Bridging Medication Across Settings of Care

Richard Ricker, RPH, MBASparrow Hospital

Barbara J. Smith, LBSW, MS, CHC, NHABurcham Hills

DATE: May 29, 2013

We have no conflict of interest to declare.

We do not have any relevant financial relationships with any commercial interests. 

Define the focus of medication reconciliationDescribe the process and outcomes of the

Sparrow, Burcham Hills “Bridging Medications Project”

OBJECTIVES

Medication errors are perhaps the most common patient safety errors.

Unintended medication discrepancies occur in nearly one-third of patients at admission.

Unintended medication discrepancies occur in 14% of patients at hospital discharge.

Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med. 2005;165:424-429

Medication Reconciliation

The Focus is on global patient safety and improved patient outcomes.

Is composed of multiple processes that:o reduce medication errorso support safe medication use by patientso encourages community-based providers and

those practicing in health systems to collaborate

o promotes overall continuity of patient care.

Focus of Medication Reconciliation:

Both organizations are members of the Community Collaborative “Capital Area Collaborative for Care Transitions”

Burcham participates on the Sparrow Hospital sponsored “Skilled Nursing Facility Readmissions” group

Richard and Barbara identified a common interest and began work to design a pilot to address medication reconciliation at transition

The Sparrow/Burcham Project

Time spent by admissions nurse to reconcile medications 3 different documents sent from hospital with

conflicting medication listsLimited access to a contact at hospital to verify

medication orders Client dissatisfaction with medication availability

at admission to Burcham Missing C-II scripts resulting in inability to provide

timely pain medication administration

Motivating Factors for Burcham Hills

Improve discharge medication reconciliation process

Provide 48-hour medication “bridge” to allow for smoother transition of patients from hospital to skilled nursing facility

Reduce 30-day readmissions

Motivating Factors for Sparrow

Agreement that there was improvement opportunity

Agreement that patient outcomes were each setting’s responsibility during transition

Identified a “One Source of Truth” both settings would acknowledge

Agreed upon process and outcome measures

Our Planning Process

When discharge to Burcham Hills is confirmed:1. Pharmacy Technician prints “After Visit Summary” (AVS)2. Reconciles Discharge Medication List.3. Contacts MD for Controlled Substance (i.e. C-II) Prescriptions for

Burcham Hills and Sparrow Hospital.4. Fills 48-hour supply of medication(unit-dose) not stocked in

automated dispensing cabinets (ADCs) at Burcham Hills.5. Notes on Discharge Medication List amount of medication being

dispensed for patient.6. Places any prescriptions, medications, and Discharge

Medication List in “tamper-proof” bag for transport with patient.

Sparrow’s Process

Admission Coordinator informs medication technician of “bed offer” for a Sparrow Client activating the Sparrow process

Upon client arrival to Burcham Hills Center for Health and Rehabilitation admission nurse: Verifies content of medication packet sent with client Reviews “One source of truth” document Conducts medication reconciliation with client/family Assesses pain

Burcham’s Process

Medication Administration Record is developed that includes medications listed on after visit summary and patient home medication list.

Medications are ordered from Burcham Pharmacy for later delivery

Medications not provided by Sparrow are obtained from Pyxis system until pharmacy delivery

Burcham’s Process Continued

Initial audit of 20 charts of clients transitioned between March 15 and March 31st reveals great improvement: 20 included the After visit summary(one source

of truth) 11 had all medications reconciled including

home medications 11 medication reconciliations had complete

dose and frequency information and no duplicate orders

Interim Status Review

Initial audit of 20 charts of clients admitted between March 15 and March 31st: 8 had either duplication of orders or

inadequate instructions for administration These were charts early in new process inception

1 had handwritten notes by an unidentified source that changed medication orders after technician did reconciliation

Status Review Continued:

Admission nurses are very pleased: Agree that admission process has been

decreased 30-60 minutes per client Nurses report greater job satisfaction, lower

stress There have been zero client complaints since

starting the project Pain issues upon admission are addressed

immediately

Burcham Reactions

QUESTIONS