WPSC Medication Blog

Medication Safety Champion, CHI Franciscan

This month’s ongoing Medication Safety Champion blog series, features Faylynn Auston and Sue West of Franciscan, St. Joes Medical Center.

Q: What have been the biggest advancements in the medication safety work being done at your organization?

A: In 2010, CHI Franciscan launched the Medication Reconciliation Technician (MRT) pilot program in the Emergency Department at St. Joseph Medical Center. The program was started with two technicians, each covering ten hour shifts seven days per week. After seeing the benefit of staffing MRTs in the ED at St. Joseph, we have further expanded our program to our sister hospitals in the region including St. Clare Hospital, St. Anthony Hospital and St. Frances Hospital. Each of these facilities currently staff two technicians each covering ten hours per day, seven days a week in their Emergency Department. Since the launching of the program, St. Joseph’s Medical Center has not only added two more MRT positions in the Emergency Department covering evening hours but has also expanded into the surgical centers creating two more MRT positions.

It is an exciting time at CHI Franciscan with the expansion of the MRT program. There are great benefits to adding these new positions, first and foremost being patient safety. Having a dedicated team of MRTs for medication reconciliation allows nursing staff to focus more on direct patient care and minimizes the risk of wrong medications/doses being entered into the patient’s chart. Through the expansion of the program, our goal is to have all admitted patients’ medications reconciled by MRTs and reviewed by pharmacists, resulting not only in a more accurate list but potentially preventing adverse drug events.

The medication reconciliation process is considered complete when the patients’ medications are verified through two steps. First, we obtain medication history from a reliable source such as pharmacy or their insurance company. Then, the medication list is verified by going over each medication with the patient or the primary caregiver. Here at CHI Franciscan we use the electronic health record program EPIC. This program gives us the capability to link with other non-CHI facilities that also use EPIC allowing MRTs to view patients’ records from multiple facilities. EPIC also has the capacity to pull records from outpatient prescription history showing what medications were filled at local pharmacies; this information includes, pharmacy name, location, medication, dose, quantity and day supply. This allows us to gather accurate medication records in a timely manner and reconcile any discrepancies. In addition to interviewing the patients/caregivers and inputting data into Epic, MRTs must have a broad knowledge of medications, indications and common doses. They must also be familiar with the limitations of these sources that are being utilized. For example, we cannot always rely on outpatient prescription records provided by third parties for medications that are paid out of pocket. Four dollar prescription plans are the perfect example of these limitations, because they bypass the prescription insurance company. Along with this knowledge, our technicians must have excellent interview skills. When interviewing, many patients do not think to disclose their use of herbal supplements and over the counter medications because they are unaware of potential side-effects and drug interactions.

We feel this is only the beginning of the benefit from the medication reconciliation program and are looking to actively engage the MRT in helping reduce medication related readmissions through identification of patients with uncertainty of the medications.

Falynn Auston CPhT

Sue West CPhT

CHI Franciscan-St. Joseph Medical Center

Medication Safety Champions: Marian Dobles and Sandy Chun

The Washington Patient Safety Coalition has been striving to highlight the efforts of those on the front line of medication safety. We have also begun new outreach efforts to students within the medical and public health fields, to engage them around patient safety. In this month’s “Medication Safety Champions” blog, we feature two University of Washington pharmacy students expressing their hopes for the role of pharmacy in medication safety work.

Student: Marian Dobles, PharmD student, Univeristy of Washington

Q: What are some of the best tools, practices, or educational materials that you use to increase medication adherence, community awareness or patient engagement around medication safety?

A: The best tool within my internship setting is access to patient charts. This, along with being mindful of when the medication was last dispensed, helps me identify potential adherence issues. I print a medication list from the patient chart, as well as a calendar, so the patient can keep track with an up-to-date and complete list of their medications. I also ask patients for an accurate list of their supplements, vitamins, and over the counter medications, so that I can add it to their chart and to their medication list. I engage the patient by filling in a medication wallet-card with them, and assisting them in filling out their calendars. For a lot of older patients, I have found that offering to set up daily reminders on their smart phones have been very useful.

Q: If youʼre currently a pharmacist, what tips and would you give those who are beginning their Pharmacy studies, or just entering the field? If you are a Pharmacy student or just entering the pharmacy field, what excites you the most about the future of the profession?

A: The future of the profession is currently changing, especially with the ever-increasing role of pharmacists as providers. I think the career of pharmacy is expanding into new roles, and I am looking forward to finding and creating a niche that fills the needs within my community. As an aspiring pharmacist, I am looking forward to being able to provide patient care and making a difference in patient lives.

Student: Sandy Chun, PharmD Student, University of Washington

A: I am extremely excited about the direction this profession is heading towards. As this profession continues to advance in the direction that focuses on the clinical aspects of pharmacy, pharmacists are now equipped with the knowledge and education to provide patient-centered care including medication management and review, chronic illness management, wellness screening, as well as disease prevention and education. All of which are key to improving medication non-adherence and maximizing therapy efficacy.

Medication Safety Champion: Dalila Troyer

In celebration of National Pharmacist Month, the Washington Patient Safety Coalition is featuring an ongoing series of blogs from clinicians on the front line of medication reconciliation efforts. As October 20th was National Pharmacy Technician day, we are highlighting the roles that pharmacy technicians everywhere are playing in keeping patients safe through increased attention to medication safety.

This week’s blog features an interview with Dalila Troyer, of MultiCare Health, on her role in medication safety.

Q: What have been the biggest advancements in the medication safety work being done at your organization?

