exploring the roles in medication management provider, nurse, pharmacist and patient
DESCRIPTION
Exploring the Roles in Medication Management Provider, Nurse, Pharmacist and Patient. Salahuddin Kazi, MDEric Spahn, Pharm D Tammy Rosenberger BSN, RN Michael Bingham, CPhT. The Role of Nurses in Medication Management. Tammy Rosenberger BSN, RN. Nursing’s role. - PowerPoint PPT PresentationTRANSCRIPT
Medication Use CrisisSponsored by the VA Medication Reconciliation Initiative
In conjunction with VHA Program Offices, DoD and IHS
Exploring the Roles in Medication ManagementProvider, Nurse, Pharmacist and Patient
Salahuddin Kazi, MDEric Spahn, Pharm D
Tammy Rosenberger BSN, RN Michael Bingham, CPhT
Medication Use CrisisSponsored by the VA Medication Reconciliation Initiative
In conjunction with VHA Program Offices, DoD and IHS
The Role of Nurses in Medication Management
Tammy Rosenberger BSN, RN
VETERANS ADMINISTRATION PATIENT CARE SERVICES
Nursing’s role
• Nurses have played a major role in patient safety for years.– Florence Nightingale– Clara Barton– Linda Richards
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VETERANS ADMINISTRATION PATIENT CARE SERVICES
Nursing and medication safety
• Nurses have the opportunity to keep the patient safe from harm when it comes to their medication.– Before the pt is seen by the provider, during prevention and completion of
clinical reminders, ask if there are any additions or changes in medication• If the pt has reminders re: chronic disease, this can alert the nurse to discuss current
medications for these conditions.• Include asking about non-va meds (herbals, OTC, prescribed meds by other providers outside
the VA system)– Nurses have the ability to enter and remove them.
• Can also document changes on check in sheet to alert provider.
– When a patient is calling for changes or new meds from outside provider.– Discharge f/u calls– Seeing patient after visit to offer education
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Nursing and medication safety
Is the pt taking b/p meds; when was last dose; taking regularly;
VETERANS ADMINISTRATION PATIENT CARE SERVICES
Nursing and medication safety
• BCMA – Bar Code Medication Administration– Idea of Sue Kinnick, RN -1994 –Eastern Kansas Health Care System
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Error Type 1993 (%)
2001 (%)
Improvement (%)
Wrong Medication 0.00371 0.00091 75.47 Wrong Dose 0.00334 0.00127 61.97 Wrong patient 0.00138 0.00009 93.48 Wrong time 0.00143 0.00018 87.41 Omission 0.00917 0.00272 70.34 Johnson, C.L, Russell, C.A, Tucker, C.L, & Willette, C. (2001). Using BCMA software to improve patient safety in veterans administration medical centers. Journal of Healthcare Information Management, Vol. 16, No.1.
VETERANS ADMINISTRATION PATIENT CARE SERVICES
Nursing and medication safety
• Case manager – 1200 patients• PACT model: High risk registry• Visit includes medication reconciliation
– Med list• Active meds, any non va meds, • Encourage patient to bring in prescription bottles• Alert provider to discrepancies
– Allergies• Review and document, alert provider
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VETERANS ADMINISTRATION PATIENT CARE SERVICES
Upcoming Med safety project
• Pilot project at Pittsburgh– Medication review will be available for the pt on the Kiosks.
• Pictures of the pills will be shown, pt will be able to choice which pill they have if manufactures are changed
• Staff will be available to assist patients with this process.
Improves the process for patients to be better prepared to see their provider.
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VETERANS ADMINISTRATION PATIENT CARE SERVICES
Kiosk Display
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Medication Use CrisisSponsored by the VA Medication Reconciliation Initiative
In conjunction with VHA Program Offices, DoD and IHS
The Provider’s Role in Medication Management
Salahuddin Kazi, MD
VETERANS ADMINISTRATION PATIENT CARE SERVICES
The Physician Visit
• Embed medication reconciliation within the workflow of the visit and NOT as a separate process– Discuss medications as part of disease management
• View remote meds• Review Allergies• Review pharmacist flags• Confirm indications, strength and indications• Review interactions• Assess appropriateness of therapy• Educate the patient and provide a written list of medications
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VETERANS ADMINISTRATION PATIENT CARE SERVICES
Clinicians are busy!
