MPA | Pharmacy News

Amy Pouillon, Pharm.D., supervisor, medication history and coordinator, 
Spectrum Health Hospitals, Grand Rapids, Mich.

 

Amy Pouillon, Pharm.D., at Spectrum Health Butterworth preparing to interview a patient remotely.

Accurate patient medication histories are a critical piece of the hospital admission process helping ensure patient safety during the inpatient stay and after discharge. Historically, emergency room nurses or other healthcare professionals were responsible for completing this detailed work during the complex admitting process. Variations in practice and lack of time during the admission process resulted in medication histories not validated with available outpatient prescription records which contributed to medication safety events (adverse drug reactions, medication errors and/or near misses).1,2,3
Spectrum Health is a multihospital system which continues to incorporate new hospitals across West Michigan. As new hospitals integrate, systems are standardized; best practices are shared, including the opportunity to spread this best practice around medication history acquisition. As the hospital system expands, the standardization of patient care across entities has required innovative thinking to provide consistent high quality care at the lowest cost. An internal assessment of medication history processes across multiple hospitals revealed significant variability. Standard interview scripting and medication validation with outpatient prescription records were not a consistent part of the medication history process. The smaller community hospitals relied on support from nursing, pharmacy or providers to update the medication history prior to reconciliation. Patient safety, system standardization, quality outcomes and provider satisfaction were the primary drivers for developing a highly reliable medication history service across the multiple hospitals. The team recognized that a new health solution was required to improve the process for how medication histories were obtained at the hospitals within the system.
Utilizing medication history pharmacy technicians from the central large teaching hospital, telemedicine and the common electronic health record, a pilot program connected the medication history team from the central campus with the patients in a small regional hospital providing 24 hours a day, seven days a week medication history service.
During the pilot phase of the program, the team was able to show improvements in all metrics identified in the plan phase of the project. Improved quality metrics were observed by a reduced medication history error rate from 11 percent to less than one percent in charts retrospectively audited by rounding pharmacists. Nursing efficiency improved by approximately 10 minutes of time per patient as they were no longer required to complete the medication history and enter the information in the electronic health record. Removing the medication history task from the nurse allowed the practitioner to devote more time to other patient care activities. The nurses reported spending approximately one minute per patient helping transfer the telemedicine hardware into the patient room and facilitating the interview process with the pharmacy technician team. The medication history turnaround time to completion improved from 27 minutes to 20.6 minutes which benefited the provider by having an accurate patient home medication list earlier in the admission process. The pharmacy team also gained efficiencies, reducing the time required to obtain the best possible medication history from 22 minutes to 11.2 minutes. Provider satisfaction improved from a baseline score of 2.1 to 3.32. Refer to Table 1 for a detailed breakdown of the results.
By leveraging these resources between entities, the health system was able to avoid an estimated $200,000 of pharmacy technician labor expense showing the value of system integration. The pilot program has become an established working model for the organization and has fully integrated four hospitals with plans for expansion to three additional hospitals by summer 2019.
Table 1: Pilot Project Metrics
 
Baseline
Goal
30 days
90 days
120 days
Medication history error rate
11%
< 5%
2.6%
1.4%
<1%
Nurse time with medication history process
10 minutes
< 5 minutes
1 minute
1 minute
< 1 minutes
Turnaround time
27 minutes
≤27 minutes
17.8 minutes
26.1 minutes
20.6 minutes
Pharmacy technician completion time
22 minutes
22 minutes
14.1 minutes
13.3 minutes
11.2 minutes
Provider Satisfaction Survey
2.1
> 2.1
3.4
3.31
3.32

References

1. Kwan JL, Lo L, Sampson M, et al. Medication reconciliation during transitions of care as a patient safety strategy: A systematic review. Ann Intern Med. 2013; 158(5_Part_2): 397-403.
2. Hellstrom LM, Bondesson A, Hoglund P et al. Errors in medication history at hospital admission: Prevalence and predicting factors. BMC Clin Pharmacol. 2012; 12(9): 1-9.
3. Meuller SK, Sponsler KC, Kripalani, S, et al. Hospital-based medication reconciliation practices: A systematic review. Arch Intern Med. 2012; 172(14): 1057-69.

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