DOM1 TASK 2 MEDICATION RECONCILIATION PRESENTATION_KRISTIN BAUTISTA
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DOM1 — DOM1 TASK 2: MEDICATION RECONCILIATION PRESENTATION
INTRODUCTION TO PHARMACOLOGY — D068
PRFA — DOM1
TASK OVERVIEWSUBMISSIONSEVALUATION REPORT
COMPETENCIES
737.5.3
:
Pharmaceutical Technology—Application of Medication
The graduate analyzes the medication module of an EHR
INTRODUCTION
Proper documentation is an important issue and area of concern to the healthcare professional. Quality of care, patient safety, and regulatory compliance are major focal points for all healthcare organizations. Healthcare professionals serve as subject matter experts to ensure that clinical practices meet the requirements of external regulatory agencies as well as internal stakeholders. Healthcare professionals can share their expertise by collecting and analyzing financial and clinical data that relate to the pharmacy department. The goal is for healthcare professionals to be familiar with how pharmaceuticals impact reimbursement and with related standards surrounding pharmacy best practices.
SCENARIO
You, as the healthcare manager of Felder Community Hospital, have been asked by the hospital CEO and CIO to create a presentation for a meeting with the board of directors. A new electronic health record (EHR) is being implemented in a staged manner at the hospital, and you will be explaining the advantages and disadvantages of implementing a medication reconciliation component to the EHR.
REQUIREMENTS
Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly.
You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.
A.
Create a multimedia presentation (e.g., Microsoft PowerPoint, Apple Keynote), that includes presenter notes, about the medication reconciliation application of an EHR for the board of directors. Include the following in your presentation:
1.
Explain the features of a medication reconciliation application as a selling point for the EHR.
Features: Automatic medication reconciliation. EHR systems have built in alerts to notify providers of medication interactions. Studies show high patient satisfaction regarding EHR systems, with a 63% reduction in patient errors. (HealthIT.gov, 2023). Electronic health records can maintain an active medication list, medication
allergy list, check for contraindications when a
new medication is added, and ensure patient care is maintained through all transitions of care. Improve Healthcare Delivery: Transmit electronically between all providers, including hospital
inpatient staff alongside the
patient’s primary care provider. There are electronic systems now which can communicate with each other even across
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different hospital systems, clinics, physical therapist, etc. This helps keep all of a patient’s providers abreast of their medication needs and issues. Poor medication reconciliation can result in poor outcomes after discharge. Approximately 20% of patients experience adverse events within 3 weeks of discharge
(pharmacytimes.com 2023). An electronic record can capture all the patient’s medications prior to admission, all medications prescribed or supplied during admission, ensure proper patient education regarding medication has taken place, and provide the patient’s PCP with updated mediation lists as well. CMS’ Merit-based Incentive Program (MIPS) is
substantially based on quality. Not only does utilizing an electronic health record make your reporting obligations much simpler, using a certified EHR technology can make you eligible for MIPS bonus points. This can
have a positive impact on your MIPS payment. “Medication reconciliation is worth up to
10 percentage point
. Medication reconciliation is a process that facilitates the transmission of accurate and comprehensive patient medication information across care interfaces. The implementation of formal and structured medication reconciliation processes should include the training of health care professionals in
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accordance with their duties and responsibilities. In addition, it should provide the professionals with the appropriate instruments and technologies. According to the available evidence from major systematic reviews and meta-analyses on medication reconciliation, a variety of components can facilitate medication reconciliation. • interventions involving the patient, including the use of patient-held medication lists or medication passports (paper or electronic), and communication between patients and health care professionals; • complex interventions to support discharge and post-discharge support, particularly for patients at high risk for adverse drug events; and • communication between patients and health care professionals.
Goal of Medication Reconciliation
The ultimate goal of medication reconciliation is to prevent adverse drug events (ADEs) at all interfaces of care (admission, transfer and discharge), for all patients.
The aim is to eliminate undocumented intentional discrepancies and unintentional discrepancies by reconciling all medications, at all interfaces of care.
An undocumented intentional discrepancy occurs when the prescriber (usually the physician) intentionally adds, changes or discontinues a medication the patient was taking prior to admission but this is not clearly documented in the patient's medical record.
An unintentional discrepancy occurs when the prescriber (usually the physician) unintentionally changes, adds or omits a medication the patient was taking prior to admission.
