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2014 Silver Award Recipient

Using Real-Time Information to Grow A Medication Reconciliation Program

Adrienne Carey, PharmD BCPS Sara Freitas, PharmD

May 16, 2016

Truven is now part of IBM Watson Health, a unit of IBM dedicated to improving health and lives and reducing the cost of healthcare through the power of cognitive insights. The Road from Volume to Value

Freeman Health System, Joplin, Missouri

• Located in Southwest Missouri.
• Not-for-profit, 485-bed, 3-hospital system.
• Our team includes more than 300 physicians

representing 60 specialties.

• Serves an area of 450,000 people from

Missouri, Arkansas, Kansas, and Oklahoma.

• U.S. News & World Report recently ranked

Freeman as the #1 hospital in Southwest Missouri and #4 hospital in the state of Missouri.

What is a Medication Reconciliation Program?

• Pharmacy Medication Reconciliation Technicians (MRTs) who are

trained to gather home medication information.

• Upon admission, technicians develop a list from several sources:
• Physician’s office
• Patient’s pharmacy
• Nursing Home/Care Facility
• Patient & patient’s family
• Previous hospital admissions
• Medication bottles
• Technicians communicate this list and any changes from previous lists

to the pharmacist.

• Pharmacists communicate this information to the provider to make

clinical decisions based on the changes.

Why a Medication Reconciliation Program?

• Historically this task fell to nurses, who with their growing list of job

duties, do not have ample time to thoroughly gather this type of information.

• Since starting our data tracking in 2014, we have discovered that when

addressed by nursing, 73% of the time there were still errors in the home medication list.

• Pharmacy technicians have knowledge of medication names, standard

doses, drug classes, etc.

• In 2013, the Joint Commission made a National Patient Safety Goal to

record and pass along correct information about a patient’s home medications.

• The Centers for Medicare and Medicaid Services defines meaningful

use Stage 2 Core Measure #13 for electronic health records as medication reconciliation.

• Effecting both patient safety and reimbursement

Why a Medication Reconciliation Program?

• To Prevent Medication Errors:
• According to the Institute of Medicine’s report entitled

To Err is Human: Building a Safer Health System, “at least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have been prevented.”

• The report estimated the total costs of these errors to

be between $17 billion and $29 billion per year in hospitals nationwide.

• Reported rates of inpatient medication errors range

from 45-76% with most errors occurring on admission due to inaccuracies in medication histories and reconciliation.

Why a Medication Reconciliation Program?

• Financial Health of Health Care Institutions
• Trend towards risk-sharing reimbursement away from fee-for-

service places greater emphasis on quality outcomes and

• performance. Overall medication management throughout

continuum of care; from home to facility to home while streamlining costs.

• Medication management requires review of medications,

compliance, disease state treatment guidelines, optimizing medication use to decrease risk of readmission or worsening health.

• Presently there is no universal network of all health records and

the patient has the right to request service at any institution. There is no link between retail pharmacy, primary provider, and institution.

Freeman Health System’s Implementation Timeline

August 2013 - MRT Program began with 5 technicians who covered our ED and Cardiology Unit Nov 2014 - Migrated documentation of interventions from Meditech to Truven May 2013 – FHS Pharmacists went live with Truven Pharmacy Intervention March 2015 – MRT Program expanded to 9.5 FTE’s. First night technician begins June 2015 – began using Truven to identify patients needing addressed by auto-assigning an intervention form August 2015 - Second Night Technician begins. Emergency room now staffed 24hrs per day

Program Growth

• Expanded from 5 to 9.5 technician FTEs.
• Increased our staffing budget to $325,000 annually.
• Expanded Emergency Room coverage to 24 hours/day.
• Increased our average monthly interventions from 832 to

994 since migrating our MRT program to Truven.

• Reached $1.2 million in potential savings to our health

system from major and minor medication error prevention since tracking started through Truven.

MRT Workflow

• The Pharmacy Intervention Profile searches for all patients in our ED,

Medical, and Cardiology Unit.

• Eligible patients identified and form assigned in Pharmacy Intervention.
• MRT calls patient’s pharmacy, physician, care facility, etc to gather the

patient’s current medication information.

• MRT interviews the patient and/or family to verify the medication

information gathered.

• MRT documents information in the Pharmacy Intervention form assigned.
• Total technician time spent is typically 10-30 min per patient, although the

time from start to finish can be much longer while waiting on information from outside sources.

MRT & Pharmacist Workflow

• All information is passed off to a pharmacist to verify.
• If needed, the pharmacist contacts the physician with any

errors or issues.

• Pharmacist documents their information and/or

intervention in the form and completes it.

• Pharmacist time spent is typically about 10 min although

it can also be much longer with complicated situations.

Operation Education

• Program targeting our surgical patients.
• Intended to decrease complications, increase patient

satisfaction and understanding, and decrease length of stay.

• MRTs receive a list of future surgical patients.
• Technicians perform same data gathering process as they

do for inpatients, so that an accurate list is compiled prior to the patient arriving at our facility.

• Data is documented in Truven Intervention form.

Prior process for tracking MRT data:

• Meditech Interventions
• Non-searchable free text
• Virtually no report running

capabilities

Current MRT Intervention Form for tracking data:

Current MRT Intervention Form for tracking data:

MRT Forms

• Completed forms are viewable during the patient’s stay for

any questions that arise.

• Completed forms are also often viewable during

subsequent admits which can provide a great reference since many patients are re-admitted.

MRT Data – Interventions by Hospital Location

MRT Data – Medication Error Prevention

• 1% of our patients (about 8 per month) have a major medication error

prevented and 24% (about 245 per month) have a minor medication error prevented by an MRT addressing their list.

200 400 600 800 1000 1200 1400 General/Op Ed Minor ADE Avoided Major ADE Avoided Total

MRT Data

58% 14.50% 36% 41% 36% Medication Ommission Incorrect Medication Incorrect Dose Incorrect Directions Discontinued medication still

• n list

% of Patients with These Error Types

MRT Data – Has the Nurse Addressed the List Yet?

10 20 30 40 50 60 70 80 %NO %YES

MRT Data

• 75% of Med Rec patients have been admitted through our ER.
• Each medication list addressed has, on average, 2.4 medications

missing.

• Approximately 7% of our patients have already had an incorrect

medication started by the time our MRT addresses it, which then prompts a call from the pharmacist to the physician.

• About 3/4th of the time we are able to verify the list with the patient. The

top reasons cited by our MRTs for not verifying with the patient were:

• Altered mental status of the patient
• The patient lives at a care facility and/or does not manage their own

medications

• The list was sent from their physician’s office pre-op for Operation

Education

Our Med Rec Technician Staff

Future Goals

• Expand our FTEs.
• To reach patients more quickly thereby avoiding incorrect

medications being started by the physician.

• To reach every patient admitted to our facility as well as

each transfer both internally and externally.

• To expand reconciliation to discharge.
• All pre-admitted patients have medication reconciliation

prior to admit, including but not limited to: cardiac cath lab,

• rthopedics, and general surgery.

Please click the link below to take our webinar evaluation. The evaluation will

• pen in a new tab in your default browser.

https://www.surveymonkey.com/r/hpoe-webinar-5-16-16

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