medication safety 2011
Medication safety 2011Medication safety 2011
Medication safety 2011
 
Medication errors
Medication errorsMedication errors
Medication errors
 
CLINICAL PHARMACY MANUAL
CLINICAL PHARMACY MANUALCLINICAL PHARMACY MANUAL
CLINICAL PHARMACY MANUAL
 
Medication errors and safety
Medication errors and safetyMedication errors and safety
Medication errors and safety
 
Medication Errors Presentation
Medication Errors PresentationMedication Errors Presentation
Medication Errors Presentation
 
Medication error
Medication errorMedication error
Medication error
 
Medication error
Medication errorMedication error
Medication error
 
Medication Errors M Pharm
Medication Errors M PharmMedication Errors M Pharm
Medication Errors M Pharm
 
Medication error
Medication errorMedication error
Medication error
 
Medication error
Medication errorMedication error
Medication error
 
MOM-NABH 5TH STANDARD
MOM-NABH 5TH STANDARDMOM-NABH 5TH STANDARD
MOM-NABH 5TH STANDARD
 
MEDICATION ERRORS
MEDICATION ERRORSMEDICATION ERRORS
MEDICATION ERRORS
 
Medication errors
Medication errorsMedication errors
Medication errors
 
MMU Chapter - JCIA 2013
MMU Chapter - JCIA  2013MMU Chapter - JCIA  2013
MMU Chapter - JCIA 2013
 
Medication Safety
Medication Safety  Medication Safety
Medication Safety
 

Viewers also liked

Medication Safety Presentation
Medication Safety PresentationMedication Safety Presentation
Medication Safety Presentation
Dien Vu
 
Medication error
Medication errorMedication error
Medication error
MEEQAT HOSPITAL
 
Gap analysis of NABH 3rd and 4th Edition
Gap analysis of NABH 3rd and 4th EditionGap analysis of NABH 3rd and 4th Edition
Gap analysis of NABH 3rd and 4th Edition
Dr.Deepak Rajendiran
 
History of Pharmacy
History of PharmacyHistory of Pharmacy
History of Pharmacy
Dr K SUDHEER KUMAR KANDIBANDA
 
Pharmacy History
Pharmacy HistoryPharmacy History
Pharmacy History
guest1912478a
 
Medical errors
Medical errorsMedical errors
Medical errors
Dr. Anees Alyafei
 
Role of the pharmacist in medication safety.
Role of the pharmacist in medication safety.Role of the pharmacist in medication safety.
Role of the pharmacist in medication safety.
Subash321
 

Viewers also liked (7)

Medication Safety Presentation
Medication Safety PresentationMedication Safety Presentation
Medication Safety Presentation
 
Medication error
Medication errorMedication error
Medication error
 
Gap analysis of NABH 3rd and 4th Edition
Gap analysis of NABH 3rd and 4th EditionGap analysis of NABH 3rd and 4th Edition
Gap analysis of NABH 3rd and 4th Edition
 
History of Pharmacy
History of PharmacyHistory of Pharmacy
History of Pharmacy
 
Pharmacy History
Pharmacy HistoryPharmacy History
Pharmacy History
 
Medical errors
Medical errorsMedical errors
Medical errors
 
Role of the pharmacist in medication safety.
Role of the pharmacist in medication safety.Role of the pharmacist in medication safety.
Role of the pharmacist in medication safety.
 

Similar to Medication Safety

Medication Non Adherence X
Medication Non Adherence XMedication Non Adherence X
Medication Non Adherence X
David Donohue
 
Rebecca Ruggear Senior Thesis 2013
Rebecca Ruggear Senior Thesis 2013Rebecca Ruggear Senior Thesis 2013
Rebecca Ruggear Senior Thesis 2013
Rebecca Ruggear
 
Med Rec And Terminology To Mcp 2008
Med Rec And Terminology To Mcp 2008Med Rec And Terminology To Mcp 2008
Med Rec And Terminology To Mcp 2008
poikonen
 
