Abstract from 2013 ACCP Annual Meeting, Alburquerque, New Mexico

Antonopoulos, Anthony

Johnson, Beth

Lanham, Kena

Reeves, David J.

Saum, Lindsay

Scherer, Colleen

Sorenson, Suellyn

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Butler UniversityDigital Commons @ Butler UniversityScholarship and Professional Work – COPHS College of Pharmacy & Health Sciences2013Assessing the Accuracy and Quality of MedicationHistory Collection: Effect of Implementation ofElectronic Health RecordKena LanhamLindsay SaumButler University, lsaum@butler.eduDavid J. ReevesButler University, dreeves@butler.eduColleen SchererBeth JohnsonSee next page for additional authorsFollow this and additional works at: http://digitalcommons.butler.edu/cophs_papersPart of the Pharmacy Administration, Policy and Regulation CommonsThis Conference Proceeding is brought to you for free and open access by the College of Pharmacy & Health Sciences at Digital Commons @ ButlerUniversity. It has been accepted for inclusion in Scholarship and Professional Work – COPHS by an authorized administrator of Digital Commons @Butler University. For more information, please contact fgaede@butler.edu.Recommended CitationLanham, Kena; Saum, Lindsay; Reeves, David J.; Scherer, Colleen; Johnson, Beth; Antonopoulos, Anthony; and Sorenson, Suellyn,"Assessing the Accuracy and Quality of Medication History Collection: Effect of Implementation of Electronic Health Record"(2013). Scholarship and Professional Work – COPHS. Paper 199.http://digitalcommons.butler.edu/cophs_papers/199AuthorsKena Lanham, Lindsay Saum, David J. Reeves, Colleen Scherer, Beth Johnson, Anthony Antonopoulos, andSuellyn SorensonThis conference proceeding is available at Digital Commons @ Butler University: http://digitalcommons.butler.edu/cophs_papers/199acute chest syndrome (6%). Eighty-six percent of patients had atleast one FDA-identified risk factor. The most common risk fac-tors included concurrent use of other QTc prolonging medica-tions (58%), age (46%), underlying cardiac disease (28%) andbaseline QTc prolongation (24%). Of 27 patients receiving azi-thromycin therapy without continuous telemetry monitoring, 18patients (67%) had baseline QTc obtained and repeat EKGs wereobtained only in five of these patients after azithromycin initia-tion. The remaining nine patients had no baseline and repeatEKGs obtained. Compliance rate with institution QTc monitor-ing guideline was 22% among patients initiated on azithromycin.CONCLUSION: Azithromycin was frequently initiated in high-risk patients and inadequately monitored. Institutions should seekto optimize data reporting within the electronic medical record toidentify patients at high-risk for QTc prolongation at the time oforder-entry in order to enhance medication safety.249. Pharmacist versus physician conducted medicationreconciliation on an internal medicine service at an urban teachinghospital. Michael J. Gonyeau, BS, Pharm PharmD, BCPS,FCCP1, EmilyHeath, B.S., Pharm.D.2; (1)Northeastern UniversitySchool of Pharmacy, Boston, MA (2) Sarasota, FLPURPOSE: Previously published studies have shown positiveimpact of pharmacists on identifying discrepancies in the medica-tion reconciliation (MedRec) process upon hospital admission.Specific medications are more prone to error, providing anopportunity where pharmacists may be influential on patient careduring healthcare transitions.METHODS: A prospective study was conducted in patients ≥18to compare pharmacist (or pharmacy student) vs. physician per-formed MedRec on general medicine inpatient service at a 760bed tertiary care hospital during a 3 month period in 2012. Phar-macist MedRec entailed patient interview, contacting outpatientpharmacies/PCP offices and review of electronic medical record(EMR) compared to physician standard of care including patientinterview and EMR review. Discrepancies were discussed withadmitting physicians and regimens clarified/altered. Discrepancytypes included Rx-drug omission, non-Rx drug omission, incor-rect dose, incorrect frequency, patient non-adherence: dosechange, patient non-adherence: frequency, and patient non-adher-ence: self-discontinuation. A severity of error grade was assignedto each discrepancy based on NCC MERP categorization methodfor medication errors.RESULTS: A total of 306 patients were enrolled in the study(age: 59.43  18.63, 42% male) and 1580 discrepancies identified(5.16 + /- 17.46/patient), with a trend toward increasing discrep-ancies observed in patients with 6–10 