Medication reconciliation completed by pharmacy on admission from the ED

2.50
Hdl Handle:
http://hdl.handle.net/10755/623666
Category:
Full-text
Format:
Text-based Document
Type:
Poster
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Medication reconciliation completed by pharmacy on admission from the ED
Author(s):
Humiston, Lauren; Duncan, Rachael; Fry, Nancy
Lead Author STTI Affiliation:
Non-member
Author Details:
Lauren Humiston, BSN, RN, CEN; Rachael Duncan, PhramD, BCPS, BCCP; Nancy Fry, BSN, RN
Abstract:

Poster presentation

Session F presented Friday, September 15, 2017

Purpose: Medication reconciliation should be performed at all transitions of care according to the Institute for Healthcare Improvement and AHRQ Patient Safety Network. A recent systematic review on errors in medication history at admission estimated that 54-67% of all admitted patients have at least one discrepancy between the medication history obtained by the admitting clinicians and the actual preadmission regimen and that, in 27-59% of those cases, such discrepancies have the potential to cause harm. This project aimed to assess the accuracy of a newly implemented pharmacy-driven admission medication reconciliation service based in the ED.

Design: This was a quality assurance project done to assess the accuracy of medication histories enterered into the EHR on patients being admitted from the ED. Prior to implementation of the pharmacy pilot, nursing staff completed medication histories. The pilot put certified pharmacy technicians in the ED, working to capture medication histories on patients being admitted. Technicians were overseen by the ED Pharmacist, who checked all medication lists for accuracy and follow-up.

Setting: This quality assurance study was completed in the emergency department at an urban level 1 trauma center.

Participants/Subjects: All ED staff participated in this project. Pharmacy technicians and ED pharmacists were assessed for the quality assurance project.

Methods: A randomly selected group of 50 patients being admitted from the ED was assessed over a one week period prior to implementation of the pharmacy pilot. Medication histories were collected and recorded in the EHR by nursing staff. Upon completion a pharmacist conducted an independent medication history on each patient and then compared the results for accuracy. During the pilot, medication histories were collected and recorded in the EHR by pharmacy technicians and pharmacists. An identical assessment of accuracy was performed with technicians completing the medication list and a pharmacist checking.
The number of total inaccuracies on the medication list were totaled for each patient studied. Inaccuracies were further defined as an omitted, incomplete, and incorrect medication. High-alert medications (defined via the ISMP definition) were identified and assessed for accuracy.

Results/Outcomes: Results of the assessment showed that 19% of the medication histories completed by ED nursing staff pre-pilot were accurate. 33 of the 50 patients studied were taking at least one high-alert medication (opioids, anticoagulants, insulin and oral hypoglycemics, antineoplastics) identified as inaccurate. When the same assessment was completed on another 50 patients completed by the pharmacy staff overall accuracy increased by over 80%. There were no inaccuracies in this group associated with high-alert medications. Physician and nursing satisfaction were measured both pre- and post-pilot, finding a significant increase in both following the implementation of the pilot.

Implications: Medication reconciliation completed upon admission from the ED is most accurately completed by pharmacy rather than nursing staff. This is likely due to the many high-level tasks and charting that nurses must complete and an inability to focus dedicated time and energy to the medication list. Pharmacy technicians and pharmacists located in the ED are in a prime position to see that an accurate admission medication reconciliation is completed in a timely manner.