Medication_NonAdherenceX
Medication_NonAdherenceXMedication_NonAdherenceX
Medication_NonAdherenceX
David Donohue
 
Finished order 896851_10
Finished order 896851_10Finished order 896851_10
Finished order 896851_10
Chris Kyeu
 
Emergency med pharmacist 2017 coralic a. et al
Emergency med pharmacist 2017 coralic a. et alEmergency med pharmacist 2017 coralic a. et al
Emergency med pharmacist 2017 coralic a. et al
M. Luisetto Pharm.D.Spec. Pharmacology
 
IMPROVING OUTCOMES AND PRODUCTIVITY FOR EMPLOYEES WITH DIABETES
IMPROVING OUTCOMES AND PRODUCTIVITY FOR EMPLOYEES WITH DIABETES IMPROVING OUTCOMES AND PRODUCTIVITY FOR EMPLOYEES WITH DIABETES
IMPROVING OUTCOMES AND PRODUCTIVITY FOR EMPLOYEES WITH DIABETES
gpartha85
 
Measuring to Improve Medication Reconciliationin a Large Sub.docx
Measuring to Improve Medication Reconciliationin a Large Sub.docxMeasuring to Improve Medication Reconciliationin a Large Sub.docx
Measuring to Improve Medication Reconciliationin a Large Sub.docx
alfredacavx97
 
Physician Dispensing
Physician DispensingPhysician Dispensing
Physician Dispensing
dispensingphysician
 
Ruthann Russo - Integrative Population Health Management - White Paper Part 3
Ruthann Russo - Integrative Population Health Management - White Paper Part 3Ruthann Russo - Integrative Population Health Management - White Paper Part 3
Ruthann Russo - Integrative Population Health Management - White Paper Part 3
Ruthann Russo
 
Medication adherence-01ccd 2
Medication adherence-01ccd 2Medication adherence-01ccd 2
Medication adherence-01ccd 2
Michelle Perron
 
Fronzi (Ghc)
Fronzi (Ghc)Fronzi (Ghc)
Fronzi (Ghc)
TORC
 
Patient Centered Medical Home (PCMH) is not a pill Kevin Grumbach 2013
Patient Centered Medical Home (PCMH)  is not a pill Kevin Grumbach 2013Patient Centered Medical Home (PCMH)  is not a pill Kevin Grumbach 2013
Patient Centered Medical Home (PCMH) is not a pill Kevin Grumbach 2013
Paul Grundy
 
More Predictive Modeling of Total Healthcare Costs Using Pharmacy Claims Data
More Predictive Modeling of Total Healthcare Costs Using Pharmacy Claims DataMore Predictive Modeling of Total Healthcare Costs Using Pharmacy Claims Data
More Predictive Modeling of Total Healthcare Costs Using Pharmacy Claims Data
M. Christopher Roebuck
 
Utilizing Care Management Nurses to Improve Transitions in Care in the Oupati...
Utilizing Care Management Nurses to Improve Transitions in Care in the Oupati...Utilizing Care Management Nurses to Improve Transitions in Care in the Oupati...
Utilizing Care Management Nurses to Improve Transitions in Care in the Oupati...
Tanisha Davis
 
Utilizing Care Management Nurses to Improve Transitions in Care in the Oupati...
Utilizing Care Management Nurses to Improve Transitions in Care in the Oupati...Utilizing Care Management Nurses to Improve Transitions in Care in the Oupati...
Utilizing Care Management Nurses to Improve Transitions in Care in the Oupati...
Tanisha Davis
 
Final dissertation
Final dissertationFinal dissertation
Final dissertation
AjeetRai13
 
Prescription auditing
Prescription auditingPrescription auditing
Prescription auditing
Sumit Kumar
 
Consumer health: time for a regulatory re-think?
Consumer health: time for a regulatory re-think?Consumer health: time for a regulatory re-think?
Consumer health: time for a regulatory re-think?
The Economist Media Businesses
 
BioTech Medical Solutions - Pain RD short 8.5x11
BioTech Medical Solutions - Pain RD short 8.5x11BioTech Medical Solutions - Pain RD short 8.5x11
BioTech Medical Solutions - Pain RD short 8.5x11
William Tillman
 

