Dr. Helen Chen1, Kevin Quach1,2, Dr. Ian MacKillop1, Dr. Joseph Kim2
1 University of Waterloo
2 University Health Network
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Faculty: Dr. Helen Chen, PhD
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Relationships with commercial interests:
 None
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Challenges of patient drug management in
transplantation
Drug standardization strategies
Lessons learned and continuous discovery
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Standard for safe medication practices
 Five rights: Patient, drug, time, dose, and route
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Patient safety
 Incomplete information about patient’s
medications
 Knowledge deficit leading to administration of
wrong dose or use of wrong route
 Serious drug interaction unknown or overlooked
Source: Medication Errors, Cohen, 2006
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Need to precisely manage patient
medications in the continuum of care
Lack of standard drug nomenclature
Lack of information management process
Interoperability of multiple drug information
systems
Fast evolving of drug products and variations
of nomenclature
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Recognized and took action to resolve a medication
information problem
Established a working committee (physicians,
nurses, pharmacists, IT specialists, IT admin)
Consulted with standardized drug databases (e.g.
Health Canada, SNOMED, RxNorm)
Established medication standardization strategies
Developed a data governance policy for future
maintenance of drug database
1. Removing non-prescribed drugs from drug database
2. Correcting misspelled drug names
3. Mapping drug name with drug formula and strength
4. Removing unnecessary use of chemical salts
5. Distinguishing between brand name and generic name medications
6. Correcting combination drug nomenclature
7. Adhering to Health Canada drug nomenclature standards
8. Identifying drug acronyms and other variations
9. Proper labeling study medications
10. Identifying limited use medications
Medication name
Medication name
Venlaxafine
venlaxafine
Venlaxafine Cap XR 150 mg
Venlaxafine Cap XR 75 mg
Venlaxafine Cap XR 37.5 mg
Venlaxafine Tab 37.5 mg
Venlaxafine Tab 75mg
Brand name
Effexor XR
Effexor
Formulation
37.5 mg capsule
37.5 mg tablet
Solution
Drug formula and dosage information will be retained in separate tables from
medication name
Medication name
Tylenol
Generic name
acetaminophen
Brand name
Tylenol
Prograf
tacrolimus
Prograf
Solution
Merging brand name information to the corresponding generic name
Medication Name
hydroxyephedrine w/ normethadone
Proposed Correction
hydroxyephedrine - normethadone
Piperacillin, tazobactam
piperacillin - tazobactam
Other problems
Specifying doses of each drug ingredient in combination drugs
Solution
Using a dash (-) to separate drug ingredients in combination medications
Medication Name
Prograf – LU #173
Proposed Correction
Prograf
Valacyclovir LU #159
Valacyclovir
Problem
• Limited use medications are offered under the Ontario Drug Benefit Program for
specific situations as for a particular medical condition and/or for a limited period
of time (Source: Ontario Ministry of Health and Long-Term Care)
• Physicians are required to review the criteria before writing the three-digit code
Solution
• Removing LU codes from medication names
• Implementing an alert system to notify physicians when LU medications are being
added to patient chart
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VID list
 List of medications to import all updated brand
name medication information
 Medications included
▪ Frequently recorded medications (e.g. acetaminophen)
▪ Immunosuppressants (e.g. cyclosporine, MMF)
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Synchronization tool with Health Canada
All medication
entries (n=3189)
Non-prescribed
entries (n=1112)
Prescribed
entries (n=2077)
Strategy
Action identified
Mapping drug name with drug formula and strength
643 (31%)
Distinguishing between brand name and generic name
medications
228 (11%)
Correcting misspelled drug names
145 (7%)
Removing unnecessary use of chemical salts
124 (6%)
Correcting combination drug nomenclature
81 (4%)
Sorting study medications
103 (5%)
Limited use medications
18 (0.7%)
Other
91 (4.3%)
No change needed
644 (31%)
Total
2077
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Aforementioned challenges continue to exist
Solutions
 Understand importance of drug nomenclature
standardization and adhere to strategies
 Develop robust processes to regulate changes
 Construct technological tools to perform updates