Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Med Rec in Rural NSW hospitals – the High 5s study and accreditation OUR HIGH 5 EXPERIENCE • 8 hospitals in southern NSW collected data from July 2010 till September 2011 – all had on site clinical pharmacists • 5 days/wk in 5 (7 days/wk for some time in 1) 4 days/wk in 3 • 3 hospitals employed junior medical staff, the remainder were VMO only • We added a measure: discrepancies on discharge • We discontinued involvement due to • requirement to only measure those reconciled within 24 hours significantly increased the sample size • workload associated with independent observer verification Our data showed .. consistently high coverage of patients in target group received clinical pharmacy services including med rec medication reconciliation rates percentage 100 90 80 70 60 50 40 30 20 10 0 percentage of patients reconciled percentage of patients with medications reconciled within 24 hours of admission percentage of patients with at least one unintentional discrepancy month Our data showed (2) .. no great change in discrepancies over time .. as expected, discharge was more of a problem than on admission medication reconciliation discrepancies number per patient 1.60 1.40 1.20 1.00 no. of undocumented intentional medication discrepancies per patient 0.80 0.60 no. of unexpected discrepancies per patient on discharge 0.40 0.20 number of unintentional medication discrepancies per patient 0.00 month how medication hx verified • Front of drug chart (red box) was common • At the time 2 sites using paper MMP • Electronic solution (GP prescribing software) in 3 hospitals • Definition of verification – 2nd source • traditional pharmacist approach or • could also be eg admitting doctor using medicines list / webster pack / nursing home charts provided evidence in clinical record that it had been checked /annotated what is different in small hospitals • Less steps between GP and inpatient stay: often same doctor or same practice sends patient to hospital -> better information • Good liaison with community pharmacy in small towns • Group GP practices have routine processes for transmitting information to and from hospital out of GP prescribing software (but these lists are not always up to date, verification still needed) • GP VMOs may access surgery software from in hospital and transmit data back on discharge • RACF charts and DAA packs are highly reliable sources of information standard 4 – what we did in 2013 • Extended the high 5 approach, incorporating key questions into routine medication chart audits done post discharge, LOS > 24hrs; pharmacist + 1 does the audit • Included all hospitals, subacute, MPS’s, mental health • Since high 5, electronic medical record used in more facilities -> forcing function if electronic discharge summaries are used Clinical pharmacy service med rec indicator discharge is where it’s at .. we were previously poor at documenting actions taken on discharge .. now if it’s not in the clinical record it didn’t happen .. med rec on discharge is incorporated into generation of pt “medilist” electronic MMP / discharge plan eg hard coded look up lists - Pharmacies - GP surgeries - Hospital pharmacists can be written to emr copy and paste medilist, medication charts can be generated Conclusion • Participation in High5 forced us to be more accountable in the way we documented histories and particularly actions taken at discharge • Electronic MMP’s are either fully implemented or being implemented in all hospitals – if emr being used for discharge summaries pharmacist med rec is not optional – “forcing function” • We continue to measure key outcome measures (% clinical pharmacy review, med rec on admission, med rec within 24 hours, discharge information given)