Medication reconciliation in ambulatory oncology new patient clinics

2020 ◽  
pp. 107815522096424
Author(s):  
Roxanne Dobish ◽  
Carol Baumgarten ◽  
Frances Folkman ◽  
Carole R Chambers
Keyword(s):  
Patient Safety ◽  
Medication Reconciliation ◽  
Medication Management ◽  
Clinic Visit ◽  
Healthcare Staff ◽  
Safe Medication ◽  
Multiple Factors ◽  
Patient Surveys ◽  
Alternative Approach ◽  
Ambulatory Oncology

Medication Reconciliation (MedRec) is an essential part of safe medication management and plays a key role in ensuring patient safety. A variety of methods and a number of different healthcare disciplines can be involved in the MedRec process and the timing and location of conducting MedRec can vary. In an effort to streamline the process in ambulatory oncology new patient clinics, a pilot of an alternative approach was undertaken whereby pharmacists with advanced prescribing privileges completed MedRec with patients prior to their clinic visit. Evaluation of the pilot was completed through the collection of various metrics, a pharmacist focus group, healthcare staff and patient surveys. Overall the evaluation indicated that there are multiple factors to consider regarding the timing and method of MedRec completion. The various phases of the pilot demonstrated that flexibility to the process is key and ongoing efforts are required at reducing duplication.

Improving medication reconciliation in ambulatory cancer care.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 224-224
Author(s):  
Carissa Milley-Daigle ◽  
Celina Dara ◽  
Genevieve Bouchard-Fortier ◽  
Anet Julius ◽  
Vishal Kukreti ◽  
...  
Keyword(s):  
Medication Reconciliation ◽  
Adverse Drug Events ◽  
Medication Management ◽  
Median Number ◽  
Medication History ◽  
Time Motion ◽  
Motion Study ◽  
Study Results ◽  
Ambulatory Oncology ◽  
Medication Documentation

224 Background: Adverse drug events are common in ambulatory oncology where care spans multiple providers and medication documentation is often poor. We undertook a QI project with the aim of having 30% of patients have a best possible medication history (BPMH) or medication reconciliation (MedRec) documented within 30 days of starting systemic therapy. Methods: An Electronic Medical record-Integrated Tool (EMITT) was developed to facilitate documentation. 2 Plan-Do-Study-Act (PDSA) cycles have been completed to date; PDSA 1 consisted of piloting EMITT in 3 clinics run by physician champions. PDSA 2 which consisted of expanding pharmacy support and addition of a 4th clinic was impacted by care changes related to COVID. The proportion of patients with BPMH/MedRec documented in EMITT was calculated monthly for each period (PDSA 1, PDSA 2 pre-COVID and PDSA 2 post-COVID). The balancing measure of time to complete an entry was evaluated through a time motion study. Results: Between 9/9/2019 and 31/5/2020, 9.4% (233/2488) of patients had BPMH/MedRec completed; Table shows proportion of patients by month. BPMH and MedRec were most frequently performed by pharmacists followed by pharmacy students and nurses. On average, it took 5.5 minutes to complete an entry (n = 10; median number of medications per patient = 12.3). Conclusions: BPMH was documented more often than MedRec. While some usage was sustained, the changes to care as a result of COVID-19 negatively impacted ambulatory medication reconciliation. Future PDSA cycles will involve engaging patients in MedRec and extending EMITT to all ambulatory cancer clinics where medication management is a major component of care. [Table: see text]

Implementation of a closed-loop medication reconciliation process for ambulatory oncology patients at Winchester District Memorial Hospital

2019 ◽  
Vol 33 (2) ◽  
pp. 85-89
Author(s):  
Emily Mulligan ◽  
LCdr Randy Tuff ◽  
Joanne Leclair ◽  
Jacqueline Mcmillan ◽  
Brian Devin ◽  
...  
Keyword(s):  
Medication Reconciliation ◽  
Closed Loop ◽  
Adverse Drug Events ◽  
Medication Management ◽  
Behavioural Change ◽  
Healthcare Providers ◽  
Open Loop ◽  
Memorial Hospital ◽  
Post Intervention ◽  
Ambulatory Oncology

Medication Reconciliation (MedRec) is a proven method of optimizing pharmacotherapy and decreasing incidence of Adverse Drug Events (ADEs); however, consistent and correct execution is often a challenge in the setting of outpatient oncology. Ambulatory chemotherapy patients are particularly susceptible to polypharmacy and ADEs and their medication management is often complicated due to gaps in communication between an increased volume of non-co-located, multidisciplinary, healthcare providers. Acknowledging these challenges, Winchester District Memorial Hospital (WDMH) led an initiative to create an ambulatory chemotherapy MedRec process using behavioural change approaches. Prior to the intervention, ambulatory chemotherapy MedRec at WDMH was conducted informally via an “open-loop” process. Through an iterative quality improvement process which involved understanding and communicating failure points in the transmission of patients’ medication information directly with the frontline medical staff, a practical and sustainable “closed-loop” system evolved, which improved rates to 97.8% overall completion post-intervention.

