Medication Reconciliation at a Psychiatric Hospital

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Medication Reconciliation at a Psychiatric
Hospital

• Raymond Lorenz, PharmD
• Psychiatric Pharmacy Practice Resident
• Medical University of South Carolina
• Institute of Psychiatry and
• South Carolina College of Pharmacy
• April 26, 2007

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Institute of Psychiatry

• Academic teaching center
• Medical University of South Carolina
• 100-bed acute care psychiatric facility
• General adult, child, geriatric, substance abuse
  and dependence, acute care, electroconvulsive
  therapy
• Average length of stay is 7 days
• Attending psychiatrist model

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Background

• According to Joint Commission
• Accurately and completely reconcile patient
  medications across the continuum of care
• Medication reconciliation (med rec)
• Prevent medication misadventures
• Decrease rates of adverse events
• Minimal literature of med rec in a psychiatric
  hospital

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Background

• Med rec at the Institute of Psychiatry
• Admitting practitioner completes medication
  history
• Pharmacist reviews medication history against
  medications ordered on inpatient profile
• Any discrepancies are discussed with patients
  treatment team
• Pharmacist documents med rec performed
• List can be updated

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Methods

• Med rec defined as
• Matching the patients admission medications to
  their inpatient medication profile
• Coordination with outside facility
• Medication history, if needed
• Perform med rec on 300 charts in a 2 month period
  (Sept Oct 2006)

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Methods

• Following data was collected
• Patient demographics
• Number of medication histories completed by
  admitting practitioner
• Number of reconciliations performed by
  pharmacists
• Number of home medications
• Number and type of interventions made by
  pharmacists
• Omissions, commissions, clarifications
• Time for med rec to occur and length of time from
  admission to reconciliation

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Objectives

• What is our rate of compliance with the Joint
  Commission goal of medication reconciliation on
  admission?
• How long does it take to perform medication
  reconciliation at IOP?
• What are the most common interventions
  pharmacists are making?

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Results Demographics

• Total of 316 reconciliations performed over 46.7
  hours
• 49.4 of admissions (316/640)
• 52.8 within 24 hours
• 70 within 48 hours
• Gender, race, age indicative of patient
  population
• Diagnoses
• 48 mood disorders
• 20 psychotic disorders
• 14 childhood disorders
• 8 substance use disorders
• 9 other

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Results Interventions
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Results Interventions
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Results Interventions

• Type of intervention
• 85 clarifications
• 14 omissions
• 1 commissions
• Medication history done by admitting team
• 99.97 compliance
• Medication history complete and accurate
• 76.3 compliance
• Documentation of continue on admission
• 69 compliance

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Limitations

• Did not collect data regarding disparate
  pharmacist coverage
• Time for medication reconciliation may be longer
• Lack of medication histories collected by
  pharmacists
• Did not reach 100 medication reconciliation rate
• Transfer and discharge aspects of medication
  reconciliation not assessed

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Conclusions

• About 50 of medication reconciliation was
  completed
• When pharmacists perform medication
  reconciliation, on average about one intervention
  is made per patient
• Interventions are clarifications to current
  therapy
• About 9 minutes per patient
• Admitting team should document if medications
  should be continued on admit
• More pharmacy staff is needed to meet the JCAHO
  goal of 100 medication reconciliation

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Acknowledgements

• Amy VandenBerg, PharmD, BCPP
• Shannon Drayton, PharmD, BCPP
• Elisabeth Mouw, PharmD
• Lizbeth Hansen, PharmD

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References

• 1. Joint Commission on Health Care Accreditation.
  National Patient Safety Goals. Accessed from
  http//www.jointcommission.org/PatientSafety/Natio
  nalPatientSafetyGoals/06_npsg_facts.htm. Accessed
  on 7/28/06
• 2. Vira T, Colquhoun M, Etchells E. Reconcilable
  differences correcting medication errors at
  hospital admission and discharge. Qual Saf Health
  Care 200615(2)122-6
• 3. Cornish PL, Knowles SR, Marchesano R, et al.
  Unintended medication discrepencies at the time
  of hospital admission. Arch Intern Med
  2005165(4)424-9
• 4. Tam VC, Knowles SR, Cornish PL, et al.
  Frequency, type, and clinical importance of
  medication histpry errors at admission to
  hospital a systematic review. CMAJ
  2005173(5)510-5
• 5. Nickerson A, MacKinnon NJ, Roberts N, Saulnier
  L. Drug therapy problems, inconsistencies, and
  omissions identified during a medication
  reconciliation and seamless care services.
  Healthc. Q. 20058 Spec No65-72
• 6. Rodehaver C, Fearing D. Medication
  reconciliation in acute care ensuring an
  accurate drug regimen on admission and discharge.
  Jt Comm J Qual Saf 200531(7)406-13

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Questions?