Keywords:
Medication Reconciliation; Quality Assurance; Emergency Department
Repository Posting Date:
4-Dec-2017
Date of Publication:
4-Dec-2017
Conference Date:
2017
Conference Name:
Emergency Nursing 2017
Conference Host:
Emergency Nurses Association
Conference Location:
St. Louis, Missouri, USA
Description:
ENA 2017: Education, Networking, Advocacy. Held at America's Center Convention Center, St. Louis, Missouri

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePosteren
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleMedication reconciliation completed by pharmacy on admission from the EDen_US
dc.contributor.authorHumiston, Laurenen
dc.contributor.authorDuncan, Rachaelen
dc.contributor.authorFry, Nancyen
dc.contributor.departmentNon-memberen
dc.author.detailsLauren Humiston, BSN, RN, CEN; Rachael Duncan, PhramD, BCPS, BCCP; Nancy Fry, BSN, RNen
dc.identifier.urihttp://hdl.handle.net/10755/623666-
dc.description.abstract<p>Poster presentation</p> <p>Session F presented Friday, September 15, 2017</p> <p>Purpose: Medication reconciliation should be performed at all transitions of care according to the Institute for Healthcare Improvement and AHRQ Patient Safety Network. A recent systematic review on errors in medication history at admission estimated that 54-67% of all admitted patients have at least one discrepancy between the medication history obtained by the admitting clinicians and the actual preadmission regimen and that, in 27-59% of those cases, such discrepancies have the potential to cause harm. This project aimed to assess the accuracy of a newly implemented pharmacy-driven admission medication reconciliation service based in the ED.</p> <p>Design: This was a quality assurance project done to assess the accuracy of medication histories enterered into the EHR on patients being admitted from the ED. Prior to implementation of the pharmacy pilot, nursing staff completed medication histories. The pilot put certified pharmacy technicians in the ED, working to capture medication histories on patients being admitted. Technicians were overseen by the ED Pharmacist, who checked all medication lists for accuracy and follow-up.</p> <p>Setting: This quality assurance study was completed in the emergency department at an urban level 1 trauma center.</p> <p>Participants/Subjects: All ED staff participated in this project. Pharmacy technicians and ED pharmacists were assessed for the quality assurance project.</p> <p>Methods: A randomly selected group of 50 patients being admitted from the ED was assessed over a one week period prior to implementation of the pharmacy pilot. Medication histories were collected and recorded in the EHR by nursing staff. Upon completion a pharmacist conducted an independent medication history on each patient and then compared the results for accuracy. During the pilot, medication histories were collected and recorded in the EHR by pharmacy technicians and pharmacists. An identical assessment of accuracy was performed with technicians completing the medication list and a pharmacist checking. <br />The number of total inaccuracies on the medication list were totaled for each patient studied. Inaccuracies were further defined as an omitted, incomplete, and incorrect medication. High-alert medications (defined via the ISMP definition) were identified and assessed for accuracy.</p> <p>Results/Outcomes: Results of the assessment showed that 19% of the medication histories completed by ED nursing staff pre-pilot were accurate. 33 of the 50 patients studied were taking at least one high-alert medication (opioids, anticoagulants, insulin and oral hypoglycemics, antineoplastics) identified as inaccurate. When the same assessment was completed on another 50 patients completed by the pharmacy staff overall accuracy increased by over 80%. There were no inaccuracies in this group associated with high-alert medications. Physician and nursing satisfaction were measured both pre- and post-pilot, finding a significant increase in both following the implementation of the pilot.</p> <p>Implications: Medication reconciliation completed upon admission from the ED is most accurately completed by pharmacy rather than nursing staff. This is likely due to the many high-level tasks and charting that nurses must complete and an inability to focus dedicated time and energy to the medication list. Pharmacy technicians and pharmacists located in the ED are in a prime position to see that an accurate admission medication reconciliation is completed in a timely manner.</p>en
dc.subjectMedication Reconciliationen
dc.subjectQuality Assuranceen
dc.subjectEmergency Departmenten
dc.date.available2017-12-04T21:27:16Z-
dc.date.issued2017-12-04-
dc.date.accessioned2017-12-04T21:27:16Z-
dc.conference.date2017en
dc.conference.nameEmergency Nursing 2017en
dc.conference.hostEmergency Nurses Associationen
dc.conference.locationSt. Louis, Missouri, USAen
dc.descriptionENA 2017: Education, Networking, Advocacy. Held at America's Center Convention Center, St. Louis, Missourien
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