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The Evolution and Outcomes of Pharmacist
Medication History ServicesMatt Kresl Pharm.D BCPSClinical Pharmacy Manager Abbott Northwestern HospitalInnovation Summit – September 26th 2015
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Disclosure
• There are no conflicts of interest or relevant financial interests in making this presentation and have indicated that my presentation does not include discussion of an unlabeled use of a commercial product, or an investigational use not yet approved for any purpose.
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Objectives
• Describe the challenges of accurate medication history taking in admitted inpatients
• Review additional services pharmacists offer beyond list acquisition
• Understand the data on process and outcome improvements with medication history services
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Patient Story #1
• 94 y/o M admitted through ED with emesis, headache and weakness
• Arrived via ambulance• Lives in assisted living • Hospitalist unclear on cause – EMS information
non-contributory • Pharmacist asked to review medications in ED• Poor historian given condition at time of interview
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Patient Story #1
• Pharmacist calls home pharmacy• Pharmacist calls assisted living facility• Convinces RN to go into patients room to
obtain medications• Found “medications strewn all across home
including empty Tylenol PM and Aleve PM”
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Patient Story # 1
• Patient diagnosed with anticholinergic OD and treated
• Patient discharged back to assisted living with RN administered medications
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Abbott’s Story
• Emergency Department (2011)• Hospitalist Consult Service (2013)• MDRs (2014)• Integrated Pharmacist Delivery Model (2015)
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Process -More Than Just a List
• Why pharmacy staff?– Experience and training –Outlined processes – Focus and attention
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Process – Pharmacy Staff Note
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Process – Pharmacist Navigator
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PRN Services –Collaboration with Other Services
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PRN Services – Referral to Outpatient Pharmacist
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PRN Services – Tracking Mechanisms
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PRN Services – IDP Note Placement
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The Data – What Do We Know?
1. Bates DW, Spell N, Cullen DJ, et al. The costs of adverse drug events in hospitalized patients. JAMA 1997;277(4):307-11.2. Reducing and Preventing Adverse Drug Events To Decrease Hospital Costs http://www.ahrq.gov/qual/aderia/aderia.htm3. Steven B. Meisel, PharmD at the Joint Commission/Institute for Safe Medication Practices Medication Reconciliation Conference, Nov. 14, 2005.
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The Data – What Do We Know?
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Patient Story # 2
• 25 y/o F admitted with abdominal pain• ED MD asks about medication use with patient
during workup• Patient self –reports taking ‘no additional
medications’• Pharmacist enters room and asks about
medication use
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Patient Case # 2
• Asks about over-the-counter and herbal products (not discussed prior)
• Patient states she is taking 10 grams/day PO acetaminophen for last 2 + weeks
• Patient admitted and treated for chronic acetaminophen overdose
• Patient education on appropriate OTC use completed
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References
• Bates DW, Spell N, Cullen DJ, et al. The costs of adverse drug events in hospitalized patients. JAMA 1997;277(4):307-11.
• Reducing and Preventing Adverse Drug Events To Decrease Hospital Costs http://www.ahrq.gov/qual/aderia/aderia.htm
• Steven B. Meisel, PharmD at the Joint Commission/Institute for Safe Medication Practices Medication Reconciliation Conference, Nov. 14, 2005.
• The Institute for Healthcare Improvement. Protecting 5 million lives from harm. http://www.ihi.org/IHI/Programs/Campaign/Campaign.htm?TabId=1. Accessed September 14, 2015
• American Society of Health-System Pharmacists. ASHP Medication Reconciliation (Med Rec) Toolkit. http://www.ashp.org/menu/PracticePolicy/ResourceCenters/PatientSafety/ASHPMedicationReconciliationToolkit_1.aspx. Accessed September 14, 2015.
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Contact Information
Matt Kresl PharmD BCPS800 E. 28th Street - Mail Route 11321Minneapolis, MN 55407-3799Phone: 612-863-8333Fax: [email protected]