Similar to Medication Safety (20)

Medication Non Adherence X
Medication Non Adherence XMedication Non Adherence X
Medication Non Adherence X
 
Rebecca Ruggear Senior Thesis 2013
Rebecca Ruggear Senior Thesis 2013Rebecca Ruggear Senior Thesis 2013
Rebecca Ruggear Senior Thesis 2013
 
Med Rec And Terminology To Mcp 2008
Med Rec And Terminology To Mcp 2008Med Rec And Terminology To Mcp 2008
Med Rec And Terminology To Mcp 2008
 
Medication_NonAdherenceX
Medication_NonAdherenceXMedication_NonAdherenceX
Medication_NonAdherenceX
 
Finished order 896851_10
Finished order 896851_10Finished order 896851_10
Finished order 896851_10
 
Emergency med pharmacist 2017 coralic a. et al
Emergency med pharmacist 2017 coralic a. et alEmergency med pharmacist 2017 coralic a. et al
Emergency med pharmacist 2017 coralic a. et al
 
IMPROVING OUTCOMES AND PRODUCTIVITY FOR EMPLOYEES WITH DIABETES
IMPROVING OUTCOMES AND PRODUCTIVITY FOR EMPLOYEES WITH DIABETES IMPROVING OUTCOMES AND PRODUCTIVITY FOR EMPLOYEES WITH DIABETES
IMPROVING OUTCOMES AND PRODUCTIVITY FOR EMPLOYEES WITH DIABETES
 
Measuring to Improve Medication Reconciliationin a Large Sub.docx
Measuring to Improve Medication Reconciliationin a Large Sub.docxMeasuring to Improve Medication Reconciliationin a Large Sub.docx
Measuring to Improve Medication Reconciliationin a Large Sub.docx
 
Physician Dispensing
Physician DispensingPhysician Dispensing
Physician Dispensing
 
Ruthann Russo - Integrative Population Health Management - White Paper Part 3
Ruthann Russo - Integrative Population Health Management - White Paper Part 3Ruthann Russo - Integrative Population Health Management - White Paper Part 3
Ruthann Russo - Integrative Population Health Management - White Paper Part 3
 
Medication adherence-01ccd 2
Medication adherence-01ccd 2Medication adherence-01ccd 2
Medication adherence-01ccd 2
 
Fronzi (Ghc)
Fronzi (Ghc)Fronzi (Ghc)
Fronzi (Ghc)
 
Patient Centered Medical Home (PCMH) is not a pill Kevin Grumbach 2013
Patient Centered Medical Home (PCMH)  is not a pill Kevin Grumbach 2013Patient Centered Medical Home (PCMH)  is not a pill Kevin Grumbach 2013
Patient Centered Medical Home (PCMH) is not a pill Kevin Grumbach 2013
 
More Predictive Modeling of Total Healthcare Costs Using Pharmacy Claims Data
More Predictive Modeling of Total Healthcare Costs Using Pharmacy Claims DataMore Predictive Modeling of Total Healthcare Costs Using Pharmacy Claims Data
More Predictive Modeling of Total Healthcare Costs Using Pharmacy Claims Data
 
Utilizing Care Management Nurses to Improve Transitions in Care in the Oupati...
Utilizing Care Management Nurses to Improve Transitions in Care in the Oupati...Utilizing Care Management Nurses to Improve Transitions in Care in the Oupati...
Utilizing Care Management Nurses to Improve Transitions in Care in the Oupati...
 
Utilizing Care Management Nurses to Improve Transitions in Care in the Oupati...
Utilizing Care Management Nurses to Improve Transitions in Care in the Oupati...Utilizing Care Management Nurses to Improve Transitions in Care in the Oupati...
Utilizing Care Management Nurses to Improve Transitions in Care in the Oupati...
 
