1. eReconciliation A Tasmanian Perspective Rory Gilmour Nov 2014 Department of Health and Human Services

2. Medication reconciliation is the formal process of obtaining and verifying a complete and accurate list of a patient’s current medicines.

3. Department of Health and Human Services Background DHHS Tasmania:  4 public hospitals Medication Reconciliation:  originally ad hoc and not well structured  paper based  electronic (web based) HCS developed the “Clinical Suite” enabling  state-wide access to information  the sharing of information between disciplines  linking medication management activities

4. Department of Health and Human Services HCS Clinical Suite Is a useful tool allowing:  Pharmacists to complete  medication admission interviews  medication reconciliations  add, withdraw or update allergies, alerts and comorbidities  medication profiles / counselling sheets  episode notes

5. Department of Health and Human Services HCS Clinical Suite  Within the same environment doctors complete  discharge prescriptions  discharge summaries  outpatient prescriptions  outpatient summaries  add, withdraw or update allergies, alerts and comorbidities  Provides decision support and access to  state formulary (MIMS, PBS, DHHS meds list and guides)  patient medication and other alerts  real time decision support

6. Department of Health and Human Services Defining eMM eMM is more than prescribe / dispense / administer – we view this as a flow where each activity informs the next. Some information withheld

7. Department of Health and Human Services Medication Admission Interview

8. Department of Health and Human Services Some information withheld

9. Department of Health and Human Services Medication Admission Interview  conducted upon admission to hospital  obtained using a systematic process (ie. using a defined checklist)  utilise several sources  check for commonly missed medications or items recently ceased or changed.  check for allergies and alerts  check whether a supply of each medication is required on discharge.  example example

10. Department of Health and Human Services Admission interview Some information withheld

11. Department of Health and Human Services Medication Admission Interview Chart Review (Paper )

12. Department of Health and Human Services Chart Review

13. Department of Health and Human Services Medication Admission Interview Chart Review (Paper ) Medication Reconciliation

14. Department of Health and Human Services Medication reconciliation Some information withheld

15. Department of Health and Human Services Medication Reconciliation A “Med Rec” should  compare a patients medication history to the medications that have been charted  highlight potential issues or discrepancies in therapy to all treating clinicians  example example Paper copy placed in the patient’s progress notes

16. Department of Health and Human Services

17. Some information withheld

18. Department of Health and Human Services Medication Admission Interview Chart Review (Paper ) Medication Reconciliation Discharge Prescription

19. Department of Health and Human Services Discharge Prescription Information obtained from the  Medication Admission interview  NIMC (inpatient drug chart) is then used to prepare an electronic prescription Still require a paper based Rx to enable PBS claiming Some information withheld

20. Department of Health and Human Services Some information withheld

21. Department of Health and Human Services

22. Medication Admission Interview Chart Review (Paper ) Medication Reconciliation Discharge Prescription Discharge Reconciliation

23. Department of Health and Human Services Discharge Reconciliation  conducted by a clinical pharmacist  review and compare the electronic Rx with medication reconciliation  once reconciled – Rx dispensed

24. Department of Health and Human Services Medication Admission Interview Chart Review (Paper ) Medication Reconciliation Discharge Prescription Discharge Reconciliation Discharge Dispensing

25. Department of Health and Human Services Discharge Dispensing  prescription dispensed  details of medications dispensed sent to the Clinical Suite  patient’s Clinical Suite medication profile updated for future admissions as well as to aid in the completion of:  discharge medication summary (Dr)  medication profile / counselling sheet (Ph)  DAA label (Ph)

26. Department of Health and Human Services Medication Admission Interview Chart Review (Paper ) Medication Reconciliation Discharge Prescription Discharge Reconciliation Discharge Dispensing Discharge Summary

27. Department of Health and Human Services Discharge Summary  Populated by numerous systems  Completed & signed off by treating doctor  Allows for other allied health involvement  Emailed to the patient’s:  GP  digital medical record  PCEHR (depending on consent status)  example example

28. Department of Health and Human Services Discharge Summary Some information withheld

29. Department of Health and Human Services eMedication Managment  DHHS Tasmania has achieved eMM across the state  true closed loop needs to involve ALL care settings!

30. Department of Health and Human Services Reporting Some information withheld

31. Department of Health and Human Services Advantages  single medication record across all hospitals  allows for information sharing  is informed by other systems (+/- … PAS, iPcy, etc)  standards compliant (AMT v3, SNOMED, Nehta stds)  promoting best practice in –  Accurate and PBS compliant prescribing  Past medication actions within reconciliations  easier reporting and statistic gathering  helps provide better communication and handover (eg tasks and worklists)

32. Department of Health and Human Services Disadvantages  initially slower than hand written  human error still possible (minimise not eliminate)  currently does not check dose ranges  relies on availability / accuracy of other systems  manual updating in some areas  IT support 9 to 5, hospitals 24/7.  user needs to be computer “savy”

33. Department of Health and Human Services eReconciliation eReconciliation works if a hospital provides  reliable software (eg HCS)  reliable wi-fi  iPad / Android or Windows tablets  and adequate training Question: Would I return to paper based reconciliations? Answer: Not if I don’t have to!

34. Department of Health and Human Services Questions Thanks for listening Rory Gilmour Nov 2014