Aiming for excellence
New medication reconciliation tool benefits high-risk patients
Medication reconciliation has been a topic of improvement for UF Health Shands Pharmacy Services. As part of a larger initiative, Pharmacy Services created a tool to better assist pharmacists and UF College of Pharmacy students in completing an accurate and thorough prior-to-admission, or PTA, medication review list.
Ben Staley, Pharm.D., BCPS, UF Health Shands Clinical Pharmacy Services pharmacist, designed the High Risk Medication Reconciliation scoring tool in EPIC to help target a patient population who would benefit most from medication reconciliation.
“We’re focusing on the front-end piece of getting an accurate prior-to-admission medication list because that’s a fundamental step that has to be done right for the remaining pieces to fall into place,“ Staley said. “We decided to direct our attention toward patients with specific qualities that are associated with having a higher rate of adverse events or readmissions.”
Here are the five risk factors that identify a high-risk patient using the scoring tool:
- Age greater than 75 years old
- Specific disease state (end-stage renal disease, diabetes, etc.)
- Polypharmacy (use of 10 or more non-as-needed medications)
- Use of high-risk medications (immunosuppressants, antidiabetic agents, etc.)
- One or more prior admission(s) in the previous 30 days
Each factor is worth 10 points. If a patient is flagged at least three times for a total of 30 points or more, a pharmacist or pharmacy student is notified to conduct a PTA medication review.
“We decided that there’s a patient population who benefits most from medication reconciliation, and we also put together which staff is best used for interviewing the patients,” said Kyle Koenig, Pharm.D., BCPS, UF Health Shands CLinical Pharmacy Services pharmacist. “We decided it’s the students who would really benefit from this process because they learn a lot from talking to patients.”
Under the new system, a pharmacy student gets a list of medications from the patient, then contacts the patient’s pharmacy to check if the medications are correct.
Every day, 15 to 20 high-risk patients are flagged. When conducting a thorough PTA medication review, the pharmacy student will ask the patient what medications he or she is taking and then call the patient’s pharmacy or pharmacies to check if the medications are correct. If there are any discrepancies, the pharmacy student will revisit the patient to discuss the findings.
“The new tool helps me to easily navigate and focus on the patients who need to be interviewed first,” said Isabel Won, UF College of Pharmacy third-year pharmacy student. “It makes our work with med recs a lot quicker, more efficient and easier to complete.”