Final dissertation
Final dissertationFinal dissertation
Final dissertation
 
Prescription auditing
Prescription auditingPrescription auditing
Prescription auditing
 
Consumer health: time for a regulatory re-think?
Consumer health: time for a regulatory re-think?Consumer health: time for a regulatory re-think?
Consumer health: time for a regulatory re-think?
 
BioTech Medical Solutions - Pain RD short 8.5x11
BioTech Medical Solutions - Pain RD short 8.5x11BioTech Medical Solutions - Pain RD short 8.5x11
BioTech Medical Solutions - Pain RD short 8.5x11
 

Recently uploaded

Use Cases & Benefits of RPA in Manufacturing in 2024.pptx
Use Cases & Benefits of RPA in Manufacturing in 2024.pptxUse Cases & Benefits of RPA in Manufacturing in 2024.pptx
Use Cases & Benefits of RPA in Manufacturing in 2024.pptx
SynapseIndia
 
Premium Girls Call Mumbai 9920725232 Unlimited Short Providing Girls Service ...
Premium Girls Call Mumbai 9920725232 Unlimited Short Providing Girls Service ...Premium Girls Call Mumbai 9920725232 Unlimited Short Providing Girls Service ...
Premium Girls Call Mumbai 9920725232 Unlimited Short Providing Girls Service ...
shanihomely
 
UX Webinar Series: Drive Revenue and Decrease Costs with Passkeys for Consume...
UX Webinar Series: Drive Revenue and Decrease Costs with Passkeys for Consume...UX Webinar Series: Drive Revenue and Decrease Costs with Passkeys for Consume...
UX Webinar Series: Drive Revenue and Decrease Costs with Passkeys for Consume...
FIDO Alliance
 
Tailored CRM Software Development for Enhanced Customer Insights
Tailored CRM Software Development for Enhanced Customer InsightsTailored CRM Software Development for Enhanced Customer Insights
Tailored CRM Software Development for Enhanced Customer Insights
SynapseIndia
 
MAKE MONEY ONLINE Unlock Your Income Potential Today.pptx
MAKE MONEY ONLINE Unlock Your Income Potential Today.pptxMAKE MONEY ONLINE Unlock Your Income Potential Today.pptx
MAKE MONEY ONLINE Unlock Your Income Potential Today.pptx
janagijoythi
 
Retrieval Augmented Generation Evaluation with Ragas
Retrieval Augmented Generation Evaluation with RagasRetrieval Augmented Generation Evaluation with Ragas
Retrieval Augmented Generation Evaluation with Ragas
Zilliz
 
Acumatica vs. Sage Intacct vs. NetSuite _ NOW CFO.pdf
Acumatica vs. Sage Intacct vs. NetSuite _ NOW CFO.pdfAcumatica vs. Sage Intacct vs. NetSuite _ NOW CFO.pdf
Acumatica vs. Sage Intacct vs. NetSuite _ NOW CFO.pdf
BrainSell Technologies
 
Finetuning GenAI For Hacking and Defending
Finetuning GenAI For Hacking and DefendingFinetuning GenAI For Hacking and Defending
Finetuning GenAI For Hacking and Defending
Priyanka Aash
 
Vulnerability Management: A Comprehensive Overview
Vulnerability Management: A Comprehensive OverviewVulnerability Management: A Comprehensive Overview
Vulnerability Management: A Comprehensive Overview
Steven Carlson
 
Using LLM Agents with Llama 3, LangGraph and Milvus
Using LLM Agents with Llama 3, LangGraph and MilvusUsing LLM Agents with Llama 3, LangGraph and Milvus
Using LLM Agents with Llama 3, LangGraph and Milvus
Zilliz
 
Acumatica vs. Sage Intacct _Construction_July (1).pptx
Acumatica vs. Sage Intacct _Construction_July (1).pptxAcumatica vs. Sage Intacct _Construction_July (1).pptx
Acumatica vs. Sage Intacct _Construction_July (1).pptx
BrainSell Technologies
 