Medication Orders Lab Orders Medication
ReconciliationClinical
Reminders
Patient EducationCodingClosing
EncountersDocumentation
Reporting of Results Phone Calls Secure
Messaging
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VETERANS ADMINISTRATION PATIENT CARE SERVICES
The Clinician’s Perspective: Visit For Diabetes
The Clinic Visit
Do I have the right patient
Is the Patient Taking the Right
Medications
How is the Diabetes
Did we set goals
Does the Patient Understand my
Instructions
How are my Other Patients Doing
How Does My Care Compare
Am I Efficient
Am I Getting Credit
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VETERANS ADMINISTRATION PATIENT CARE SERVICES
Workflow Check the patient in (Clerk)
• Hi Mr. Jones! Nice to see you again. While you are waiting to be called by the nurse, I need you to look at this list of medications that our system shows that you are taking
• Please review the list and cross out those that you are no longer taking and write in those that you are taking but are missing from this list
Provider pre-visit chart review• look at medications, labs, imaging, your last note, notes by others, consult results
Provider patient interview• Hi Mr. Jones! How are you doing?• Thanks for reviewing your medication list!• So how is the metformin working for you? I see that you haven’t filled it in 4 months• You are supposed to be taking 500 mg twice daily• Oh, it is caused a stomach upset?• So you are only taking it once a day?• Well, that seems to be OK, because your hemoglobin A1C is good• I will correct your prescription in the computer It will send you a new bottle automatically!
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VETERANS ADMINISTRATION PATIENT CARE SERVICES
Three Pronged Approach to Medication Reconciliation
Check in
•Printed current medication list given to patient - obtaining
MD Visi
t
•Medication reconciliation occurs and after visit summary is written – comparing and assembling
Check
out
•Patient collects after visit summary - communicating
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VETERANS ADMINISTRATION PATIENT CARE SERVICES
The After Visit SummaryA printed document that summarizes the
clinic visitBasic elements
Vitals
Medications
Visits
Advanced elements
Annotated problem lists
Goals of therapy
Education
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VETERANS ADMINISTRATION PATIENT CARE SERVICES
After Visit SummaryAn important
communication tool
Improved Provider-Patient Communication
Improved patient recall
Decreased phone-calls
Improved treatment adherence
Improved patient
satisfaction
http://ixblog.wordpress.com/ix-reports/the-after-visit-summary-avs/
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VETERANS ADMINISTRATION PATIENT CARE SERVICES
Timing is everything!The after visit
summary (AVS) must be written after:
Medications are ordered,
discontinued
Medications are reconciled
Labs/imaging are ordered
Consults are written
New process
Writing the plan in patient friendly
language
Writing the plan in the AVS
Copying the plan to the progress note
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VETERANS ADMINISTRATION PATIENT CARE SERVICES
After Visit Summary
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LOCAL TITLE: RHEUMATOLOGY AFTERVISIT SUMMARY STANDARD TITLE: MEDICATION MGT NOTE DATE OF NOTE: APR 25, 2012@09:07 ENTRY DATE: APR 25, 2012@09:07:53 AUTHOR: Provider #1 EXP COSIGNER: URGENCY: STATUS: COMPLETED ***CLINIC AFTERVISIT SUMMARY***XXXXXXXXXXXXXXXX DOB: XXXXXXXXXXXAPR 25, 2012Thank you for allowing us to participate in your healthcare. Pleasereview and retain this document. It may contain additional information orinstructions from your care provider. ________________________________________________________________________Today your provider was: Provider #1Primary Care Team: Blue Team #1Primary Care Doctor: Provider A
VETERANS ADMINISTRATION PATIENT CARE SERVICES
After Visit Summary
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Future Appointments: 5/5/12 11:30 am GI LAB SATURDAY 5TH FLOO ext.715905/7/12 1:00 pm DIABETES INTRODUCTION ext.742707/9/12 1:00 pm XLAB CLINIC-X ext.706787/9/12 3:00 pm DALLAS PC CL10 ext.78914 Labs that were ordered today: No pending labs. Imaging studies that were ordered today: NO recent pending Radiologyfound. Consults or procedures that were ordered today: NO recent pending Consults found.
