Agee, Angela, ADN, RN, CMSRN

Heckman, Tracie, MSN, RN, CMSRN

Heckman, Tracie, MSN,RN,CMSRN

Kromis, Leroy, BS,PharmD,BCPS

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksPatient Care Services / NursingDon't Ask Alice -- Medication Reconciliation: ANew Role to Decrease DiscrepanciesTracie Heckman MSN, RN, CMSRNLehigh Valley Health Network, Tracie.Heckman@lvhn.orgAngela Agee ADN, RN, CMSRNLehigh Valley Health Network, Angela_L.Agee@lvhn.orgTracie Heckman MSN,RN,CMSRNLehigh Valley Health Network, Tracie.Heckman@lvhn.orgLeroy Kromis BS,PharmD,BCPSLehigh Valley Health Network, Leroy.Kromis@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/patient-care-services-nursingPart of the Nursing CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtHeckman, T. (2014, May 27-29). Don't ask Alice -- medication reconciliation: A new role to decrease discrepancies. Poster presented at: TheQuality and Safety Education for Nurses, Baltimore, MD.Heckman, T., Goodman, M. (2014, October 30). Don't Ask Alice -- Medication Reconciliation: A New Role to Decrease Discrepancies.Poster presented at: Research Day 2014, Lehigh Valley Health Network, Allentown, PA.Agee, A., Heckman, T., Kromis, L. (2014, Oct.). Don't Ask Alice -- Medication Reconciliation: A New Role to Decrease Discrepancies.Poster presented at:The American Nurses Credentialing Center National Magnet Conference, Dallas, TexasReferences:1.		Van	Den	Bemt,	P.,	Van	Den	Broek,	S.,	Van	Nunen,	A.K.,	Harbers,	J.	&	Lenderink,	A.W.	(2009).		 Medication	reconciliation	performed	by	pharmacy	technicians	at	the	time	of	preoperative	screening,	The	Annals	of	Pharmacotherapy,	(5)43,	868-74.		 AbstractApproximately 54% of inpatients have at least one discrepancy in the medications they report taking at home compared to those reported at time of admission. Twenty-seven percent of prescribing errors in hospitals are caused by incomplete medication records at the time of admission. These statistics prompted key stakeholders evaluate current medication reconciliation processes.   FeedbackBackground/Current State•  47.5% of inpatient medication reconciliations had at least one error.  •  Multistep process with no identified “owner” or location to document.•  Practitioners working in silos resulting in duplicated work.•  Tremendous amount of time spent to reconcile medication lists. Evidence-Based Process RedesignCommon thread in literature: Employ individuals who specialized in their function.	 	A rapid improvement event with key stakeholders including physicians, nurses and pharmacists determined a single health care resource as the best means to improve our process accuracy. Medication Reconciliation Technician (MRT) - a certified pharmacy technician, with specialized training in patient interviewing and primary source medication list verification.MRT Standard Work1  Enter Best Possible Medication History (BPMH) into Home Medication Management system.2  Print validated medication history for providers to use during admission process. 3  Document the reconciliation of the medication list. Evaluation of EffectivenessOther Metrics Identified•  Medication reconciliation order usage•  MRT process completion (ordering physician to floor metric)•  Physician medical record time (how long a physician spent on medication reconciliation)•  Length of stay (med. rec. vs. non-med. rec. patient)•  Readmission rate (med. rec. vs. non-med. rec. patient)Physicians: “I like the completeness.” • Need MRT coverage at night•  Trigger the process even earlierNurses: “This is how it should be done!”•  Eliminates 2:00 am calls to doctors to verify medication orders“The right discipline is doing the right job.”Case Manager: “Best thing we could do for patients is get it right from the beginning.”•  Helps with insurance plans that restrict the number of medications coveredDate  Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14Discrepancies (NUM) 4 4 5 3 2 5 0 4 1 0 3 2Monthly Target (Mean) 3% 4% 4% 4% 4% 4% 3% 3% 2% 2% 2% 2%Total Med Rec Completed (DEN) 164 125 127 147 80 61 141 175 86 133 138 152© 2014 Lehigh Valley Health Network Next Steps•  Expand data analysis to second campus•  Re-validate process with stakeholders•  Build business case to expand program to include discharge processLehigh Valley Health Network, Allentown, PAMedication Reconciliation:  A New Role to Decrease Discrepancy Med. Rec. Unintended Discrepancies by Month for LVH-CC(Data From 3/01/13 to 2/28/14)Number of Unintended Discrepancies/Total Med Rec Completed2.4%3.2%3.9%2.0%2.5%8.2%0.0%2.3%1.2%0.0%2.2%1.3%0.0%1.0%2.0%3.0%4.0%5.0%6.0%7.0%8.0%9.0%DataMeanUCLDate Mar-13 Apr-13 May-13 Jun-13 J l- g- Se - ct- v- Dec-13 Jan-14 Feb-14Discrepancies (NUM) 4 4 5 3 2 5 0 4 1 0 3 2Monthly Target (Mean) 3% 4% 4% 4% 4% 4% 3% 3% 2% 2% 2% 2%Total Med RecCompleted (DEN) 164 125 127 147 8 1 3 138 52Mean= 2%, Upper Control Limit= 6%The spike in discrepanciesduring August ’13 waspotentially due to 2 new FTEbeing trained at the Cedar Crestlocation.MagnetTM	Since2002

Don\u27t Ask Alice -- Medication Reconciliation: A New Role to Decrease Discrepancies

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Don\u27t Ask Alice -- Medication Reconciliation: A New Role to Decrease Discrepancies

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