scholarly journals Overview of Tertiary Addictions Services response to Opioid dependence during the COVID-19 Pandemic

2021 ◽  
pp. 1-14
Author(s):  
K Hennigan ◽  
E Corrigan ◽  
N Killeen ◽  
E Keenan ◽  
M Scully
Keyword(s):  
At Risk ◽  
Opioid Dependence ◽  
Medication Management ◽  
Health Problems ◽  
Healthcare Staff ◽  
Addiction Services ◽  
Patients At Risk ◽  
Guidance Documents ◽  
High Level ◽  
Opioid Users

Abstract The emergence of the COVID-19 pandemic has presented the addiction services with an unprecedented set of challenges. Opioid users are particularly vulnerable because of their high level of pre-existing health problems and lifestyle factors. In order to minimise their risks to self and to others in the current Covid-19 crisis, the service has sought to urgently identify vulnerable individuals, and induct them into OST treatment promptly. Additionally, several guidelines have been created and regularly updated by the HSE for any healthcare staff working with opioid users. These include guidance documents, to facilitate prompt induction of patients onto the OST programme, the prescribing of naloxone to all patients at risk of overdose, eConsultation, medication management for those in self-isolation, and the delivery of injecting equipment. The guidance documents and resources will provide a template for a new way of working for the sector during these challenging times and into the future.

scholarly journals Usability Flaws in Medication Alerting Systems: Impact on Usage and Work System

2015 ◽  
Vol 24 (01) ◽  
pp. 55-67 ◽  
Author(s):  
E. Ammenwerth ◽  
E. Roehrer ◽  
S. Pelayo ◽  
F. Vasseur ◽  
M.-C. Beuscart-Zéphir ◽  
...  
Keyword(s):  
Patient Safety ◽  
New Technology ◽  
Medication Management ◽  
Secondary Analysis ◽  
Previous Attempt ◽  
Negative Consequences ◽  
Negative Outcomes ◽  
Work Systems ◽  
Work System ◽  
Alerting Systems

Summary Objectives: Previous research has shown that medication alerting systems face usability issues. There has been no previous attempt to systematically explore the consequences of usability flaws in such systems on users (i.e. usage problems) and work systems (i.e. negative outcomes). This paper aims at exploring and synthesizing the consequences of usability flaws in terms of usage problems and negative outcomes on the work system. Methods: A secondary analysis of 26 papers included in a prior systematic review of the usability flaws in medication alerting was performed. Usage problems and negative outcomes were extracted and sorted. Links between usability flaws, usage problems, and negative outcomes were also analyzed. Results: Poor usability generates a large variety of consequences. It impacts the user from a cognitive, behavioral, emotional, and attitudinal perspective. Ultimately, usability flaws have negative consequences on the workflow, the effectiveness of the technology, the medication management process, and, more importantly, patient safety. Only few complete pathways leading from usability flaws to negative outcomes were identified.Conclusion: Usability flaws in medication alerting systems impede users, and ultimately their work system, and negatively impact patient safety. Therefore, the usability dimension may act as a hidden explanatory variable that could explain, at least partly, the (absence of) intended outcomes of new technology.

scholarly journals Mixed-methods study protocol: do national reporting and learning system medication incidents in palliative care reflect patient and carer concerns about medication management and safety?

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e048696
Author(s):  
Sarah Yardley ◽  
Sally-Anne Francis ◽  
Antony Chuter ◽  
Stuart Hellard ◽  
Julia Abernethy ◽  
...  
Keyword(s):  
Palliative Care ◽  
Patient Safety ◽  
Professional Learning ◽  
Public Involvement ◽  
Medication Management ◽  
Patient And Public Involvement ◽  
Learning System ◽  
Mixed Methods Study ◽  
Professional Perspectives ◽  
Medication Incidents

IntroductionApproximately 20% of serious safety incidents involving palliative patients relate to medication. These are disproportionately reported when patients are in their usual residence when compared with hospital or hospice. While patient safety incident reporting systems can support professional learning, it is unclear whether these reports encompass patient and carer concerns with palliative medications or interpersonal safety.AimTo explore and compare perceptions of (un)safe palliative medication management from patient, carer and professional perspectives in community, hospital and hospice settings.Methods and analysisWe will use an innovative mixed-methods study design combining systematic review searching techniques with cross-sectional quantitative descriptive analysis and interpretative qualitative metasynthesis to integrate three elements: (1) Scoping review: multiple database searches for empirical studies and first-hand experiences in English (no other restrictions) to establish how patients and informal carers conceptualise safety in palliative medication management. (2)Medication incidents from the England and Wales National Reporting and Learning System: identifying and characterising reports to understand professional perspectives on suboptimal palliative medication management. (3) Comparison of 1 and 2: contextualising with stakeholder perspectives.Patient and public involvementOur team includes a funded patient and public involvement (PPI) collaborator, with experience of promoting patient-centred approaches in patient safety research. Funded discussion and dissemination events with PPI and healthcare (clinical and policy) professionals are planned.Ethics and disseminationProspective ethical approval granted: Cardiff University School of Medicine Research Ethics Committee (Ref 19/28). Our study will synthesise multivoiced constructions of patient safety in palliative care to identify implications for professional learning and actions that are relevant across health and social care. It will also identify changing or escalating patterns in palliative medication incidents due to the COVID-19 pandemic. Peer-reviewed publications, academic presentations, plain English summaries, press releases and social media will be used to disseminate to the public, researchers, clinicians and policy-makers.