Getting a new, dedicated medication reconciliation position in both adult and pediatric wards. We’re now able to complete the medication reconciliation process preemptively for everyone who is admitted. There are 2 medication technicians now, one who does all the emergency department patients and one who floats throughout the rest of the hospital. Also, getting Epic EHR has really helped keep everyone connected. Now, it’s easy to follow how, where, and what people are prescribed and what they’re buying. It also connects to other organizations, so we can look at patient charts from when they received care elsewhere.

Q: How does your organization use other community resources, or marketing outlets (including social media) to engage the public around medication safety?

Mostly we just engage via in-person contact, likely in the Emergency Department. It helps to have medication technicians be present in the ED and in inpatient wards, because you become engaged and familiar with patients on another level. This relationship with patients isn’t directly about the clinical care they’re receiving, it is about wanting to know more about them as individuals. So we find that patients really respond well to this and they really feel more invested in.

Q: What have the biggest setbacks been for you in advancing medication safety at your organization, and what would you suggest to an individual experiencing the same barriers in their medication safety work?

Workload remains the biggest issue. We sometimes don’t have the ability to get everyone’s information. Also, Epic software has some barriers. It allows clinicians to close out a patient’s electronic medication list even if the list may not be complete with dosage, dates, or drug frequency.

Q: What are some of the best tools, practices, or educational materials that you use to increase adherence or patient engagement around medication safety?

The EHR. It really helps us stay connected and in constant touch with pharmacies in the community. Sometimes there is a little friction with local pharmacies who are worried about sharing patient information. They aren’t used to a lot of organizations reaching out to them directly to inquire about patients. I think there’s potential for improvement here, in terms of normalizing more collaboration between health care organizations and local pharmacies.

Dalila Troyer, CPhT

MultiCare Health

Medication Safety Champion: Jennifer Waters

In celebration of National Pharmacist Month, the Washington Patient Safety Coalition is featuring an ongoing series of blogs from clinicians on the front line of medication reconciliation efforts. As October 20th is National Pharmacy Technician day, we are highlighting the roles that pharmacy technicians everywhere are playing in keeping patients safe through increased attention to medication safety. This blog was submitted by Jennifer Walters, of MultiCare Health.

Q: What are some of the best tools, practices, or educational materials that you use to increase adherence or patient engagement around medication safety? Please provide observations or suggestions you have learned from your work that would improve the accuracy of the medication reconciliation process.

A: In 2010, Multicare Health System Pharmacy Services started providing medication reconciliation on a part time, evening shift basis in Tacoma General’s Emergency Department. Now, in 2015, we provide medication reconciliation full time, both day and evening shifts, for Tacoma General Hospital, Mary Bridge Children’s Hospital, Allenmore Hospital, Good Samaritan Hospital, and Auburn General Hospital. At our Tacoma General/Mary Bridge 500 inpatient bed campus we have three full time technicians on a daily basis covering 18 hours a day, strictly devoted to medication reconciliation.

Through the course of developing this program, great strides have been made to document our processes and we work to constantly improve them as more resources come into play. Maintaining technician staff that are fully trained and have great attention to detail is imperative. The expectations for complete accuracy are very high for these specially trained staff. A Competence Based Learning (CBL) module has been developed, with required competencies such as up to date drug knowledge. This knowledge is critical in order to recognize medications when a patient states he or she is taking them. Technicians need to have a general overall knowledge of a medication’s indication and usage in order to ask appropriate open-ended questions regarding the patient’s current course of therapy.

For example, a technician who knows that warfarin dosages fluctuate according to the patient’s frequently drawn International Normalized Ratio (INR) levels would know to ask the patient what dosages they take on what days, ascertaining the exact strength of the tablet. A technician who sees that a patient has an insulin pump needs to be fully trained on how to read pumps, check for basal rates, carb ratios, insulin sensitivities, and ensure the insulin in the pump is recorded accurately.. It is critical that technician staff not overlook these details. Technician staff print out all findings and compile them with any handwritten notes, and then record the details in the form of an electronic progress note in the patient’s chart. All of this documentation is then submitted to the pharmacist for review and co-signature.

With the advent of electronic health records, there is a much greater continuity of care not only within our own health system of hospital and community clinics, but also on a nationwide scale. With any facility that uses EPIC, we are able to see current medications prescribed with that facility. In RX HUB we are able to visualize current medications dispensed through community pharmacies, including quantities, days’ supply, prescriber name, and pharmacy name and location. Pharmacists also have access to the Washington State Prescription Monitoring Program where confirmation of current narcotic prescriptions can be verified. All of these sources hold immense value in our day to day operation and we are able to see a much bigger picture of the patient’s complete medication history.

I think there are still a lot of improvements that can be made to this process. Moving to full 24 hour coverage and a possible community clinic role would be ideal. I am passionate about the medication reconciliation process and I enjoy the challenge it provides.

Jennifer Waters, Ph T, Medication Reconciliation Technician

MultiCare Health System- Tacoma General and Mary Bridge Children’s Hospital

Inpatient Pharmacy

NEW! Member Spotlight: Medication Safety Champion Blog Series

The Washington Patient Safety Coalition holds bi-monthly meetings dedicated to medication safety. Part of the ongoing work of this Medication Reconciliation workgroup, is to increase awareness of common medication safety issues, concerns, efforts, and best practices.

In an effort to bring attention to the roles of medication safety professionals, the WPSC is featuring an ongoing series of blogs from clinicians on the front line of medication reconciliation efforts. Our intention is not only to drive awareness of medication safety, but to highlight the work that many dedicated individuals are already playing in keeping Washington patients safe from medication harm.

Click here to read these blogs.