Russian Girls Call Navi Mumbai 🎈🔥9920725232 🔥💋🎈 Provide Best And Top Girl Ser...
Russian Girls Call Navi Mumbai 🎈🔥9920725232 🔥💋🎈 Provide Best And Top Girl Ser...Russian Girls Call Navi Mumbai 🎈🔥9920725232 🔥💋🎈 Provide Best And Top Girl Ser...
Russian Girls Call Navi Mumbai 🎈🔥9920725232 🔥💋🎈 Provide Best And Top Girl Ser...
bellared2
 
The Impact of the Internet of Things (IoT) on Smart Homes and Cities
The Impact of the Internet of Things (IoT) on Smart Homes and CitiesThe Impact of the Internet of Things (IoT) on Smart Homes and Cities
The Impact of the Internet of Things (IoT) on Smart Homes and Cities
Arpan Buwa
 
Generative AI Reasoning Tech Talk - July 2024
Generative AI Reasoning Tech Talk - July 2024Generative AI Reasoning Tech Talk - July 2024
Generative AI Reasoning Tech Talk - July 2024
siddu769252
 
Step-By-Step Process to Develop a Mobile App From Scratch
Step-By-Step Process to Develop a Mobile App From ScratchStep-By-Step Process to Develop a Mobile App From Scratch
Step-By-Step Process to Develop a Mobile App From Scratch
softsuave
 
Girls call Kolkata 👀 XXXXXXXXXXX 👀 Rs.9.5 K Cash Payment With Room Delivery
Girls call Kolkata 👀 XXXXXXXXXXX 👀 Rs.9.5 K Cash Payment With Room Delivery Girls call Kolkata 👀 XXXXXXXXXXX 👀 Rs.9.5 K Cash Payment With Room Delivery
Girls call Kolkata 👀 XXXXXXXXXXX 👀 Rs.9.5 K Cash Payment With Room Delivery
sunilverma7884
 
Computer HARDWARE presenattion by CWD students class 10
Computer HARDWARE presenattion by CWD students class 10Computer HARDWARE presenattion by CWD students class 10
Computer HARDWARE presenattion by CWD students class 10
ankush9927
 
Google I/O Extended Harare Merged Slides
Google I/O Extended Harare Merged SlidesGoogle I/O Extended Harare Merged Slides
Google I/O Extended Harare Merged Slides
Google Developer Group - Harare
 
Mule Experience Hub and Release Channel with Java 17
Mule Experience Hub and Release Channel with Java 17Mule Experience Hub and Release Channel with Java 17
Mule Experience Hub and Release Channel with Java 17
Bhajan Mehta
 
Communications Mining Series - Zero to Hero - Session 3
Communications Mining Series - Zero to Hero - Session 3Communications Mining Series - Zero to Hero - Session 3
Communications Mining Series - Zero to Hero - Session 3
DianaGray10
 

Recently uploaded (20)

Use Cases & Benefits of RPA in Manufacturing in 2024.pptx
Use Cases & Benefits of RPA in Manufacturing in 2024.pptxUse Cases & Benefits of RPA in Manufacturing in 2024.pptx
Use Cases & Benefits of RPA in Manufacturing in 2024.pptx
 
Premium Girls Call Mumbai 9920725232 Unlimited Short Providing Girls Service ...
Premium Girls Call Mumbai 9920725232 Unlimited Short Providing Girls Service ...Premium Girls Call Mumbai 9920725232 Unlimited Short Providing Girls Service ...
Premium Girls Call Mumbai 9920725232 Unlimited Short Providing Girls Service ...
 
UX Webinar Series: Drive Revenue and Decrease Costs with Passkeys for Consume...
UX Webinar Series: Drive Revenue and Decrease Costs with Passkeys for Consume...UX Webinar Series: Drive Revenue and Decrease Costs with Passkeys for Consume...
UX Webinar Series: Drive Revenue and Decrease Costs with Passkeys for Consume...
 