scholarly journals Electronic Health Records and Patient Safety

2015 ◽  
Vol 06 (01) ◽  
pp. 136-147 ◽  
Author(s):  
D. Gans ◽  
J. White ◽  
R. Nath ◽  
J. Pohl ◽  
C. Tanner
Keyword(s):  
Primary Care ◽  
Patient Safety ◽  
Electronic Health Records ◽  
Medication Management ◽  
Health Records ◽  
Safety Practices ◽  
Care Practices ◽  
Electronic Health ◽  
Primary Care Practices ◽  
Promote Patient Safety

Summary Background: The role of electronic health records (EHR) in enhancing patient safety, while substantiated in many studies, is still debated. Objective: This paper examines early EHR adopters in primary care to understand the extent to which EHR implementation is associated with the workflows, policies and practices that promote patient safety, as compared to practices with paper records. Early adoption is defined as those who were using EHR prior to implementation of the Meaningful Use program. Methods: We utilized the Physician Practice Patient Safety Assessment (PPPSA) to compare primary care practices with fully implemented EHR to those utilizing paper records. The PPPSA measures the extent of adoption of patient safety practices in the domains: medication management, handoffs and transition, personnel qualifications and competencies, practice management and culture, and patient communication. Results: Data from 209 primary care practices responding between 2006–2010 were included in the analysis: 117 practices used paper medical records and 92 used an EHR. Results showed that, within all domains, EHR settings showed significantly higher rates of having workflows, policies and practices that promote patient safety than paper record settings. While these results were expected in the area of medication management, EHR use was also associated with adoption of patient safety practices in areas in which the researchers had no a priori expectations of association. Conclusions: Sociotechnical models of EHR use point to complex interactions between technology and other aspects of the environment related to human resources, workflow, policy, culture, among others. This study identifies that among primary care practices in the national PPPSA database, having an EHR was strongly empirically associated with the workflow, policy, communication and cultural practices recommended for safe patient care in ambulatory settings. Citation: Tanner C, Gans D, White J, Nath R, Pohl J. Electronic health records and patient safety – co-occurrence of early EHR implementation with patient safety practices in primary care settings. Appl Clin Inf 2015; 6: 136–147http://dx.doi.org/10.4338/ACI-2014-11-RA-0099

Engineering care transitions: Clinician perceptions of barriers to safe medication management during transitions of patient care

2021 ◽  
Vol 91 ◽  
pp. 103299
Author(s):  
S.M. Hannum ◽  
E. Abebe ◽  
Y. Xiao ◽  
R. Brown ◽  
I.M. Peña ◽  
...  
Keyword(s):  
Patient Care ◽  
Medication Management ◽  
Care Transitions ◽  
Safe Medication

Responding to health information technology reported safety events: Insights from patient safety event reports

2019 ◽  
Vol 24 (3) ◽  
pp. 118-124 ◽  
Author(s):  
Katharine T Adams ◽  
Tracy C Kim ◽  
Allan Fong ◽  
Jessica L Howe ◽  
Kathryn M Kellogg ◽  
...  
Keyword(s):  
Information Technology ◽  
Patient Safety ◽  
Health Information Technology ◽  
Health Information ◽  
Healthcare Systems ◽  
Healthcare Staff ◽  
Or Education ◽  
Training And Education ◽  
Safety Event ◽  
Policy Information

Objective We analyzed the described resolutions of patient safety event reports related to health information technology to determine how healthcare systems responded to these events, recognizing that certain types of solutions such as training and education have a limited impact. Methods A large database of over 1.7 million patient safety event reports was filtered to include those identified by the reporter as being related to health information technology. The resolution text was manually reviewed and coded into one or more of four categories: No Resolution, Training/Education, Policy, Information Technology-oriented solution. Results Most events (64%) did not include a resolution. Of those that did, Training/Education was the most commonly reported single or component of a multi-pronged solution (55%), followed by Information Technology (45%). Only 59 events (6% of resolutions) described more than one method of resolution. Conclusion Health information technology-related patient safety event resolutions most often described a solution that suggested additional training or education for healthcare staff, despite the recognized limitations of training and education in resolving these events. Few events suggested multiple resolution methods. Ensuring health information technology-related events are resolved and incorporate effective solutions should be a continued focus area for healthcare systems.

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