3. Sustainable solutions to primary care problems
- Release date:
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This webinar will be available for a limited time after the conference- don't miss it on Wednesday October 12th during the conference!
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- Style: On-demand Webcast
- Focus: Balance between both (e.g. Presentation of a best-practice guideline that combines research evidence, policy issues and practical steps for implementation)
- Target Audience: Leadership, Clinical providers
Learning Objectives
- Program framework implemented to ensure accuracy of medication lists post-hospital discharge.
- Key actions to implement to adopt a similar model within a Family Health Team.
- Important metrics to capture to elucidate gaps and build measures to create sustained change.
Summary/Abstract
Building on a previous QI initiative, a project was commenced in March 2021, which would dedicate a team pharmacist to do Medication Reconciliation for patients recently discharged from the hospital. Bi-weekly EMR searches for all patients across the 3 clinics of the STAR FHT recently discharged from the hospital is performed and forwarded to the pharmacist. The pharmacist then commences a comprehensive review of all sources of information related to the patient to ensure a Best Possible Medication History (BPMH). This entails looking closely at the medication list in the patient profile, review of the admitted patient’s BPMH, reviewing the discharge summary, checking Clinical Connect, consulting with the patient’s main dispensing pharmacy and in some cases following up with the patient. Several metrics being tracked is revealing to the gaps that exist, elucidating where potential errors lie and potential areas for improvement. This information is valuable as we continue to move forward with this important program to ensure that all patients have an accurate medication list post-hospital discharge. It is not fully discernable, one year into the project, as to whether it has prevented readmissions to hospital, we do know, that patient and provider feedback has been very positive. Program framework and key actions to engage a complex system to ensure accuracy of the patient medication list: A foundational piece to this framework is an EMR search tool that “finds” recently discharged patients, and generates a note with this list of patients to the team pharmacist. This search is performed x2/week. The pharmacist accesses the patient chart and reviews a number of valuable sources to ensure that there is no discrepancy of medication information that comes from the various sources (e.g. the patient upon admission, the patient profile sent from the FHT/facility, specialist notes, discharge summary etc.). In an effort to ensure an accurate medication list post-discharge the pharmacist in some cases consults with the patient’s main dispensing pharmacy and pharmacies out of the area in the case where the patient is seeing a specialist and is prescribing medication. Clinical Connect is reviewed for patients who have had treatment/procedures outside of the area and subsequent medication has been prescribed. The team pharmacist documents a note in the patient EMR and in circumstances where discrepancies or changes to medications have occurred the family physician is messaged. A number of metrics are being tracked in this project, the results of which are providing valuable insight of where errors can occur, and what measures to put in place to mitigate. The consideration that there are many points in the patient’s journey from admission to discharge where there is potential for error in the patient medication list, suggests the importance for other primary care teams to embark on a similar project, challenging to engage complex systems to ensure an accurate patient medication list at all times.
Presenters
- Teresa Barresi Primary Clinical Team Coordinator, STAR FHT
- Kristy Adair, Pharmacist, STAR FHT
Authors
- Teresa Barresi BSc RN MHS
- Kristy Adair BPharm