Tailored CRM Software Development for Enhanced Customer Insights
Tailored CRM Software Development for Enhanced Customer InsightsTailored CRM Software Development for Enhanced Customer Insights
Tailored CRM Software Development for Enhanced Customer Insights
 
MAKE MONEY ONLINE Unlock Your Income Potential Today.pptx
MAKE MONEY ONLINE Unlock Your Income Potential Today.pptxMAKE MONEY ONLINE Unlock Your Income Potential Today.pptx
MAKE MONEY ONLINE Unlock Your Income Potential Today.pptx
 
Retrieval Augmented Generation Evaluation with Ragas
Retrieval Augmented Generation Evaluation with RagasRetrieval Augmented Generation Evaluation with Ragas
Retrieval Augmented Generation Evaluation with Ragas
 
Acumatica vs. Sage Intacct vs. NetSuite _ NOW CFO.pdf
Acumatica vs. Sage Intacct vs. NetSuite _ NOW CFO.pdfAcumatica vs. Sage Intacct vs. NetSuite _ NOW CFO.pdf
Acumatica vs. Sage Intacct vs. NetSuite _ NOW CFO.pdf
 
Finetuning GenAI For Hacking and Defending
Finetuning GenAI For Hacking and DefendingFinetuning GenAI For Hacking and Defending
Finetuning GenAI For Hacking and Defending
 
Vulnerability Management: A Comprehensive Overview
Vulnerability Management: A Comprehensive OverviewVulnerability Management: A Comprehensive Overview
Vulnerability Management: A Comprehensive Overview
 
Using LLM Agents with Llama 3, LangGraph and Milvus
Using LLM Agents with Llama 3, LangGraph and MilvusUsing LLM Agents with Llama 3, LangGraph and Milvus
Using LLM Agents with Llama 3, LangGraph and Milvus
 
Acumatica vs. Sage Intacct _Construction_July (1).pptx
Acumatica vs. Sage Intacct _Construction_July (1).pptxAcumatica vs. Sage Intacct _Construction_July (1).pptx
Acumatica vs. Sage Intacct _Construction_July (1).pptx
 
Russian Girls Call Navi Mumbai 🎈🔥9920725232 🔥💋🎈 Provide Best And Top Girl Ser...
Russian Girls Call Navi Mumbai 🎈🔥9920725232 🔥💋🎈 Provide Best And Top Girl Ser...Russian Girls Call Navi Mumbai 🎈🔥9920725232 🔥💋🎈 Provide Best And Top Girl Ser...
Russian Girls Call Navi Mumbai 🎈🔥9920725232 🔥💋🎈 Provide Best And Top Girl Ser...
 
The Impact of the Internet of Things (IoT) on Smart Homes and Cities
The Impact of the Internet of Things (IoT) on Smart Homes and CitiesThe Impact of the Internet of Things (IoT) on Smart Homes and Cities
The Impact of the Internet of Things (IoT) on Smart Homes and Cities
 
Generative AI Reasoning Tech Talk - July 2024
Generative AI Reasoning Tech Talk - July 2024Generative AI Reasoning Tech Talk - July 2024
Generative AI Reasoning Tech Talk - July 2024
 
Step-By-Step Process to Develop a Mobile App From Scratch
Step-By-Step Process to Develop a Mobile App From ScratchStep-By-Step Process to Develop a Mobile App From Scratch
Step-By-Step Process to Develop a Mobile App From Scratch
 
Girls call Kolkata 👀 XXXXXXXXXXX 👀 Rs.9.5 K Cash Payment With Room Delivery
Girls call Kolkata 👀 XXXXXXXXXXX 👀 Rs.9.5 K Cash Payment With Room Delivery Girls call Kolkata 👀 XXXXXXXXXXX 👀 Rs.9.5 K Cash Payment With Room Delivery
Girls call Kolkata 👀 XXXXXXXXXXX 👀 Rs.9.5 K Cash Payment With Room Delivery
 
Computer HARDWARE presenattion by CWD students class 10
Computer HARDWARE presenattion by CWD students class 10Computer HARDWARE presenattion by CWD students class 10
Computer HARDWARE presenattion by CWD students class 10
 
Google I/O Extended Harare Merged Slides
Google I/O Extended Harare Merged SlidesGoogle I/O Extended Harare Merged Slides
Google I/O Extended Harare Merged Slides
 