Preventing of Medication Errors
Reconciliating medications can help prevent medication errors such as failure to prescribe clinically important home medications, incorrect doses or dosage forms, missed or duplicated doses due to inaccurate medication records, failure to specify which home medications should be resumed and/or discontinued at home after hospital discharge, and duplicate therapy at discharge.
Medication reconciliation is a process used to identify and prevent medication errors..
Medication Reconciliation provides clinicians with a detailed report of the patient's prior medication history, including drug potency, quantity, initial fill date, and most recent refill.
Alerts for potential drug interactions, duplicate drug therapies, compliance issues, and formulary exchanges are displayed.
Clinicians can promptly create a drug order and/or enter additional medications.
Key Features
o
Merged medication records (permits reconciliation of inpatient and home medications on a single screen). Create, maintain, and update active medication lists and allergy lists
Provide the necessary information to perform medication reconciliation during care transitions.
Multiple interfaces between a clinical information system, such as a laboratory system and diagnostic imaging.
Closed Loop Medication Management is an electronic process that integrates automated
and intelligent systems to close the inpatient medication management and administration
loop. It includes Ordering, validating, preparing, and giving medications are facilitated electronically with decision support. a current prescription order; an electronically-
identified nurse; a bar-coded medicine; and an electronically-identified patient.
Single-sign-on for simple system access and multi-factor authentication.
Pharmacy Interface
Link your client's pharmacy orders easily to MedSupport to guarantee dosage
and prescription data uniformity. At the pharmacy, ongoing orders are updated, and information is automatically sent to MedSupport for verification and addition to the client's medication regimen.
Alerts and tracking for core measures
Display of home medications from retail prescription data
• To assist clinical decisions, alerts and interventions should be integrated into workflow and medication administration processes, as well as embedded in CPOE systems. They should be focused and suitable in order to alert clinicians to issues that demand attention. Excessive
notifications can cause alert fatigue, which can lead to vital warnings being overlooked.
Making reporting duties much easier, utilizing approved EHR technology may qualify you for MIPS bonus points. This may have an effect on your MIPS payment. Medication reconciliation is worth up to ten percentage points in the Quality Payment Program's (QPP) Promoting Interoperability performance category.
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The process of medication reconciliation involves the following key components:
The medication management cycle is a complicated process that includes deciding whether or not to prescribe a drug, dispensing and storing the drug, giving the drug, and watching for a reaction.
This process is called a "closed-loop" when the information from each step is used to keep the process going and start a new cycle.
In a hospital-based closed-loop medication management system (CLMMS), all of the steps in the medication management cycle are done automatically.
This includes checks for important things like the Six Rights of Medication Administration and the accurate recording of information that is needed to keep the process going.
To close the loop, the CLMMS has a fully linked system with electronic prescribing, technology for automating dispensing and/or stock control, and automated dispensing cabinets or barcoded unit-doses with a linked electronic drug administration record.
The clinical electronic health record (EHR) applications that are used by clinicians at
the point of care are referred to as core applications. There exist five primary categories of applications, namely results management, point-of-care documentation, medication management, clinical decision support, and reporting, despite the possibility of numerous specific applications.
The fundamental applications utilized by clinicians during patient care, which are known as core applications, pertain to the clinical electronic health record (EHR). There are five principal classifications of applications, including results management, point-of-care documentation, medication management, clinical decision support, and reporting, notwithstanding the potential existence of various distinct applications.
point-of-care documentation,
Point-of-care (POC) patient charting, also known as POC documentation applications, provides guidance to users on the essential data to be collected in the context of a particular patient. This is often facilitated through context-sensitive templates that react to the nature of the data being entered, thereby customizing the template to the specific data entry requirements.
Medication Management
Applications that support the closed-loop medica-tion management process, where patient
safety is ensured through proper drug ordering, dispensing, administering, and monitoring of reactions are spe-cial forms of POC documentation.
These systems include CPOE, e-Rx as a special type of CPOE, elec-tronic (EMAR) or barcode medication administra-tion record (BCMAR), medication reconciliation systems, and automated drug dispensing.