medications. The most com-mon discrepancies identified were patient non-adherence: self-discontinued (n=597; 37.78%) and prescription drug omission(n=593; 37.53%). The most common severity score categoryassigned was F (n=609; 38.54%). Most discrepancies were identi-fied in the drug class “Rx-other” (n=699; 44.24%). Cardiovascu-lar agents accounted for 295 (18.67%) discrepancies. Medicationsmost likely to reveal discrepancies included aspirin and albuterol,while medications with the fewest discrepancies included non-pre-scription gastrointestinal agents and non-prescription non-opioidanalgesics.CONCLUSION: Pharmacy-directed medication reconciliationmay have a substantial impact on the clarity of outpatient medi-cation regimens, adherence, and quality of care in hospitalizedpatients. Many of the discrepancies identified could result in sig-nificant morbidity and mortality.250. Creation and implementation of a web-based home-grownpharmacy intervention system using Microsoft SharePoint. AdamB. Woolley, Pharm.D., BCPS1, Maria Scarlatos, BS1, ShawnSaunders, PharmD2; (1) School of Pharmacy, Northeastern Uni-versity, Boston, MA (2)VA Boston Healthcare System, WestRoxbury, MAPURPOSE: To develop a pharmacy intervention database incompliance with strict security standards that is easy to create,use, manage and update without unnecessary resource expendi-tures.METHODS: A committee was formed to evaluate several thirdparty web-based intervention programs and determine which bestfit the needs of the pharmacy department. After weighing severalfactors, the decision was ultimately made to build a home-grownweb-based intervention database, utilizing Microsoft SharePoint.A small task force developed the intervention database, and train-ing was provided to the pharmacy department regarding how touse the system.RESULTS: Intervention fields were created and customized forinstitution-specific optimization. View options were restricted toprotect employee privacy, and the database was set up on the in-tranet to meet institutional standards for protected health infor-mation (PHI). The system has the ability to trigger customizedemails to specific members of the pharmacy department in orderto assist with hand-offs. The intervention database also generatesreports through utilization of an ExcelPivot Table.CONCLUSION:Microsoft SharePoint allows the pharmacydepartment to utilize an intervention tracking service at no addi-tional expense. The system can be replicated because this softwareis already widely available at all VA medical centers as well asmany other institutions. The system is easy to create and use,issustainable, and can be customized to service goals in real-time.Further assessment of the intervention database is needed to eval-uate pharmacist perception of the system as well as to analyzedocumented interventions.251. Innovative use of prescription cancellation data to improvepatient safety and efficiency within a mail order pharmacy. CarrieNolan, PharmD, George Dooling, PharmD, Gia Leonetti,PharmD Candidate, Michael Sutherland, PharmD; VA SWCMOP, Tucson, AZPURPOSE: Prescription cancellation by pharmacists at theDepartment of Veterans Affairs Southwest Consolidated MailOutpatient Pharmacy (VA SW CMOP) can cause delays in ser-vice to veterans and duplicate work for both the CMOP and VAmedical centers (VAMCs). In this study, prescription cancellationdata was aggregated in a structured format and reported toVAMCs in order to bring prescriber attention to preventableproblems with prescriptions and increase the efficiency of the mailorder system by reducing the number of prescription cancella-tions.METHODS: Every month VAMCs serviced by the SW CMOPreceived a site progress chart showing the total number ofmonthly cancels over time, a progress chart with the top threereasons for site cancellation, and a cancellation rate chart com-paring the different VAMCs. Decrease in average prescriptioncancellation rate was analyzed using a t-test.RESULTS: Over a one year period (January 2012 to December2012), the average number of prescription cancellations among allVAMCs fell from 48.8 cancels per 10,000 fills to 37.5 cancels per10,000 fills. This represents a 23% decrease in the overall cancel-lation rate to VAMCs (p=0.006).CONCLUSION: By providing benchmark data to the VAMCsfor analysis, CMOP is able to play a more active role in promot-ing patient safety and improving the efficiency of mail orderservice.252. Assessing the accuracy and quality of medication