Medication Safety Program Insights

PHARMACY MANAGED MEDICATION HISTORY PROGRAM McLaren Bay Region Inpatient Pharmacy David Haugh, Pharm.D. Director of Pharmacy

MEDICATION SAFETY - LITERATURE 40% of medication errors are believed to be a result of inadequate medication history (Hart) Rx managed med rec program reduced admission medication history errors by 80% (Pevnick) 90% of nurses feel the med rec duties interfere with their other tasks Nursing is 7.5 times more likely to make an error on a medication history than a pharmacy staff member. (Hart)

MEDICATION SAFETY MCLAREN BAY REGION % of Admission Medication Errors compared to Total Errors 2016 2017 2018 2019 Q1 10% Q2 27% Q3 20% Q4 20% Q1 13% Q2 8% Q3 18% Q4 20% Q1 26% Q2 17% Q3 22% Q4 40% Q1 33% Q2 27% Q3 40% Q4 35% Full Time Med Rec Program Total Errors 14% Med Rec Program Ended Q3 2018 (November) Total Errors 35% These are only reported errors

MEDICATION SAFETY ACTUAL CASES Employee Story OB Patient delivered here. Long labor = long stay Started feeling off, jittery , etc. realized wasn t taking antidepressants (missed 3 days). Nursing brushed it off w/ initial patient concern Side effects of abrupt stopping of antidepressants Implications of existing depression (now untreated) & post partum depression

MEDICATION SAFETY ACTUAL CASES Significant Cases Week of 2/17/2020 Methotrexate dose free texted in huge error waiting to happen Each year is a ISMP high alert. Last 18 months ISMP reports 14 errors 5 resulting in death. Patient admitted w/ syncope. Home med list - Accupril 25mg QID (last dose taken the day prior). Patient hasn t been on since 2017 then it was a different dose (20mg daily) (Note:25mg QID exceeds max dose) Ferrous sulfate 325mg/kg (17,348mg) instead of 325mg Ultracet 37.5 tablets every 4 hours as needed instead of 37.5mg every 4 hours as needed

MEDICATION SAFETY ACTUAL CASES Evening of 2/26 11 McLaren Safety First Entries (14 drugs) Gabapentin & Methadone not on home med list How did Brad know? Valtrex and Gabapentin on home med list patient no longer taking Lisinopril 10mg/kg 1400mg dose ordered instead of 10mg Incorrect calcium dose Plavix free-texted on home med list Frequency free-texted as daily should have been MWF 7 medications w/ no PRN reason Doctor selects random reasons Aquaphor for pain Tylenol for GI prophylaxis TJC issue will result in a citation

WHY CAN PHARMACY PRODUCE BETTER OUTCOMES? Focused, Controllable Team 7 vs 300 Biohazard bag example Deep Dig Sole Focus RN doesn t investigate past what the patient says (Accupril example hasn t been on since 2017) Pharmacy utilizes 9 different resources Focused questions depending on drug Does your doctor ever change your warfarin dose? Last dose taken documentation routinely missed

PHARMACY RESOURCES Patient Family Members BRAC McLaren Bay Region Pharmacists Patient s Pharmacy MRT MAPS Reports Dr. First* Care facilities Physician Offices *Dr. First Can Cerner do this?

JOINT COMMISSION IMPLICATIONS 2017 Survey MRT Program was recognized as a best practice Closing meeting = long discussion about the completes of our program Suggested she was going to use our program as an example at future visits for other hospitals. MAPS TJC will be looking at how often we run MAPS, who is doing it and when. Current Physicians & Pharmacists = Sporadic MRTs run MAPS on all patients

HCAHPS Increased time for nursing to focus on patient care Average medication history time for nurses = 60 minutes (Health Services Advisory Group) 2019 ED + Direct Admits = 12,870 12,870 hours back to nursing (6.2 FTEs) MRT program would develop HCAHPS driven scripts I m here to get a complete medication history, in addition to getting the most accurate information, this allows me to free up your nurses time so he/she can devote time to listening & explaining things during your stay . The more pharmacy can help nursing do their job the more time they can focus on the patient. Implementation of a Rx run MRT program = 124% increase in nursing satisfaction (Legacy Health)

HCAHPS Physician Concerns Dr. Libby & Hospitalist Team Day shift physician RN hasn t completed med history prior to end of shift Multiple errors Nursing/Physician disagreements Dr. Kochar (MSF #239340) P&T Committee MRT has come up at the last 2 meeting Dr. Bruck, Dr. Kochar MEC Dr. Stuart Letter to the board

PHARMACY MANAGED MRT PROGRAMS 2 FTE Program McLaren Bay Pre-2015 Overwhelmed Confusion Procrastination Demonstrated Failure

PHARMACY MANAGED MRT PROGRAMS Emergency Only Full MRT Program 6FTEs, 20 hours/day 8 FTEs, 24 hours/day All ED & Direct Admits are covered (no PPH, CVH, Surgical) 100% of Admits (add PPH, CVH, Surgical) $395,200 $296,000 Dr. First NOT included (~$45k) Dr. First NOT included (~$45k) $19/hr + 25% benefits $19/hr +25% benefits

COST SAVINGS Emergency Only Full MRT Program 6FTEs, 20 hours/day 8 FTEs, 24 hours/day 12,870 admits 16,150 admits Frees up 6.2 FTEs of nursing time Frees up 7.8 FTEs of nursing time

OTHER CONCERNS/NEEDS Rebuilding Program Will need to find qualified technicians Supplies Cisco Wireless Phones, Computers Workstation