Hospitals have implemented CPOE last due to difficulty getting physicians to use it, but insurers and Medicare are providing incentives for its use. This is changing as MU incentives require use of a CPOE system. Computerized Provider Order Entry (CPOE) systems enable ordering of everything from patient admission, laboratory tests, x-rays, dietary/food and nutrition, therapies, nursing services, and consults to discharge of patient, referrals, and even building personal task lists, as well as entering orders for medications. However, physicians may dislike CPOE systems due to their view of order entry as a clerical task and lack of drug-allergy checking and drug-drug contraindication checking. In the past, physicians typically handwrote these orders, which were then faxed to the respective departments or transcribed by nursing personnel into an order communication system.
The order communication system, however, only enabled transmission of the order to various departments’ information systems. CPOE systems
today have at a minimum drug-
allergy checking and drug-drug contraindication checking. Another concern with CPOE systems is that they are based on stan-dard order sets. These order sets reflect the current thinking about patient care from research, referred to as evidence-based medicine (EBM).
E-Rx is a special type of CPOE application used to write prescriptions and transmit them to retail pharmacies via the Prescription Drug Pro-grams (NCPDP) SCRIPT standard that is sent
through a pharmacy information exchange.
E-Rx is used in doctor offices, hospital outpatient clinics, and when a patient is discharged from the hospital or emergency room with a prescription. In addition to formulary information from Pharmacy Benefit Managers (PBMs), the e-Rx system offers prescription alerts and reminders, similar like the hospital-based CPOE system.
CDS
Prefer studies with a pre–post intervention scheme.
Enrol population with complex morbidity and medication regimen at baseline but adequate life expectancy; one hospital setting (one or more wards) should be preferred for subject enrolment.
Plan interprofessional collaboration and pharmacist involvement.
Integrate a user-friendly CDSS with the healthcare facility’s computerised systems with information sharing capability among healthcare professionals.
Take into consideration active patient engagement and education of the healthcare professionals involved (contribution still uncertain).
Physician order entry (CPOE) The process of prescribing and administering a medication involves several steps, each of which has vulnerabilities that are addressed—to greater or lesser degrees—by CPOE:
Ordering: the clinician must select the appropriate medication and the dose and frequency at which it is to be administered.
Transcribing: if handwritten, the prescription must be read and understood by the recipient (usually a pharmacy technician or pharmacist).
Dispensing: the pharmacist must check for drug–drug interactions and allergies, then release the appropriate quantity of the medication in the correct form.
Administration: the medication must be received by the correct person and supplied to the correct patient at the right time in the right dosage. In hospitalized patients, nurses are generally responsible for this step, but in the outpatient setting, this step is the patient's or caregiver's responsibility.
o
E-prescribing and/or automatic electronic faxing. Generate and transmit prescriptions electronically
, which means pharmacists and patients can reliably read handwriting and avoid potential errors
o
Automatically
check for problems whenever a new medication is prescribed
and alert you to potential drug/drug and drug/allergy interactions
EHRs can help your organization avoid medication errors and improve patient outcomes
.
1-4
Achieving Meaningful Use
One of the best ways to ensure you take full advantage of the
benefits of electronic health records
to prevent adverse medication events in your organization is to
achieve meaningful use
. Achieving the following meaningful use objectives will help you prevent
adverse medication events and improve patient outcomes.
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o
Drug Interaction Checks
o
e-Prescribing
o
Active Medication List
o
Medication Allergy List
E-Rx is a special type of CPOE application used to write prescriptions and transmit them to retail pharmacies via the NCPDP SCRIPT standard. It includes medication alerts and reminders, formulary information from PBMs, and electronic communication from retail pharmacies for renewal approvals.
The electronic medication administration record (EMAR) is used by nurses to document the giving of drugs to patients. Early EMAR systems were paper lists, but did not fully address the medication five rights of right patient, drug, dose, route, and time. Today, many hospitals are moving to BCMAR systems, which require the hospital to have each patient identified with a barcode and package drugs in unit dose form with a barcode or RFID tag. BCMAR systems provide CDS and patient safety assurances, but there are issues to be overcome. To use a BCMAR system, nurses must bring a computer, barcode device, and medication to the patient's bedside. Alternatives include wireless workstations on wheels (WOWs), tablet computers, and bedside terminals. Special labels are needed for specially compounded drugs administered intravenously, and translations are needed to ensure drug naming conventions are followed.
