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The Future of Healthcare Five Basic Rights of Medication Delivery Lorna Hanebuth-Sherman Presented to the Minnesota Futurists 27 August, 2011 Five Basic Rights of Medication Delivery Right Patient Right Medication Right Time Right Dose Right Route 1945 - 1949 How the rights were met. Med Cards were Color Coded • Each med card had – – – – – – room number, bed number Patient name Medication Dose Time Route (assume oral unless stated) • Used to record to the chart. Cards were then placed in a rack for the next administration. 1950 - 1959 • Changes in patient identification and increasing number of Medications Patient Identification • Was a simple band including – Room and bed number – Patient’s name – Doctor’s name – This was hand written by the nurse 1960 - 1969 • Changing level of patient care Physician’s order to med card and med sheets by ward secretary • Instead of bulk drugs, medications were delivered in individual bottles and placed in a small tray identified for the specific patient. • Medications were still individually poured into a med cup. Time and number of drugs were being looked at by • Federal and state regulations agencies in Long Term Care (LTC) facilities. • The time allowed was ½ hour before or after the scheduled time. • The problem was only one person was giving medication to 25-30 patients with multiple drugs to each person Route • As more and more complicated surgery and therapies required intravenous (IV) medication and fluids, machines with alarms were initiated which controlled the proper fluid and lessened complications. • LTC did not have the staff to observe the flow of IV fluids, nor the machines to regulate this flow. Patients stayed in the hospital longer. • LTC did eventually obtain the machines but it was the start of specialized Extended Care and rehabilitation units with more professional staff. 1970 - 1979 • Changing method of preparing and documenting medication Preparing and documenting medication • Med cards were discontinued. • Individual med sheets were placed on a rolling cart and brought to the patient’s room in both hospital and LTC facilities. • Large pharmacies in the hospital delivered meds at scheduled hour or the day’s pass • LTC contracted with pharmacies to deliver individual patient drugs. This was done in a number of ways. Ex. 30 day card supply. • Cost of medication increased. Medication Carts Harloff SL600PC Tall Punchcard Medication Cart, 600 Card Capacity "Better“ Harloff AL460PC Optimal Punchcard Cart W/460 Punchcard Capacity "Best“ Harloff Al600PC Optimal Punchcard Cart W/600 Punchcard Capacity "Best" From: $2,319.75 From: $2,567.75 From:$2,756.25 http://www.claflinequipment.com/carts/medication.html Medication Blister Card Patient’s name Room number Dr. Name Medication Prescription # 0 0 0 0 0 0 0 0 0 0 0 Dosage 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 medication per pass. 4 X a day means 120 pills would be sent from Pharmacy. The problem was if a change in medication, the existing medications would be disposed of… 1980 - 1989 • Changing regulation on ordering and distributing medication as well as increasing levels of care / specialty care New Federal Regulation for LTC • Required all nursing assistants working in long term care to take at least 70 hours of class. • Nursing Assistant could take another 25 hours to become a medication aide. This assisted LTC to meet the regulation for distributing meds on time. • Looked at the number of medications given to the elderly. Right Patient - Identification – Bands – bracelets – Asking the patient their name (a problem in LTC) Right Medication – Massive increase in new drugs – Increased cost of medication – Generic drugs increased – Increased number of drugs given, Particularly to the elderly The Rise of Generics PDR – The Physicians Desk Reference 1990 - 1999 • Changes in diagnostic and surgical technology, and the influence of complementary/alternative medicine Right Patient Right Medication Right Dose Right Time Right Route 2000 - 2010 • Changing cost of – Various levels of Health Care – Medications – Medication errors Hospital Cost Length of stay Cost Day Midwest 4.3 $21,522 $8,292 Overall US 4.6 $26,120 $8,692 Health Care Facility Costs Assisted Living One bedroom Nursing Home Semi-private Nursing Home Private room $3,261 per month $ 193 per day $ 213 per day Medication Errors Studies indicate drug related errors 400,000 in Hospitals 800,000 in LTC 530,000 in Clinics Cost Harmful 1.5 million Additional cost of $3.5 billion Health Care providers to do not always inform patient of errors unless injury occurs. Recommendations • Improve Patient-Provider Relationships – iPhone, iPad, smart tablets – FaceTime® (video chat) – Talking wristwatch (reminder) – Improve order/dispense/monitor in Assisted Living • Usually a 7 day set-up • A way to check to see if meds were taken with a centralized check once per day? Recommendations • Improve Drug Information, Labeling and Packaging – Written and computer data • Multiple languages, voice translator • Complex and plain language • Live chat via computer to answer questions about meds • Rural/small hospitals contact 24 hr centralized help desk to handle med problems, errors, effectiveness of meds • Better way to handle changes in color, size of pills by including this in info provided to patient by pharmacies • Diagram of drug on information sheet Recommendations • Monitoring drugs – Monitor patients while driving • Diabetes, seizure disorders, heart rhythm changes – Various ways to identify right patient in setting • At school – Reexamine use of Ritalin in students – Long term and short term meds for students • LTC – Bar code like hospital – med & location – Some LTC have TV at nurses station for hallways, lounges, but not patient room – Lab test to check • verify right med and test for allergy Recommendations • Request patient/customer list all – drugs, OTC medications, vitamins, supplements, herbals, even food types – To check for interactions and effectiveness • DNA/genetic testing for allergy or med effectiveness • Robot/automation for delivery timing Present • Right Patient – Bar code – Issues • Right Med – Hand held or iPhone PDR – Electronic ordering – Various packaging of drugs – Reports of adverse effects of drugs *ISMP – List of Drug Name Suffixes *ISMP – List of Confused Drug Names http://www.ismp.org/Tools/drugnamesuffixes.pdf http://www.ismp.org/Tools/confuseddrugnames.pdf PDR eDrug Update “In the last year alone, over 60% of prescription drugs in the PDR® had a clinically significant change in labeling.” From print ad in PDR There’s an app for that http://medgadget.com/2006/12/thomson_clinical_xpert.html http://itunes.apple.com/us/app/mobilepdr-65th-edition/id397813684?mt=8 Tech Assist for Rx Refills Walgreens is following the mobile apps trend with a new app for most of the major platforms (iOS, Android, and BlackBerry) that allows users to renew prescriptions by taking a photo of the barcode on a pill bottle using a smartphone. Dan Buckand, 01Feb2011 - Medgadget http://medgadget.com/2011/02/walgreens_mobile_apps_allow_prescription_renewal_via_phones_camera.html Steps to Fill a Prescription 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Personal record: Verify your contact information. Prescription accuracy: Ensure all prescription details are entered correctly. Allergies: Review your personal Walgreens health record for known allergies. Over-the-counter interactions: Look for unsafe interactions with off-the-shelf medications you’ve told us about. Prescription interactions: Review your current Walgreens prescriptions for potential interactions. Appropriate Dosage: Review your personal Walgreens health record to confirm the dosage is right for your age, gender and health conditions you’ve told us about. Refill frequency: Check whether refill is too early. Correct medication: Visually inspect the medication and scan its container for accuracy Electronic check: Perform an electronic check to ensure previous safeguards have been completed. Consultation: Inform you about important information or answer questions about your mediation. Walgreens ad Right Dose - Individual dose - Single packaged injections * ISMP – list of error-prone abbreviations, symbols, dose designations Right Time * ISMP – Guideline for Timely Administration Right Route Control or calculated meds for specific conditions http://www.ismp.org/tools/errorproneabbreviations.pdf http://www.ismp.org/Tools/guidelines/acutecare/tasm.pdf Probable, Possible, Preferable Ways of preventing Med Errors and Adverse Drug Effects - with various age groups - various levels of health care Recent News • J&J cuts maximum Tylenol dose to prevent overdoses – 29July11 – Extra Strength Tylenol max daily dose to be 3,000 mg (6 tab/day) vs. 4,000 mg – FDA reduces acetominophen in Vicodin, Percocet to 325 mg from 700 mg (Jan 11) – Excessive acetominophen can cause liver damage, 200 fatal overdose/year, and 56,000 ER visits per year http://hosted2.ap.org/APDefault/*/Article_2011-07-28-US-Tylenol-Dosing-Change/id1175fe2d64ec4dc0abeaeb30933ecb89 Recent News • FDA Urges Reduced Doses for Anemia Drugs – 24June11 – Procrit, Epogen, Aranesp (made by Amgen) should be used more cautiously – Users face higher risk of cardiovascular problems, heart attack, heart failure, stroke, blood clots and death – Reduce target hemoglobin level from 10-12 gm/dl to less than 10. http://consumer.healthday.com/Article.asp?AID=654311 Recent News • Prilosec, Nexium, Prevacid, Protonix, Aciphex, Zegerid (heartburn medications) • Possible risk of birth defects to a fetus if medication taken by mother four weeks prior to becoming pregnant http://prilosecnexiumlegalad.com/ Recent News • Avandia (diabetes medication) from GlaxoSmithKline • Greatly increased risk of heart failure, – 43% increased risk of heart attack – 64% increased risk of death from all cardiovascular causes • Add prominent “Black Box” warning label http://avandialegalad.com/ Recent News • Prescription Drug Shortage Hits U.S. Doctors and Hospitals – 05Aug2011 – 99.5% of hospitals experienced one or more drug shortages in past 6 months (Jan-Jun ‘11) – 44%, of 820 surveyed, reported shortages of more than 21 drugs – 63% reported that patients did not receive recommended treatment http://www.aarp.org/health/drugs-supplements/info-08-2011/prescription-drug-shortage-hits-doctors-hospitals.html Recent News • Prescription Drug Shortage Hits U.S. Doctors and Hospitals continued http://www.aarp.org/health/drugs-supplements/info-08-2011/prescription-drug-shortage-hits-doctors-hospitals.html Robo-nurse: replace people with robots. Give them pills. Save lives. Humans are not good at delivering drugs. Doctors, nurses, pharmacists and pharmacy techs can mix pills up, provide too many or too few, or fail to dispense them quickly enough. In some cases, controlled substances disappear from hospitals, bound for the black market. http://www.popsci.com/technology/images/2011-05/robo-nurse Medication errors lead to some 1.5 million "preventable drug-related injuries" every year, at a cost of $3-5 billion, a report by the National Academies found. The stakes are highest in trauma units, where lifesaving drugs must be given within the "golden hour"--when medications are most effective. Article from: Popular Science | June 1, 2011 | Bradley, Ryan Thank you