1. Patient Population Nursing-Pharmacy Collaboration on Medication Reconciliation: A Novel Approach to Information Management Michelle Silas MPH, BSN, RN, Melissa Vista BSN, RN, Linda Costa PhD, RN, NEA-BC The Johns Hopkins Hospital, Baltimore, Maryland For questions please email : msilas1@jhmi.edu or lcosta5@jhmi.edumsilas1@jhmi.edulcosta5@jhmi.edu FUNDED BY THE ROBERT WOOD JOHNSON FOUNDATION MedicationBreakfastLunchDinnerBedtimeUse Medication calendar Patient Name Background What is the significance using a nursing-pharmacy collaboration in information management towards patient care? Limited members of a hospital multidisciplinary team obtain medication histories from patients basing their treatment according to patients’ home medication lists Expected Theoretical Outcomes  Reduce preventable adverse drug events by improving medication reconciliation process  Conduct cost-benefit analysis of medication reconciliation process  Identify relationship of patient variables to adverse drug events Learning Objectives Quality improvement intervention aimed to evaluate time required to reconcile medications at hospital admission and hospital discharge Methods The study involved patients admitted to medicine services of The Johns Hopkins Hospital. Primary exclusion criteria excluded patients with an admission time less than 24 hours. Oral consent was obtained during recruitment from the participating patients. There were 564 patients recruited of the 686 cases. The remaining 122 cases included patients that re-entered the study. To account for overestimation, patient variables were not entered for the repeated cases when analyzing relationships of patient variables to adverse drug events. Research Design A quasi-experimental design was used to evaluate the effectiveness of the clinical coordination information team in preventing potential adverse drug events for two medicine services within 24 hours of admission and discharge. A generalized linear model using a log link was used to test for relationships between age, sex, time for initial interview, and time for the remainder of the protocol. An innovative care coordination team lead by clinical nurses and clinical pharmacists interviewed patients to determine their current level of medication compliance and usage. Subsequently, the nurse consults with the primary nursing team, case manager, physician, and pharmacist to develop a plan to address medication issues experienced by the patient. A protocol was developed to determine and address unintentional discrepancies upon admission and discharge as well as provide a comprehensive home medication list for the patient. Results Preliminary data show that 44% (95% CI, 37%-50%) of patients had at least one unintended discrepancy (defined as potential to cause harm to patient). The average age was 55.6 years (SD 16.6, range 19-89), 50.2% were male, and 66% of the patients were African-Americans. 67% of the discrepancies were ranked as having the potential to cause moderate to severe harm (Level 3 discrepancy). The most common error of discrepancy was ‘dose’ and medication use and education were predictors of having at least one discrepancy. The average interview time was 11.2 minutes and average protocol time to obtain the best medication list was 29.3 minutes. Medication Calendar used during patient education teaching – patients would demonstrate understanding of when to take their medications and what they were used for Wallet-sized medication cards with patient’s home medication list from discharge Discussion Q: Why is “medication reconciliation” necessary? Feroli: Take the 57-year-old man on Lipitor for high cholesterol. That’s recorded on the admissions form when he comes in to be treated for an acute illness. When he’s discharged a couple of weeks later, the doctor knows he’s supposed to be on medication to reduce cholesterol, so he prescribes Zocor. The patient goes home. He now has the new Zocor prescription and the leftover Lipitor. He doesn’t know that they are the same kind of medicine, so he winds up taking both. Patient Population