Clinical decision support (CDS) systems are interactive programs designed to assist clinicians in making patient care decisions. Knowledge-based CDS systems are composed of four components: a knowledge-based system that provides facts, production rules, an inference engine, and a user interface. Non-knowledge-based CDS systems use artificial intelligence (such as neural networks or genetic algorithms) to learn from clinical data patterns without a knowledge base. Non-
knowledge-based CDS systems can learn "favorite" medications to display first using non-knowledge-based methods.
CDS is often integrated into CPOE, e-Rx, EMAR/BCMAR, point-of-care patient charting, and other applications, such as a pharmacy information system that alerts pharmacists to drug contraindications.
2.
Describe how the medication reconciliation function could be used to improve healthcare delivery as a selling point for the EHR.
Improves Patient Safety
The primary objective of medication reconciliation is to put the patient's safety and health first in relation to whatever drugs and supplements they might be taking at any one time.
The fact that medication errors are the most common type of patient safety error has been confirmed by a new study which found that an average hospitalized patient experiences at least one medication error per day. The elimination of all adverse drug events (ADEs) and adverse drug effects (ADEs) continues to be one of the most important patient safety goals in every type of healthcare environment.
Reliance on Electronic Solutions In order to deliver treatment that is more efficient and oriented on the patient, organizations need to rely on technological solutions. Electronic health records, clinical event notification systems, and task management systems are some examples of these types of systems.
Enhances patient and family centered care
Asking patients about all their medications and relevant information empowers them to take charge of their health. Patient engagement in medication reconciliation helps patients understand how drugs interact and how they affect their treatment plan.
Increased medication transparency empowers patients. Improves communication between providers across all settings
Comprehensive Data for Better Treatments
This will make it easier for organizations to find problems, gaps, possible dangers, and other things that could get in the way of good results.
1.
Describe consequences that should be enforced at Felder Community Hospital for violating ethical or legal guidelines regarding the use of a medication reconciliation application.
To ensure safe practice, it is imperative that safeguards are recognized and applied; therefore, pertinent legislative frameworks, policy and professional regulation are discussed. Safeguarding patients when administering prescribed medicines means the
nurse must have up-to-date knowledge and skill, and a key aspect of this is to ensure consent to treatment from the service user is secured; for this reason, drawing on relevant legislation, the consensual process is reviewed. Not infrequently, medicine management provokes ethical and legal challenges for the healthcare professional; these demand reflection and careful consideration; consequently, in this lesson legal and ethical parameters and professional boundaries are appraised.
Reconciliation is a joint responsibility.
The responsibility of managing medications is equally shared between a patient and his/her health care provider. While the provider is responsible for writing prescriptions and educating patients, it is ultimately up to the patient to follow the provider’s recommendations.
Consistent reconciliation of your medications will help ensure that you and your primary care provider are on the same page and that your health needs are being addressed in the best possible way.
C. Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized.
https://www.ahrq.gov/patient-safety/settings/hospital/match/chapter-3.html
https://health.uconn.edu/health-interoperability-learning/wp-content/uploads/sites/
252/2020/11/Med_Rec_App_HEALTHINFO_2020.pdf
Robyn Tamblyn
and others
, Improving patient safety and efficiency of medication reconciliation through the development and adoption of a
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computer-assisted tool with automated electronic integration of population-based community drug data: the RightRx project,
Journal of the American Medical Informatics Association
, Volume 25, Issue 5, May 2018, Pages 482–495,
https://doi.org/10.1093/jamia/ocx107
https://www.longwoods.com/content/22842/medication-reconciliation-in-the-hospital-what-why-
where-when-who-and-how-
2014 Edition EHR Certification Criteria Grid Mapped to Meaningful Use Stage 1 (healthit.gov)
Coffey M, Cornish P, Koothanam T, Etchells E, Matlow A. Implementation of admission medication reconciliation at two academic health sciences centres: challenges and success factors. Healthc Q. 2009; 12:1029.
College of Nurses of Ontario, Practice Standards: Medication, 2008 http://www.cno.org/Global/docs/prac/41007_Medication.pdf Accessed: August 2013
Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med 2005: 165:424-9
Diguid, M. The importance of medication reconciliation for patients and practitioners, Aust Prescr. 2012; 35(1): 15-9.
Dobrzanski S, Hammond I, Khan G, Holdsworth H. The nature of hospital prescribing errors. Br J Clin
Govern. 2002; 7:187-93