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Bridging Medication Across Settings of Care Richard Ricker, RPH, MBA Sparrow Hospital Barbara J....
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Transcript of Bridging Medication Across Settings of Care Richard Ricker, RPH, MBA Sparrow Hospital Barbara J....
Bridging Medication Across Settings of Care
Richard Ricker, RPH, MBASparrow Hospital
Barbara J. Smith, LBSW, MS, CHC, NHABurcham Hills
DATE: May 29, 2013
We have no conflict of interest to declare.
We do not have any relevant financial relationships with any commercial interests.
Define the focus of medication reconciliationDescribe the process and outcomes of the
Sparrow, Burcham Hills “Bridging Medications Project”
OBJECTIVES
Medication errors are perhaps the most common patient safety errors.
Unintended medication discrepancies occur in nearly one-third of patients at admission.
Unintended medication discrepancies occur in 14% of patients at hospital discharge.
Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med. 2005;165:424-429
Medication Reconciliation
The Focus is on global patient safety and improved patient outcomes.
Is composed of multiple processes that:o reduce medication errorso support safe medication use by patientso encourages community-based providers and
those practicing in health systems to collaborate
o promotes overall continuity of patient care.
Focus of Medication Reconciliation:
Both organizations are members of the Community Collaborative “Capital Area Collaborative for Care Transitions”
Burcham participates on the Sparrow Hospital sponsored “Skilled Nursing Facility Readmissions” group
Richard and Barbara identified a common interest and began work to design a pilot to address medication reconciliation at transition
The Sparrow/Burcham Project
Time spent by admissions nurse to reconcile medications 3 different documents sent from hospital with
conflicting medication listsLimited access to a contact at hospital to verify
medication orders Client dissatisfaction with medication availability
at admission to Burcham Missing C-II scripts resulting in inability to provide
timely pain medication administration
Motivating Factors for Burcham Hills
Improve discharge medication reconciliation process
Provide 48-hour medication “bridge” to allow for smoother transition of patients from hospital to skilled nursing facility
Reduce 30-day readmissions
Motivating Factors for Sparrow
Agreement that there was improvement opportunity
Agreement that patient outcomes were each setting’s responsibility during transition
Identified a “One Source of Truth” both settings would acknowledge
Agreed upon process and outcome measures
Our Planning Process
When discharge to Burcham Hills is confirmed:1. Pharmacy Technician prints “After Visit Summary” (AVS)2. Reconciles Discharge Medication List.3. Contacts MD for Controlled Substance (i.e. C-II) Prescriptions for
Burcham Hills and Sparrow Hospital.4. Fills 48-hour supply of medication(unit-dose) not stocked in
automated dispensing cabinets (ADCs) at Burcham Hills.5. Notes on Discharge Medication List amount of medication being
dispensed for patient.6. Places any prescriptions, medications, and Discharge
Medication List in “tamper-proof” bag for transport with patient.
Sparrow’s Process
Admission Coordinator informs medication technician of “bed offer” for a Sparrow Client activating the Sparrow process
Upon client arrival to Burcham Hills Center for Health and Rehabilitation admission nurse: Verifies content of medication packet sent with client Reviews “One source of truth” document Conducts medication reconciliation with client/family Assesses pain
Burcham’s Process
Medication Administration Record is developed that includes medications listed on after visit summary and patient home medication list.
Medications are ordered from Burcham Pharmacy for later delivery
Medications not provided by Sparrow are obtained from Pyxis system until pharmacy delivery
Burcham’s Process Continued
Initial audit of 20 charts of clients transitioned between March 15 and March 31st reveals great improvement: 20 included the After visit summary(one source
of truth) 11 had all medications reconciled including
home medications 11 medication reconciliations had complete
dose and frequency information and no duplicate orders
Interim Status Review
Initial audit of 20 charts of clients admitted between March 15 and March 31st: 8 had either duplication of orders or
inadequate instructions for administration These were charts early in new process inception
1 had handwritten notes by an unidentified source that changed medication orders after technician did reconciliation
Status Review Continued:
Admission nurses are very pleased: Agree that admission process has been
decreased 30-60 minutes per client Nurses report greater job satisfaction, lower
stress There have been zero client complaints since
starting the project Pain issues upon admission are addressed
immediately
Burcham Reactions
QUESTIONS