Start to Finish
Medication
Reconciliation
Raymond Fung MD
Andrew Liu RPh
Toronto East General Hospital
May 27, 2013
Disclosures
• Raymond Fung – none
• Andrew Liu - none
Outline
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Introduction
Medication reconciliation setup
Results
Success factors and challenges
Future directions
• Single site community teaching
hospital serving southeast Toronto
• TEGH has over 2,500 employees and 400
physicians
Inpatient Care
Beds
Patients admitted
Cerner - CPOE (2009)
510
14,673
Medication Reconciliation
• Systematic way to prevent medication
errors at transition points
– Best possible medication history (BPMH)
– Examine/update list at admission,
transfer, and discharge
– Effective communication of list to patient
and next care provider at points of
transfer/discharge
Why Medication Reconciliation
• Medication Errors are common!
• ISMP Canada
– Voluntary medication incident reports
– 30612 (2000-2008), 1169 caused harm
or death
• 67% prescription medication histories
have errors
• 46% medication errors occur on
admission or discharge
Dialogue, December 2008
Medication Reconciliation
• 3 hospitals in Massachusetts
– 85% reduction in medication errors over
10 months
• Provides opportunity to reconsider
appropriateness of patient’s
medications and reduce polypharmacy
• Required Organizational Practice
(ROP) – Accreditation Canada
• Safer Healthcare Now priority
Dialogue, December 2008
Admission Med Reconciliation
Process
Med Rec Process – 1.Document BPMH
Completed Medication History
2. Add Admission PowerPlan
3. Admission Reconciliation
Admission Reconciliation Screen
Discharge Reconciliation Screen
Completed D/C Reconciliation
Prescriptions and Med Discharge Report
• Print out prescriptions
– Signature
– Included CPSO No.
– Limited use code
• Medication Discharge Report
– Instructions for patient to know which medications
to continue at home/stop, etc
– Can take it to their family physicians, pharmacy
Prescription
Custom Report: Medication Discharge Report
Challenges
• Build challenges
– Preferences not honored
• Discont’d, compl’d meds still showed
• Orders package broke PowerPlan build tools
– Accuracy of Discharge Medication Report
– Prescription printing
• Resend
• End user adoption
– Ease of use a barrier: dispense quantity,
updating BPMH
– End user expectations have increased
– Use was not mandated
How are we doing?
Medication History Completion
Medication History Frontline Report
Discharge Reconciliation -Trends
D/C Med Rates by Dept – Mar 2013
Success Factors
• Multidisciplinary team
– Pharmacists
– Physician assistants
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Physician champions -specific
Integrated electronic process and reports
Reporting rates at departmental meetings
Timely reporting of real-time metric and
goal to frontline staff
• Competition –participation in CHI
ImagiNation Challenge
Challenges
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Residents
Engaging different physician groups
Sustain enthusiasm
Technical
– Outpatient/inpatient/conversion
– Dispense quantity
– Customizing to provincial formulary (LU)
Future Directions
• Expanded ambulatory clinic areas
• Expand into other inpatient areas
• Incorporation into depart process/ discharge
summary
• Relook at technical challenges
• Optimization of admission
BPMH/reconciliation workflow
• Prioritize and measure med rec in high risk
populations
Acknowledgements
• eChart team
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Karen Hunter
Owen Osmond
Tina Price
Pegi Rappaport
• Pharmacy
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Valerie Leung
Jessica Ma
Kieu Mach
Carmine Stumpo
Questions
For more information:
Toronto East General Hospital
825 Coxwell Ave.
Toronto, Ontario
M4C 3E7
Tel: (416) 461-8272
www.tegh.on.ca
Fax: (416) 469-6106
Above all,
we care.