August 19th Webex

Review article and discuss strategies for application of learning

Round table discussion/question list

Jennifer R. Pippins, Tejal K. Gandhi et al, Classifying and Predicting Errors of Inpatient Medication Reconciliation, Journal of General Internal Medicine, Springer New York, Vol. 23, No. 9, 1414-1422, September 2008.

Objective: To determine the reasons, timing and predictors of potentially harmful medication discrepancies

Design: Prospective observational study

Patients: Brigham and Women’s Hospital admitted general medical patients

Measurements: Study pharmacists took gold-standard medication histories and

compared them with medical team’s medication histories, admission and discharge orders. Blinded teams of physicians adjudicated on all unexplained discrepancies

Results :  Among 180 patients, 2066 medication discrepancies were identified, and 257

(12%) were unintentional and had potential for harm (1.4 per patient). Of these, 186 (72%) were due to errors taking the preadmission medication

history, while 68 (26%) were due to errors reconciling the medication history with discharge orders.

Most PADEs occurred at discharge (75%). In multivariable analyses, low patient understanding of preadmission

medications, number of medication changes from preadmission to discharge, and medication history taken by an intern were associated with PADEs.

 Conclusions : Unintentional medication discrepancies are common and more

often due to errors taking an accurate medication history than errors reconciling this history with patient orders. Focusing on accurate medication histories, on potential medication errors at discharge, and on identifying high-risk patients for more intensive interventions may improve medication safety during and after hospitalization.

Journal Link: http://psnet.ahrq.gov/resource.aspx?resourceID=7896&sourceID=1&emailID=8

405

Training for medication history taking

Get it right at admission reliably◦ Do you have a check system to determine if BPMH’s

are gold standard?

Develop ways to illicit all medications.

Incorporate strategies for low literacy patients

Make medication changes visible throughout various transitions

• Poll• Share comments, • Your experience with BPMH training

https://communities.saferhealthcarenow.ca/medrec?go=1514513

Create secondary ways to capture missed meds

Addendum History Form (used for medications left off BPMH)

Redundancy provision to ensure all medications are captured on BPMH

https://communities.saferhealthcarenow.ca/medrec?go=1422706

Visible medication changes throughout transitions

Patient Home Medication Record - Includes Admission, Transfer and Discharge

Ensure medications visible in one place for all transitions

https://communities.saferhealthcarenow.ca/medrec?go=z1110065

Create tools for patients

https://communities.saferhealthcarenow.ca/medrec?go=1680807

Standardize training

Orientation checklist for training

Use Pharmacy Techs for obtaining BPMH

Use DVD training videos

Use prompts for different questions on BPMH forms

VIHA Picture tool with tips https://communities.saferhealthcarenow.ca/medrec?go=1829493

Use of pictures for low literacyReminders & tips for improved BPMH

Your questions & comments