1. Medication and Allergy Histories Using a Scripted, Electronic Interview Tool Curtis Dorn MD, Leslie Eidem RPh, Tina Nester RPh Wesley Medical Center Wichita, KS

2. Medication & Allergy Histories Introduction Study Design Hurdles Results Summary

3. Medication & Allergy Histories Problem: No one looking at the Big Picture No repository of complete patient data –Multiple Doctors / Specialists –Multiple prescriptions –Multiple pharmacies –OTC / Herbals under-reported –Vague Allergy Histories

4. Medication & Allergy Histories Med/Allergy Hx- Needed for safe and effective medication choices on admission to hospital. Without complete Med/Allergy Hx: –Important home meds may not be continued. –Herbal or OTC meds (unknown to MD) may interact with blood thinners or anesthetic agents. –Dangerous drug-drug interactions may be created –Medications may be ordered patient is allergic to.

5. Medication & Allergy Histories Goal: Create repository of patient data to allow reconciliation of the patient’s current condition and new medication orders with home meds and allergies, from admission through discharge.

6. Medication & Allergy Histories 1 st Step: Obtain an accurate medication and allergy history from the patient on admission, and enter it into the hospital information system.

7. Medication & Allergy Histories Previous Studies: Medication histories taken by pharmacists uncover more home meds, herbal and OTC products than RNs. Training vs. Interview Tool? Rozich JD, Resar RK. Medication Safety: One Organization’s Approach to the Challenge. J.Clin Outcome Mgmt. 2001; 8:27-34. Nester TM, Hale LS. Effectiveness of Pharmacist-acquired Medication History in Promoting Patient Safety. Am J.Health-Syst Pharm. 2002;59.

8. Medication & Allergy Histories Purpose - Current Study: Create a scripted, interview tool to close the gap between the patient/RN history and that of the pharmacist. Load the interview tool into the new wireless, laptop / scanner / med-carts.

9. Medication & Allergy Histories Methods: Sequential, 3 Phase Study Collect patient medication / allergy Hx N = 100 patients (~ 1 month per phase) Day shift, weekdays One floor of hospital

10. Medication & Allergy Histories Methods: 7 Tower Floor 48 beds Cardiac, Pulmonary, Renal, Diabetic Patient Age: 69 years (range 12-103) –“We’ll take them, if they code like an adult”

11. Medication & Allergy Histories Methods: Phase I – Patient / RN History Form Phase II – Pharmacist History Form Phase III – Design, Implement, Measure Scripted Interview Tool for Bedside Hx

12. PHASE I Patient / RN Med / Allergy History Form -Patient/family fill out form. -RN reviews w/ Patient -RN scans to pharmacy -Pharmacist enters into pharmacy computer

13. PHASE II Pharmacist Med/Allergy History Form ( Page 1)

14. PHASE II Pharmacist Med/Allergy History Form (Page 2) -Pharmacist interviews patient -Pharmacist enters data into pharmacy computer

15. Phase III – Scripted Tool

16. Phase III Lionville Cart Wireless Laptop Scanner Med Drawers Supply Drawers

17. Phase III Stinger Cart Wireless Laptop Scanner Med drawer

18. Medication & Allergy Histories Hurdles IRB Committee approval Projects Committee approval HIPAA Compliance Behavior / routine change (scanning Hx) Equipment roll-out

19. Medication & Allergy Histories Results N = 100 sufficient power Phase I - N = 75 (waiting on 25 charts) Phase II – N = 85 (waiting for 15 admits) Phase III – N = 0 (waiting for equipment)

20. Results – Phase I & II

22. Medication & Allergy Histories Results Summary Pharmacist (or RPh Form) uncovered: –More OTC meds –More Herbal / Nutraceutical products –Better description why med being taken

23. Medication & Allergy Histories Results Summary Patient / RN (or Hosp Form) equivalent in obtaining: –Rx meds –Allergies and Allergy Description –When last dose taken

24. Medication & Allergy Histories Humble advice Start early. Overestimate time requirement. Underestimate your ability to change other’s behavior.

25. Wesley Medical Center Wichita, KS