Collaborative Development and Implementation of a Universal Medication List

Jeanne R. Ezell, Blount Memorial Hospital, Maryville, Tennessee; Baeteena M. Black, Tennessee Pharmacists Association, Nashville, Tennessee

PROBLEMS Medication reconciliation at hospital admission is extremely difficult to accomplish when patients fail to bring an up-to-date list of all their medications Past history and medication response are needed to plan patient treatment Complete medication profile is needed to screen and prevent interactions,omissions and duplications Communication of medication profile, allergy history, and vaccination history is needed to prevent discontinuity and fragmentation of care

PURPOSE TPA Continuum of Care Project Goal To improve medication safety in Tennessee by providing a universally consistent process for communicating vital patient information regarding medications and allergies across the continuum of care

Initial Objective Develop and promote a common paper- based method of medication information interchange that Tennesseans can use in all healthcare encounters

Additional Project Objectives Until electronic systems are widely available to share personal health information, all Tennessee pharmacists will provide their patients with a medication list All Tennessee pharmacists will encourage patients to carry an up-to-date medication list with them at all times to be available at entry and exit from all healthcare encounters

Methods Searched for available medication list forms Conducted a survey of health care professionals (pharmacists, physicians, nurses) to determine most important elements and formats for a universal medication list form, regardless of whether electronic or paper Graded available lists based on important elements from survey Adapted Universal Medication List (UML) from South Carolina (developed by AnMed Health and South Carolina Hospital Association 2004) Sought collaboration with other healthcare professional organizations in Tennessee

Methods Posted UML on TPA website for free download (887 hits Feb15-May15) Translated UML into Spanish Sent out UML Press Releases to TPA members and partner organizations UML presented at state association-sponsored meetings, published in newsletters, and included in meeting packets Surveyed TPA members on usefulness of UML Community hospital surveyed patients on usefulness of discharge UML Community hospital assessed accuracy and completeness of discharge UML

Pilot Projects Blount Memorial Hospital, Maryville – UML adapted for use with discharge instructions UT Medical Center, Knoxville – UML included in ambulatory clinic visit patient check-in process Community pharmacies are displaying the UML in waiting areas UML provided to seniors with Vial of Life at Nashville Senior Health Expo UML forms displayed in physician offices UML used in MTM sessions

Results Survey of TPA members (110 respondents) –20% had implemented UML in their practice –Most common use was distributing UML to patients –Most common barrier to use was lack of pharmacist time to assist patients in filling out the UML form –Frequent barrier was difficulty incorporating the UML elements into the pharmacy’s electronic system

Results Survey of BMH patients’ discharge UML - 70% said medication list was legible - 60% were carrying UML at all times

Results Discharge UML Audit

Recommendations Healthcare providers must encourage and expect their patients to carry up-to-date medication information Tennessee e-health initiative is anticipated to provide support for sharing medication information across the continuum of care Regional Health Information Organizations (RHIOs) need to be encouraged to include the contents of the UML in design of patient health information exchange

Conclusions Development and implementation of a Universal Medication List for use in Tennessee has been a collaborative project among health care professionals. The potential impact of this project on medication safety should be significant if widespread adoption of the UML among healthcare practitioners and the public is fully achieved.

Medications play a key role in the success or failure of patient care.

Tennessee Pharmacists Association Baeteena Black, Executive Director Continuum of Care Committee Jeanne Ezell, Chairperson Partner Organizations: Tennessee Hospital Association Tennessee Nurses Association Tennessee Medical Association Tennessee Academy of Family Practitioners Tennessee Dental Association Tennessee Poison Center Blue Cross Blue Shield of Tennessee

Disclosure Authors of this presentation have the following to disclose concerning possible financial or personal relationships with commercial entities that may have a direct or indirect interest in the subject matter of this presentation: Jeanne Ezell: Nothing to disclose Baeteena Black: Nothing to disclose