historycollection: effect of implementation of electronic health record.Kena Lanham, PharmD, BCPS1, Lindsay Saum, PharmD, BCPS,CGP2, David Reeves, PharmD, BCOP, Colleen Scherer, PharmD,MPA, BCPS, Beth Johnston, PharmD, BCPS1, Anthony Antonopou-los, RPh MBA, Suellyn Sorensen, PharmD, BCPS1; (1)Depart-ment of Pharmacy, Saint Vincent Hospital, Indianapolis, IN(2)Department of Pharmacy Practice, Butler University, India-napolis, INPURPOSE:We hypothesized that pharmacy staff auditing of pre-viously recorded admission medication histories will identify sig-nificant and potential medication errors, and that implementationACCP 2013 ANNUAL MEETING ABSTRACTS e257of an electronic medical record [EMR] will not improve the quan-tity of discrepancies or the quality of admission medication histo-ries, despite showing Joint Commission and Heart Failure CoreMeasure compliance.METHODS: At our institution, medication reconciliation is com-pleted at the time of admission through collaboration with pre-scribers and nursing staff. A pharmacy medication reconciliationteam is utilized on the cardiac step down unit and employs phar-macy technicians to obtain an accurate and complete medicationhistory. This history is verified by a pharmacist, compared to theinitial medication history and inpatient medication orders. Identi-fied discrepancies are reconciled with a licensed prescriber. A ret-rospective evaluation assessed the discrepancies identified by thepharmacy team medication history audits, as well as audits com-pleted by clinical pharmacists on other hospital units, and com-pared the quantity of discrepancies before and after EMRimplementation.RESULTS:With support provided by the pharmacy team, medi-cation reconciliation completion was 82% pre-EMR implementa-tion and increased to 91% immediately post-EMRimplementation; Core Measure compliance has remained above90%. The average number of medication omissions per patientupon admission medication reconciliation was 0.55 pre-EMRimplementation and increased to 2.32 post-EMR implementation.The average number of incorrect drugs/patient upon admissionmedication reconciliation 0.16 (pre) and 0.61 (post); and incorrectdoses/patient was 0.32 (pre) and increased to 0.63 (post).CONCLUSION: Despite showing medication reconciliation andcore measure compliance with the implementation of EMR, ourdata shows discrepancies between the medication lists collected asa routine part of admission and those lists collected via the phar-macy team audit. In fact, more errors were identified after EMRimplementation. The pharmacy team’s activities should be contin-ued and even expanded in order to prevent future discrepancies.253. The positive impact of a med Rec ED pharmacist onmedication management in patients admitted to a hospitalists’service. Anthony Intintoli, MD, FACP, FHM1, Anna Dushenkov,Pharm D, BCPS2, Sanu Koshy-Varghese, Pharm D3, William Hen-dricks, RPh4, Jack Mateyunas, RPh5; (1)Huntington HospitalNSLIJ HS (2) Pharmacy, Huntington Hospital NS LIJ HS(3)Emergency Department/Pharmacy, Huntington HospitalNSLIJ HS (4) Pharmacy, Huntington Hospital NSLIJ HS(5)Huntington Hospital NS LIJ HSPURPOSE: TJC recognizes medication reconciliation, known as“med rec”, as a critical step in medication therapy managementthat affects patient outcomes through continuum of care. Eightyfive percent of admission errors originate from inaccurate medica-tion histories that could lead to the increased risk of preventableADEs (pADEs). We hypothesized that teaming a full time EDpharmacist dedicated exclusively to med rec (EMRP) with thehospitalists’ admitting service can substantially reduce pADEsthereby improving patient care.METHODS: This was a six month (October 2012 – April 2013)observational case study. An EMRP performed medication recon-ciliations on patients admitted to hospitalists’ service during thepeak hours of ED volume. Patients admitted by hospitalists butnot seen by the EMRP over the same period of time served asthe control group. The impact was assessed for: medication his-tory accuracy, delays in medication administration due to medrec discrepancies, cost avoidance associated with pADEs, andadmitting hospitalist’s time savings.RESULTS: The EMRP performed an average of 1,600 interven-tions per month. Ninety percent reduction in medication historyinaccuracies and 97% decrease in delays in medication adminis-tration were achieved within the first two months. Seventy threeinterventions were identified as high potential to cause patient’sharm with