Medication Reconciliation in Continuing Care

Medication Reconciliation in Continuing Care

Getting It Right TogetherCreating a Culture of Safety

September 8, 2008

Dr. Paula Creighton MD, FRCP(C)Geriatric Medicine Specialist

Cape Breton District Health Authority

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Outline

Understand why Medication Reconciliation

is getting so much attention through:

• Understanding how adverse drug events (ADEs) commonly occur

• Identify practical steps that can reduce the risk of ADEs in practice

• Identify key features of a safer system

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Definition Adverse Event

• UNINTENDED act or event during care

• May result in potential harm

• Harm = increase length of stay

= temporary/permanent disability

= death

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How ADEs occur?

• Increase range of medicines to treat or prevent disease

• Multiple co-morbid conditions

• Age-related changes physiology

Tsilimingras, Rosen, &. Berlowitz 2003.

Canadian Patient Safety (CPSI) Institute 2006

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How ADEs occur?

• Multiple health care practitioners

• Frequent visit to hospital setting (hospitalization, procedures, tests)

• Adherence problems

Tsilimingras, Rosen, &. Berlowitz 2003.

Canadian Patient Safety (CPSI) Institute 2006

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How ADEs occur?

• OTC medication use

• Impaired vision, dexterity, literacy

Tsilimingras, Rosen, &. Berlowitz 2003.

Canadian Patient Safety (CPSI) Institute 2006

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When ADEs occur?

• Entry and exit points of clinical encounters

Cornish P. et al Arch Intern Med 2005:165; 424-429

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• Labels

• Lists

• Verbal (open ended inquiry)

• Someone else has/will complete

Traditional Medication History

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Limitations to Traditional Medication History

Discrepancies:

• Unintentional

• Undocumented Intentional

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Unintentional Discrepancies

•Over-the-counter medications

•Shared prescriptions

•Labels “as directed”

•Prescription change without script

•Samples

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Undocumented Intentional Discrepancies

• What changed and why?

• Convey a clear understanding of desired outcomes to therapy.

• Written communication with patient/family and pharmacist

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Get Involved

Now!safer healthcare

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Key Features toward a Safer System

Change

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Key for a Safer System

•Doing our jobs differently…

…If you always do what you have always done;

You always will get what you always got

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Practical steps to reduce risk of ADEs

• “To prescribe according to best evidence from scientific research and to be mindful of the precepts of patient autonomy”

Holland R, Wright D. Medication Review for Older Adults. Geriatrics and Aging March 2006, Vol 9. No.3.

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Practical steps to reduce risk of ADEs

• When might it be best to withhold or discontinue medications that are otherwise appropriate on the basis of guidelines?

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Practical steps to reduce risk of ADEs

• Consider life expectancy

• Goals of care and quality of life defined by patient/family

• Potential benefit & risk of medications

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Practical steps to reduce risk of ADEs

Start low,

Go slow,

Or don’t start at all!

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Practical steps to reduce risk of ADEs

Partnering with Patients

“Nothing about me, without me”

(author unknown)

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Medication Reconciliation

Partnering with Patients

• patient/family interview

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Practical steps to reduce risk of ADEs

• Humans require formal cues/processes to stay on track reliably

• Reliable work processes account for the known imperfections of humans

Adapted from PSO Training Course (IHI) 2004

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Medication ReconciliationMEDICATION RECONCILIATION: include on list below Over the counter products, Samples, Shared pills

Drug NameDrug

Strength

When Taken

Indicate if: -New-Change from label-Effects from new and change

Morning Noon Evening Bedtime

1  

2  

3  

4  

5  

6  

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Threats for Change toward a Safer System

• Power Gradient

• Fear

• (Mis)-Perception “touchy, feely” initiatives

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Key for Change toward a Safer System

Self audit:

• More mirrors and fewer windows

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Self Audit

• "One of the major impediments to convincing people of the prevalence and seriousness of cognitive error is the faith they have in their own thinking abilities"

Croskerry, P. The Science of Human Factors in Healthcare, QHN, October 2003

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Key for Change toward a Safer System

“ Many little people

Doing many little things

In many little places

Can change the world.”(Chinese Proverb; author unknown)

Susan Sheridan, Chair, Patients for Patient Safety Strand, WHO World Alliance for Patient Safety; Co-Founder, Consumers Advancing Patient Safety, Eagle, Idaho

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Get Involved

Now!safer healthcare