Medication Management resources (includes Medication Reconciliation)

Hi,

I'm a hospital pharmacist. I'm really interested in continuation of care between hospital pharmacist and community pharmacist for high risk elderly inpatients returning home. Pharmacist have a important role to play in transition of care for these patients.

For exemple, when my patient return home I write all the informations necessary for the community pharmacist on the prescription at discharge (why the medication is stopped, added and more). At the end of the prescription I also suggest some follow-ups I would like the community pharmacist to do if possible.

Do you do the same ? Share your practice please.

Is there tools or electronic tools to facilite communication and continuation of care for pharmacist during transition. I'm talking to go further than medication reconciliation; continuation of pharmaceutical cares.

Thank you

Yannick

Higher accuracy of complex medication reconciliation through improved design of electronic tools

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Here is a recent study comparing eMedrec errors using two different types of screen set-ups.
The side by side and grouping version yielded fewer errors.

This should come as no surprise.

There is other work available, specifically Twinlist – available as open source software, that has demonstrated few errors using side by side, grouping and colour coding to reduce the cognitive load of comparing lists.

Check out their video demonstration:

So, the technology is available – what are the challenges and barriers to implementing these solutions in your organization?

Lisa Sever
ISMP Canada

The RightRx eMedRec solution has been developed, modified and tested at McGill University Health Centre.

They have published their results in full text: academic.oup.com/jamia/advance-article/doi/10.1093/jamia/ocx107/4443115

Some interesting points to note:
- Pre-populates medications dispensed from community based records
- Supports dose based prescribing
- Allows documentation for medication changes and hospital pharmacist recommendations
- Used for admission, transfer and discharge Medrec
- Increased Medrec completion rates
You can find more features on their website: www.rightrx.ca/mcgill-university-medication-reconciliation-software.html

I find this quote in the discussion intriguing.
“RightRx was developed with federal research and innovation funding, with the expectation that this software could be tested at the McGill University Health Centre and, if successful, would be available for deployment in other hospitals. The transferability of RightRx to other institutions is unknown and will likely depend on local leadership, the extent of integration of health informatics into care in the outpatient and inpatient areas, and pre-existing medication reconciliation practices.”

I would like to know if this software is open source? And how do organizations get it?

What questions do you have? Please respond on this forum or send me an email at This email address is being protected from spambots. You need JavaScript enabled to view it. . I will compile all of our questions and send them to Dr. Tamblyn. Then post the answers here for us all to see and benefit from.

Many of us are working with poorly designed paper, hybrid or electronic MedRec solutions. We all need to benefit from this great development.

Send me your questions - so we can get answers!

Lisa
ISMP Canada

The World Health Organization has produced a nice document that has pulled together some data regarding medication errors in primary care.

They present evidence, contributing factors and some potential solutions to reduce.

Solutions are:
1. Medication reviews and reconciliation (especially by pharmacists)
2. Automated information systems
3. Education
4. Multi-component interventions

It's a short read - so if you are working in primary care, take a look.
Medication Errors - Technical Series on Safer Primary Care (WHO)

What strategies has your team implemented? What barriers are you encountering? What successes have you had?

In Ontario, we have Family Health Teams. It is not mandated that a pharmacist is part of the team - which leaves many of the FHTs without clinical pharmacist services across Ontario. This needs to be addressed.
What about other provinces?

Please share your thoughts.

Lisa
ISMP Canada

this is so true! I encounter this often even with the Pharmacy Network that users are assuming its completely accurate when there can be omissions and errors as with any system. The information accuracy and completeness is reliant upon the users inputting the information whether it is electronic or paper. i find we sometimes forget this important aspect.

As the industry works towards integrating electronic records of patient's medication from one or more sources, the clinician must always consider this information may be incomplete or inaccurate. The only person that knows what actually a patient has been taking is the patient or their medication caregiver. Do not be deceived by an electronically captured medication list!

This is highlighted by a recent CMAJ publication: Incidence of clinically relevant medication errors in the era of electronically prepopulated medication reconciliation forms: a retrospective chart review.
This showed that the reliance on information from medication dispensing systems, as the primary source of information led to 47% of patients being exposed to medication errors on admission to hospital. Over 20% of the errors were considered clinically significant.

To help organizations remember the limitations of medication information sources, please become familiar with the document What are the Potential Benefit and Limitations of the Sources of Information for the BPMH .

Remember always to incorporate the patient interview upon admission to and discharge from your organization - whatever sector -using written/electronic sources to compare and lead your conversation.

I welcome any comments.
Lisa
ISMP Canada