Using Key Performance Indicators (KPIs) from Medication Reconciliation (MR) to Quantify and Prevent Future Adverse Drug Events (ADEs) Stephen Lim, TT.

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Using Key Performance Indicators (KPIs) from Medication Reconciliation (MR) to Quantify and Prevent Future Adverse Drug Events (ADEs) Stephen Lim, TT Chih, E Fong Pharmacy, Armadale Health Service Delivering a Healthy WA

Armadale Health Service (AHS) 2

Overview: Med Rec (MR) in AHS Aim and Method to quantify MR Definition of: Adverse Drug Events (ADEs) Key Performance Indicators (KPIs) Achievements of KPIs Prevention of future ADEs Lesson learnt

Med Rec (MR) in AHS Since 2007 SQuIRe funded project Marketed as Med Matching (M+M) program 70-90% M+M for all admitted patients Sustainable program Common errors in MR 4

Common Drug Errors in MR Exclude ADR documentation 5

Aims and Method to Quantify MR: To quantify success or failure in MR Use KPIs to  or prevent ADEs Method: Daily data collection from MR activities Analyse data monthly using 4 KPIs 6

Definition of ADEs: (Adverse Drug Events Ξ Actual Drug Errors) Potential Drug Errors: MR < End of Next Calendar Day (ENCD) near misses (rectified before drug admin) Not counted as ADEs Actual Drug Errors: MR > ENCD Counted as ADEs due to: Med not admin (Rx omission) Wrong drug/dose admin (incorrect Rx)

Case study (patient AO, 70y, ♀) ADE Ξ Adverse Drug Events Ξ Actual Drug Errors NIMC NIMC dose BPMH (Best Possible Med History) Dose admin? Aspirin (commission error) 100mg mane Ceased months ago 1 dose (ADE √) Mirtazapine (commission error) 15mg nocte -ditto- Tamoxifen (commission error) 20mg nocte Calcium (omitted Vit D) 1 d Ca plus Vit D 1 dose omitted (ADE √) Frusemide 40mg m 20mg mane Intentional dose change (ADE X) Olmesartan (omitted HCT) 40mg mane Olmesartan + HCT 40/12.5mg mane Prochlorperazine 5mg mane (wrong dose) 5mg tds 2 doses missed (ADE √) Fosamax plus (commission error) 1 weekly Not admin (ADE X)

Definition of 4 KPIs: KPI1 = ADEs per 1000 doses administered Number ADEs ÷ Number med doses admin (30 random patients/month) X 1000 KPI2 = ADEs per 100 med written (Rx) Number ADEs ÷ total med written X 100 KPI3 = Pharmacy Interventions per 100 patients Total pharmacist clinical interventions ÷ total MR patients X100 KPI4 = ADEs per 100 patients seen >ENCD Number ADEs ÷ total MR patients X 100 9

ACHIEVEMENT : KPI1 ADEs per 1000 doses Average 4.7 ADEs per 1000 doses = 1 ADE per 200 doses Trendline ADEs 10

ACHIEVEMENT: KPI2 ADEs per 100 med Rx 17 drug errors for every 100 meds written 13 ADEs prevented due to MR 4 ADEs for every 100 meds written Trendline ADEs 11

ACHIEVEMENT: KPI3 Pharmacy Interventions per 100 patients 122 clinical interventions per 100 patients 64 MR activities per 100 patients Trendline  MR 12

KPI4: ADEs per 100 admissions (Do Nothing KPI!) 83 ADEs per 100 patients (MR > ENCD) Flat trendline: Error when no MR 13

Prevent Future ADEs: Goal:  ADEs to  harm: KPI1  KPI2 ↑ KPI3 KPI4

Lesson learnt:

Lesson learnt:  KPI1 and KPI2 (≠ 0 ADE): ↑ KPI3: timely Med Rec (within ENCD) involve all clinicians in MR ↑ KPI3: 50% clinical pharmacist workload is MR related KPI4 remains constant if no MR 0.8 ADE per patient

Assigning Risk Rating to ADEs ADEs risk rating: from 0-3 0 = near miss 1 = low (no harm has occurred) 2 = moderate (extra monitoring eg. digoxin level had to be ordered, extra obs (BP/BSL) needed, Dr reviewed patient, no extra treatment required). 3 = severe (required extra treatment, t/f to another hospital/unit, ↑ LOS, readmission)

Conclusion: To  ADEs: Timely Med Rec within ENCD Involve all clinicians in MR