Medication Medication Reconciliation: Reconciliation: Pharmacy Integrated Model Pharmacy Integrated Model Steve A. Carlson, RPh Sara E. Grove, Pharm.D. Northeast Georgia Health System (NGHS) Gainesville, Georgia Best Practice Power Hour Best Practice Power Hour
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Medication Reconciliation: Pharmacy Integrated Model Steve A. Carlson, RPh Sara E. Grove, Pharm.D. Northeast Georgia Health System (NGHS) Gainesville,
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Medication Reconciliation:Medication Reconciliation:Pharmacy Integrated Pharmacy Integrated Model Model
Steve A. Carlson, RPhSara E. Grove, Pharm.D.
Northeast Georgia Health System (NGHS)Gainesville, Georgia
Best Practice Power HourBest Practice Power Hour
NGHSNGHS
Private, not-for-profit, community Accredited by DNV 557 inpatient beds 261 skilled nursing beds Serves almost 700,000 people in more
January 2006: Nurse Managers Interviewed March 2006: Base-Line Survey Conducted May 2006: Results Presented May 2006: Pilot on 2 Floors Conducted July 2006: Proposal Presented & Approved November 2006: Initial Deployment February 2007: Full Implementation March 2007: Survey Repeated May 2007: Results Presented July–August 2007: Focus Groups Met
Initial FTE RequirementsInitial FTE Requirements
7.6 FTE’s; 10 hour shifts 7on / 7off Open pharmacist position (1 FTE)
converted to 2.8 FTE’s Redeployed 2.0 FTE’s Requested a net of 2.8 new FTE’s
Initial UBT AssignmentsInitial UBT Assignments
UBT ResponsibilitiesUBT Responsibilities
Delivery of medications directly to nurse or nurse server
Resolution of missing medications Facilitating transfer of medications
on/off unit with patient Removal/return of discontinued meds Automated Dispensing Cabinet
troubleshooting/restock
UBT ResponsibilitiesUBT Responsibilities
Delivery of cart fill to nurse server Med error/ADR reporting to
pharmacist Notification of allergy/height/ weight Monthly nursing unit inspections Assistance with faxing of orders Obtain new orders from units and
expedite medication needs
Customer Service SurveyCustomer Service Survey
2006 2007
Pharmacy Customer Service SurveyPharmacy Customer Service SurveyAll Nursing Units - Medical Center
Pharmacy Customer Service SurveyPharmacy Customer Service Survey
2006 2007
Areas Serviced by Unit-Based Technicians - Medical Center
Survey Comments and Survey Comments and SuggestionsSuggestions
“These techs are the smartest thing I’ve seen around here in a long time. They are beyond measure – an asset to having quality – acceptable nursing care.”
“Excellent teamwork – assists nurses to complete essential nursing tasks & focus on this vs. non-nursing duties.”
“Go unit based techs! You rock.”
Survey Comments and Survey Comments and SuggestionsSuggestions
“Still have a problem with medication missing, but turn around time to get it is much better.”
“The morning meds that are due before breakfast…are scheduled at 0730 and this isn’t working well. By the time we get out of report, the breakfast trays have already been passed. Can these meds please be scheduled for 0630?”
• Interview patient at admission• Document home medication list• Print list for physician to address
Discharge• Document discharge medication list as
specified by physician orders• Notify nurse of discrepancies
Technician TrainingTechnician Training
Software• Demonstrate Proficiency in Entry
Procedure• Identify Discrepancies
Communication• Demonstrate Appropriate Body Language
• Review Principle
• Identify Barriers
Pilot: Heart FailurePilot: Heart Failure
Pharmacist Pre-Pilot• October to Mid-December 2008
Locations• Emergency Department
• 3 Medical/Cardiac Inpatient Units
Redistribution of Workload• Reduced # Beds/UBT
• Added 3 Positions per Week
Pilot UBT AssignmentsPilot UBT Assignments
Pharmacy-Based Medication Reconciliation PilotPharmacy-Based Medication Reconciliation PilotStarts December 16Starts December 16thth
Floors Participating: S3E S4D S4E ED
1) To improve patient safety and care by striving to optimize the medication reconciliation process2) To demonstrate improvement through increased Heart Failure Core Measure scores
Goals:
Here to Help
Rx
•Interview admitted patients and document current home medication list
•If medication history is needed immediately and a pharmacy technician is not available, collect and document current home medication list
•Record “MD Discharge Medication Orders” in Clinical Profile
•Resolve discrepancies with physician
Pharmacy Tech Duties Nurse DutiesAdmission
Discharge
•Print “Admission Medication List” and attach it to the chart
•Notify nursing of any discrepancies
•Sign “MD Discharge Medication Orders” to indicate completion
•Counsel the patient on discharge medications and instructions•Sign “Patient Discharge Medication List”
Coverage from 0700-2300Coverage from 0700-2300
•Late admissions will be completed the following morning
•Review and sign off “MD Discharge Medication Orders”
Opportunities for Opportunities for ImprovementImprovement
Nurse/Technician Clarifications Developed a formal discrepancy form
Discharge Summary Development of electronic bridge
Improperly Completed Forms Form revision
Discrepancy ReasonsDiscrepancy Reasons
Therapeutic Interchange New Prescription Duplicate Therapy Medication Not Addressed No Prescription Inappropriate Form Completion Inappropriate Alteration of Form
Medication Reconciliation:Medication Reconciliation:Pharmacy Integrated Pharmacy Integrated Model Model
Steve A. Carlson, RPhSara E. Grove, Pharm.D.
Northeast Georgia Health System (NGHS)Gainesville, Georgia