Mule Experience Hub and Release Channel with Java 17
Mule Experience Hub and Release Channel with Java 17Mule Experience Hub and Release Channel with Java 17
Mule Experience Hub and Release Channel with Java 17
 
Communications Mining Series - Zero to Hero - Session 3
Communications Mining Series - Zero to Hero - Session 3Communications Mining Series - Zero to Hero - Session 3
Communications Mining Series - Zero to Hero - Session 3
 

Medication Safety

  • 1. Spotlight Case November 2005 Reconciling Doses
  • 2. Source and Credits This presentation is based on the November 2005 Spotlight Case in Emergency Medicine See the full article at http://webmm.ahrq.gov CME credit is available through the Web site Commentary by: Frank Federico , RPh , Director, Institute for Healthcare Improvement Editor, AHRQ WebM&M: Robert Wachter, MD Spotlight Editor: Tracy Minichiello, MD Managing Editor: Erin Hartman, MS
  • 3. Objectives At the conclusion of this educational activity, participants should be able to: List the steps involved in medication reconciliation Describe the role of each of the stakeholders in medication reconciliation Discuss how medication reconciliation decreases the opportunity for medication errors and harm
  • 4. Case: Reconciling Doses A 68-year-old man with a history of diabetes and atrial fibrillation (maintained on warfarin) presented to the emergency department (ED) with fever and mental status change. Lumbar puncture was attempted three times without success; empiric treatment for meningitis was started. Further examination revealed an area of cellulitis, and intravenous antibiotic therapy was changed accordingly.
  • 5. Case (cont.): Reconciling Doses At the time of admission, the patient was unable to recite his medication list, and his wife was unclear about the doses. However, the EMS run-sheet had a list of the patient’s medication and doses. The patient was started on the medication regimen per the EMS report.
  • 6. Medication Reconciliation The process of collecting the best medication history possible, verifying that list, and comparing it with orders written at admission, transfer, and discharge Ensures each member of health care team has access to a list of home medications and what was ordered at transitions in levels of care Provides a method to communicate when an intentional medication change is made
  • 7. Medication Reconciliation: The Data More than one half of medication errors occur at the interfaces of care Up to 67% of cases had errors in prescription medication histories An average of 10 prescriptions needed to be changed weekly in the ICU as a result of implementing a reconciliation process Rozich JD, Resar RK. JCOM. 2001;8(10):27-34. Tam VC, et al. CMAJ 2005;173:510-515. Pronovost P. J Crit Care. 2003;18:201-205.
  • 8. Medication Reconciliation Recommended change for teams participating in IHI collaboratives to reduce adverse drug events One of six changes chosen by the 100,000 Lives Campaign to improve patient care and prevent avoidable deaths JCAHO selected medication reconciliation as one of the National Patient Safety Goals 100K Lives Campaign. IHI Web site. National Patient Safety Goals for 2006 and 2005. JCAHO Web site.
  • 9. Case (cont.): Reconciling Doses After 2 days, the patient was transitioned to Augmentin. While in hospital, the patient had been receiving 5 mg of warfarin at bedtime, which, according to the EMS intake sheet, was his usual outpatient dose. The team did not confirm this dose with the patient’s family, primary physician, or pharmacy.
  • 10. Case (cont.): Reconciling Doses At the time of discharge, the patient’s INR was noted to be 4. Realizing the warfarin dose was too high, the team instructed him to decrease his dose to 3 mg at bedtime and to have his INR rechecked in 3 days. After 3 days, his INR was 10. He was treated with vitamin K.
  • 11. Case (cont.): Reconciling Doses Two days later, the patient returned to the ED with back pain, lower extremity weakness, and incontinence. He was found to have an epidural hematoma. The hematoma was emergently evacuated. One week post-operatively, the patient still had neurologic deficit.
  • 12. Starting a Medication Reconciliation Program Identify a champion and a multidisciplinary team to work on testing changes that will lead to the desired system Ensure senior leadership support Secure commitment for resources for the project during its development Start with a small sample of the hospital population