an estimated cost avoidance of $860,816/year. TheEMRP has saved up to 2.25 hours of admitting hospitalist’s timeper shift.CONCLUSION: The implementation of a dedicated EMRP hassubstantially decreased medication history inaccuracies andstreamlined the medication therapy management. There was alsoa considerable time savings for the hospitalists’ admitting servicethat might allow to increase the admitting hospitalists’ productiv-ity and efficiency, and contribute to ED throughout. Theseaccomplishments can ultimately translate into improved institu-tion’s performance and reduced liability.Other254. A collaborative effort to develop clinical pharmacy servicesand Advanced Pharmacy Practice Experience (APPE) studentexchange programs in Ethiopia and China. Golden Peters,Pharm.D., BCPS1, Shin-YuLee, Pharm.D2, KennethSchafermeyer,Ph.D.3; (1) Saint Louis College of Pharmacy, Saint Louis, MO(2) Pharmacy Practice Division, Saint Louis College of Pharmacy,Saint Louis, MO (3) Pharmacy Administration, Saint Louis Col-lege of Pharmacy, Saint Louis, MOPURPOSE: An initial visit was conducted to Mekelle, Ethiopiaand Shanghai, China to discuss potential opportunities for collab-oration between the St. Louis College of Pharmacy (STLCOP)and Mekelle University College of Health Sciences (CHS) Schoolof Pharmacy (SOP) and Fudan University School of Pharmacy(SOP).METHODS: One STLCOP faculty member each visited MekelleUniversity CHS SOP and Fudan University SOP in Spring of2013. Discussions with current clinical pharmacists and facultymembers centered around ways for further clinical pharmacydevelopment, and parameters for implementing APPE studentexchange programs.RESULTS:Major outcomes identified as shared points of interestinclude: establishing a faculty exchange/sharing program,Advanced Pharmacy Practice Experience (APPE) rotation sitesfor students and a distance learning/educational series betweenSTLCOP and the two schools of pharmacy. Basic clinical phar-macy services have been established with the associated hospitalsnear the SOPs. Services currently involve daily hospital roundsinvolving pharmacists and students. Cultural activities at FudanUniversity help round out APPE student experiences whichinclude observing practices of traditional Chinese medicine (her-bal medicine, coining, cupping, acupuncture) at hospital basedintegrative medicine clinic.CONCLUSION: This is a prime example of how US clinicalpharmacy skills can be greatly utilized to advance global healthinitiatives. Based upon the relationships between these interna-tional pharmacy schools, there are plans for STLCOP APPE stu-dents and faculty members to return to Mekelle and FudanUniversity to further develop the relationships by increasing inte-gration of interdisciplinary care teams in more specialized medicalunits. This will enhance both the quality of patient care providedand the educational experience for nursing, medical, and phar-macy students, and medical residents. One major limitation asso-ciated with this discussion is that only one School of Pharmacywas visited in each country, and may not be fully representativeof the other Schools of Pharmacy in those countries.255. A clinical decision support system facilitates appropriateprescribing and monitoring of epoetin alfa in the inpatient setting.Danny McNatty, Pharm.D., MHA, BCPS, Ephu Yip, Pharm.D.,Denise Erickson, Pharm.D., BCPS; Banner Health, Phoenix, AZPURPOSE: A clinical decision support system (CDSS) thatrestricts orders for epoetin alfa (EPO) to appropriate indicationsand encourages patient monitoring will align use of this agentwith evidence-based practice.METHODS: A CDSS consistent with guideline and manufacturerrecommendations for use of epoetin alfa was recently imple-mented. A pre-post analysis of patients who received EPO at oneof three facilities between August 1, 2011 – October 31, 2011(pre-CDSS) and August 1, 2012 – October 31, 2012 (post-CDSS)was performed. Indication for EPO, hemoglobin, ferritin, andorders for iron supplementation were collected for each patient.Indication for use, administration when contraindicated fore258 PHARMACOTHERAPY Volume 33, Number 10, 2013

Assessing the Accuracy and Quality of Medication History Collection: Effect of Implementation of Electronic Health Record

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Assessing the Accuracy and Quality of Medication History Collection: Effect of Implementation of Electronic Health Record

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