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Patient Safety Academy 2016 9/8/16
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Long Term Care Pharmacy
Medication Reconciliation in The Electronic Age Courtney Doherty Oland R.Ph, MBA
President
The LTC setting is currently under enormous transformation
“silver tsunami” - greater demand/ more DEMANDING
Facility staff expertise level/ expectations
Diversification in the definition of “Long Term Care”
Increased demands for specialty solutions that are “timely, convenient, clinically appropriate and cost
effective”
Explosion of Technology
Collaborative practice including vaccinations
Patient Safety Academy 2016 9/8/16
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Federal Guidelines & Rules NCPDP 10.6 vs HL7
State Guidelines & Rules Pharmacy Board Rules (Tech Ratio’s / Access/
Outdated/Retail Oriented) DHHS Licensing Rules (often conflict
/incompatible/outdated/ Acute Care Oriented) Sate Board of Nursing Rules – Unclear/? LTC
Multi-Dose Packaging “Compliance Packaging”
Fill Schemes – Cycle/ anniversary/ on demand
DEAAgent issuesTransmission of Rx E RX and Remote Dispensing
A “transition in care” is defined by the American Geriatrics Society as a set of actions designed to ensure the coordination and continuity of healthcare as patients transfer between different locations or different levels of care within the same location. Successful transitional care depends upon a comprehensive treatment plan, shared by healthcare providers at both the transferring facility and the receiving facility or community-based provider(s). Clinicians, well-trained in chronic, complex care needs and focused on the patient's goals, preferences and evolving clinical status, are mandatory. A successful transition of care moves beyond the obligatory medication reconciliation and includes patient and caregiver education and extensive coordination of services between the healthcare professionals involved in each transition.
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Case Study Alfred, a healthy 81-year old, was hospitalized for a knee
replacement. He was started on a blood thinner to prevent blood clots following surgery. Shortly thereafter, he developed symptoms suggestive of internal bleeding. The blood thinner
was stopped pending testing. Meanwhile, Alfred was transferred to a rehab facility. Three days later, he was
lethargic, experiencing chest pain, difficulty breathing and was subsequently sent to the emergency room. He was diagnosed with multiple blood clots. Testing for possible internal bleeding
had never been completedand the rehab facility did not question his post-surgical
transfer orders, which were missing a blood thinner. Missed opportunities from both the discharging and receiving
healthcare providers caused not only a re-hospitalization, but almost cost Alfred his life.
Formulary Utilization and Therapeutic Interchange
E-Kits / Starter Dose Kits
On call Requirement 24/7
Medication Therapy Management (MTM)
Chart order vs Traditional Prescription
E Prescribing Triangle
PBM Pressure / Lack of Flexibility
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A taste of the Present !
A taste of the future!
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This is what they sell!
This is what they sell!
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Why EHR Are Imperative for Nursing Homes/ LTC Even without federal EHR adoption incentives, skilled nursing settings will soon find that they have to adopt EHRs
Three factors will motivate the move to technology:
Stage 2 requirements: The Stage 2 Meaningful Use requirements require hospitals and physicians to submit written care summaries for every care transition. That includes the point when a patient moves between a hospital and a nursing home.
Interoperability: The Stage 2 Meaningful Use requirements also stipulate that EHR systems must be interoperable. This requirement will ease concerns among nursing home administrators that the software they purchase will not be able to interact with hospital-based systems.
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Why EHR Are Imperative for Nursing Homes
Physician expectations: Young physicians who grew up using technology will expect skilled nursing settings to have EHRs. These physicians are unlikely to work in long-term care settings that don't have the tools they already use.
What Your Electronic Health Record Can Communicate
ADT ( Admit, Discharge, Transfer Information )
Billing Information
Resupply request – formerly a “refill”
New Order – NOT Legally ERX – Unless done by a prescriber!Renewal Request – (Pharmacy – Prescriber)
Cancel Rx (d/c)
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Electronic prescribing
Electronic prescribing is a way for your prescribers (your doctor or other health care provider who is legally allowed to write prescriptions) to send your prescriptions electronically and directly to your pharmacy.
Prescribers can check which drugs your insurance covers and prescribe a drug that costs you less.Electronic prescriptions are easier for the pharmacist to read than handwritten prescriptions. This means there's less chance that you'll get the wrong drug or dose.Prescribers will have secure access to your prescription history, so they can be alerted to potential drug interactions, allergies, and other warnings.
Electronic prescribing – Continued…
Prescribers can check which drugs your insurance covers and prescribe a drug that costs you less.
Electronic prescriptions are easier for the pharmacist to read than handwritten prescriptions. This means there's less chance that you'll get the wrong drug or dose.
Prescribers will have secure access to your prescription history, so they can be alerted to potential drug interactions, allergies, and other warnings.
Patient Safety Academy 2016 9/8/16
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eRx/HER Process: The Players
LTC FacilitiesPrescribers Pharmacy Information
system
eRx/HER Process: The Players
LTC Facilities
How will you determine who is and who is not qualified to enter of edit information within the e-HR?
Prescriber Portal – Prescriber or agent
“Nursing staff” - RN, LPN Medication Aids - CRMA/CNAM
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eRx Process: Prescription Initiated
Prescribers
LTC Facilities
Sure Scripts
EHR System
RxSystem
Pharmacy Information
System
eRx Process: Rx Transmitted
Prescribers
LTC Facilities
Sure Scripts
Prescribers Connection
EHR System
RxSystem
Or
Pharmacy Information
System
Patient Safety Academy 2016 9/8/16
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eRx Process: Rx Fulfilled
Prescribers
LTC Facilities
Sure Scripts
Prescribers Connection
EHR System
RxSystem
Pharmacy Information
System
DocuTrackDispensing Systems
eRx Process: Confirmations / Refills Sent
Prescribers
LTC Facilities
Sure Scripts
Prescribers Connection
EHR System
RxSystem
DocuTrack Dispensing Systems
Pharmacy Information
System
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What Has Not Been Addressed ?
Facility Workflow ChangesWho can do what!
Staff Qualifications and Training
State Surveyor Guidance Patient Safety
Courtney Doherty Oland R.Ph, MBA President
Michael SwanHealth Facility Survey Manager
Division of Licensing and Regulatory Services(207) 287-5825
[email protected] of Licensing and Regulatory Services
Patient Safety Courtney Doherty Oland R.Ph, MBA
President