  • 13. Recruiting Medication Reconciling Team Multidisciplinary team should include: Executive sponsor Physician champion Nursing leader, staff nurse Pharmacy leader, pharmacy support Patient safety/QI representative Staff education representative Other group representatives (see form) Team planning form available here Massachusetts Coalition for the Prevention of Medical Errors.
  • 14. Examine the system currently in place Use high-level flow diagram to determine the different entry points into the hospital Use similar diagram for transfers and discharges Use a proven improvement methodology (eg, Model for Improvement) to test and implement changes Developing a Medication Reconciliation Program Plsek PE. Pediatrics. 1999;103 (suppl):203-214. Model for Improvement. IHI Web site.
  • 15. Developing the Reconciliation Process Identify who should participate in each step and define the responsibility of each position Medication history can be completed by a physician, nurse, pharmacist, or pharmacy technician Base decision on available resources Pharmacists found to be more effective in taking medication history but may train others to do so Michels RD, Meisel SB. Am J Health Syst Pharm. 2003;60:1982-1986. Nester TM, Hale LS. Am J Health Syst Pharm. 2002;59:2221-2225.
  • 16. Potential Reconciliation Model RN collects medication history Pharmacist verifies information Physicians use the list to aid in decisions about drug therapy and document reasons to discontinue, change, or hold medications
  • 17. Medication Reconciliation Forms Most organizations use forms Often adapted to serve as order form Columns can indicate whether medication should be continued, discontinued, or placed on hold Place the list prominently in the chart or use colored paper to facilitate access to information Hospitals must determine if these changes introduce new opportunities for errors
  • 18. Example Reconciliation Form http://www.macoalition.org/Initiatives/RecMeds/CooleyDickinsonReconcilForm.doc
  • 19. Example Form (cont.) http://www.macoalition.org/Initiatives/RecMeds/CooleyDickinsonReconcilForm.doc
  • 20. Another Reconciliation Form http://www.macoalition.org/Initiatives/RecMeds/CaritasNorwoodReconcilForm.doc
  • 21. Another Form (cont.) http://www.macoalition.org/Initiatives/RecMeds/CaritasNorwoodReconcilForm.doc
  • 22. More Example Forms and Tools Massachusetts Coalition for the Prevention of Medical Errors Reconciling medication toolkit Institute for Healthcare Improvement Medication reconciliation tools
  • 23. Medication Reconciliation: Technology Linking electronic medical records to download medication histories onto a form reduces the number of steps and the need to manually complete form At discharge, reformatting the medication profile from the pharmacy system onto a prescription form can efficiently generate discharge prescriptions
  • 24. Evaluate Reconciliation Success Use a measurement strategy to determine program’s effectiveness Assessment form available here Collecting data per admission or chart may help determine if reconciliation is occurring Information about the percent of unreconciled medications at different transfer points can identify how well the process is working
  • 25. Medication Reconciliation: Role of the Patient Patients can be active participants in medication reconciliation Organizational level: One health system has engaged patients in developing a statewide universal medication form Individual level: Carry up-to-date medication list and present it at each health care visit Patient medication card available here Medication Reconciliation can Save Your Life. McLeod Health Web site.
  • 26. How to Perform Medication Reconciliation Collect the best medication list possible If patient is unable to provide list, interview family members and contact primary physician or local pharmacy Complete medication reconciliation at each transition of care At discharge, reconcile prescriptions with most recent inpatient orders and patient medication list prepared at admission
  • 27. Take-Home Points Medication reconciliation is an effective process to reduce errors and harm associated with loss of medication information at transitions in care Collect the 'best' medication history possible; use open-ended questions when taking a medication history Patients can play a vital role in this process by carrying up-to-date medication list
  • 28. Take-Home Points Hospitals should develop medication reconciliation processes based on patient entry points and available resources Medication reconciliation should be applied whenever medication orders are rewritten or whenever there is a change in treatment plan or level of care For medication reconciliation to be successful, all stakeholders must be involved