Strategies for Medication Nomenclature Standardization at Multi-Organ Transplant Program

Dr. Helen Chen1, Kevin Quach1,2, Dr. Ian MacKillop1, Dr. Joseph Kim2

1 University of Waterloo2 University Health Network

Faculty/Presenter Disclosure

Faculty: Dr. Helen Chen, PhD

Relationships with commercial interests: None

Outline

1. Challenges of patient drug management in transplantation

2. Drug standardization strategies3. Lessons learned and continuous

discovery

Challenges

Five Rights for Drug Administration Practices

Standard for safe medication practices Five rights: Patient, drug, time, dose, and

route

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

overlookedSource: Medication Errors, Cohen, 2006

Challenges in Organ Transplant Programs

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

Desired State

Methodology/Approach

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

Drug Standardization Strategies

Standardization Strategies

1. Removing non-prescribed drugs from drug database2. Correcting misspelled drug names3. Mapping drug name with drug formula and strength4. Removing unnecessary use of chemical salts5. Distinguishing between brand name and generic name medications6. Correcting combination drug nomenclature7. Adhering to Health Canada drug nomenclature standards

8. Identifying drug acronyms and other variations9. Proper labeling study medications10. Identifying limited use medications

Mapping drug name with drug formula and strength

Medication name

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

Medication name

venlaxafine

Brand name

Effexor XR

Effexor

Formulation

37.5 mg capsule

37.5 mg tablet

SolutionDrug formula and dosage information will be retained in separate tables frommedication name

Distinguishing between brand name and generic name medications

Medication name Generic name Brand nameTylenol acetaminophen Tylenol

Prograf tacrolimus Prograf

SolutionMerging brand name information to the corresponding generic name

Correcting Combination Drug Nomenclature

Medication Name Proposed Correctionhydroxyephedrine w/ normethadone  hydroxyephedrine - normethadone

Piperacillin, tazobactam piperacillin - tazobactam

Other problemsSpecifying doses of each drug ingredient in combination drugs

SolutionUsing a dash (-) to separate drug ingredients in combination medications

Limited Use (LU) MedicationsMedication Name Proposed CorrectionPrograf – LU #173 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

Very Important Drug (VID) List

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)

Synchronization tool with Health Canada

Results

All medication

entries (n=3189) Non-

prescribed entries

(n=1112)Prescribed

entries (n=2077)

Results

Strategy Action identifiedMapping 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

Lessons learned and continuous discovery

Lessons learned and continuous discovery

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

Thank you!