1. Engaging the C-suite to Advance Pharmacy Practice Providing quality patient care through progressive pharmacy practice Ensuring the Accuracy of the Medication List

2. Medication Reconciliation/Transitions of Care

3. Medication-Focused Transitions of Care Initiatives Ensuring Accurate Medication Handoffs Inpatient Medication Reconciliation Validation of PTA medication list for high risk patients Transition to SNF High Risk Patients ED PTA Medication List High Risk Admits CHF PTA=Prior to Admission

4. Validation of Prior to Admission Medication (PTA) List Pharmacist PTA Medication List Validation- High Risk Pts 1. Duplicates deleted 2. High Risk Patients PTA List Validation CHF Therapeutic Class duplicates Greater than 10 chronic meds (not PRNs) Professional judgment N=2000pts Drug Related Problems Resolved=16,000 Evaluation process: pt medication history, contact community pharmacy, contact MD(s) Resolve variances on PTA list and inpatient medication orders

5. Prior to Admission (PTA) Medication List-Pharmacist Evaluation Drug Related Problems (DRP) Resolved in High Risk Pts April-August 2012 16,000 drug-related problems resolved (2,100 pts): 7.5 DRPs/pt) 21% of inpatient orders were changed due to PTA discrepancies 40% of resolved DRP were classified as life threatening or serious/significant

6. Transitions of Care 60% of resolved DRPs were classified serious/significant or life-threatening 6 PTA med lists reviewed on admit Hospital Meds reconcile d on admit Med rec done at time of Discharge* Post- Discharge follow-up call performed** # of Patients Average DRP per patient

7. Post-Discharge Follow Up 7 * # based on physician validation **Excludes vitamins, minerals, herbals, and/or supplements