VETERANS ADMINISTRATION PATIENT CARE SERVICES
After Visit Summary
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Your vitals for today are: Blood Pressure - 140/66 (04/25/2012 08:25) Weight - 254 lb [115.5 kg] (04/25/2012 08:25) Pain Level - 5 (04/25/2012 08:25) Allergies:Patient has answered NKA
VETERANS ADMINISTRATION PATIENT CARE SERVICES
After Visit Summary
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These are the MEDICATIONS we show you should continue taking: Active Medications============================================================ 1) Acetaminophen 500Mg Tab Take one tablet by mouth twice a day as needed for pain. Maximum of 3000mg of acetaminophen per day from all sources 2) Allopurinol 100Mg Tab Take one tablet by mouth every day for gout 3) Gemfibrozil 600Mg Tab Take one-half tablet by mouth twice a day for cholesterol 4) Magnesium Citrate 300Ml Bt Take 2 bottles by mouth once drink 2 bottles as directed By gi lab instructions. 5) Polyethylene Glycol,(golyte/colyte) 4L Take 4 liters (1 bottle) by mouth once 6) Prednisone 20Mg Tab Take one tablet by mouth every day for inflammation You have 6 active medications______________________________________________________________________ Your provider has NOT prescribed any new medications today. _______________________________________________________________________ These are DISCONTINUED medications that you should NO LONGER TAKE:1) Indomethacin 25Mg Cap
Take Two Capsules By Mouth Three Times A Day For Pain
VETERANS ADMINISTRATION PATIENT CARE SERVICES
After Visit Summary
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Additional provider instructions: If you get a gout flare, please callclinic. a. Please give a list of these medications to each provider you see.b. You can use this list of medications to update the information when any of these medications are discontinued, doses are changed, or new medications (including over the counter products, herbals and supplements) are added. c. Please carry medication information at all times in the event of emergency situations. _______________________________________________________________________If you have any questions, please notify an assistant before you leave. If you have questions or concerns after today, please contact the clinic. Please leave a message for the rheumatology nurse at 1-800-849-3597extension 72105. Your call will be returned in 1 business day. For medication refills please call 1-800-849-3597 extension 79000. After hours and weekends: Registered nurses are available 24 hours, 7 daysa week and on holidays to answer medical advice questions by calling800-677-8289. /es/ Provider #1, RN, MSN, FNP-cRHEUMATOLOGY NPSigned: 04/25/2012 09:09
Medication Use CrisisSponsored by the VA Medication Reconciliation Initiative
In conjunction with VHA Program Offices, DoD and IHS
The Pharmacist’s Role in Medication Information Management
Eric Spahn, PharmD
VETERANS ADMINISTRATION PATIENT CARE SERVICES
“Pharmacists are the most accessible health care professionals in the United States and have always been one of the most trusted professions.”
- 2011 USPHS Report to USSG
Access to Care
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VETERANS ADMINISTRATION PATIENT CARE SERVICES
Veteran Pharmacy Prescribing Clinic
COMMUNICATION
Part of a Team
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VETERANS ADMINISTRATION PATIENT CARE SERVICES
Medication Experts
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VETERANS ADMINISTRATION PATIENT CARE SERVICES 33
• Interpretation and verification of physician’s orders, patient medication profile review (allergy, drug interaction screens, etc.) providing drug and policy information to patients and medical center staff.
• Direct and Indirect patient care, drug therapy monitoring, formulary management, staff education, prescription inputting, patient counseling, and cost containment
• Recommend, implement, monitor, and modify patient-specific pharmacotherapy in collaboration with patients and other health care professionals to optimize drug therapy.
• Notification of safety and drug alerts (CMOP delays, shortages, recalls, etc.) to patients and providers
• Assignment to specific clinical areas including discharge pharmacy, anticoagulation, geriatric medicine, home-based primary care, antibiotic stewardship, behavioral medicine, and other clinical areas.
Part of Our Job
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Medication Use CrisisSponsored by the VA Medication Reconciliation Initiative
In conjunction with VHA Program Offices, DoD and IHS
The Role of the Patient in Medication Information Management
Michael Bingham, CPhT
VETERANS ADMINISTRATION PATIENT CARE SERVICES
Ask A Pharmacist – Secure Messaging
VETERANS ADMINISTRATION PATIENT CARE SERVICES
Questions?
OREmail: [email protected]
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• Use the Q&A on Live Meeting to ask Questions