Download The Future of Healthcare Five Basic Rights of Medication Delivery

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