Improving medication histories in hospital


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Pharmacists and colleagues at a Blacktown hospital in NSW have seen medication histories improve vastly by implementing a new system

Changes at the Blacktown Hospital in western Sydney began after a new electronic medication system was rolled out.

Cardiology pharmacist Christine Ibrahim conducted a random audit of the medication reconciliation process at the C63 ward, and found the results were significantly poorer than ideal.

Only 10% of the patients had had their correct medication history taken.

Ms Ibrahim’s response was to form a project team and guidance team, starting in April 2017.

“I gathered my project team and put together proper solutions for the problem—and we implemented a new medication reconciliation procedure, which is considered to be a midday solution between paper and electronic system,” she told the AJP.

“We included patients into our project too, to fulfil standard 4 of medication safety.”

The Blacktown Hospital medication reconciliation system team.
The Blacktown Hospital medication reconciliation system team.

The project team consisted of two to three medical interns, two registered nurses, herself and patients; the guidance team included the hospital’s pharmacy director, Margaret Macarthur; head of Cardiology Dr David Burgess; nurse unit manager of Cardiology Gloria Miranda; and Abraham Mahachi, overseeing clinical governance.

The aim was to increase medication reconciliation for patients admitted to the pilot ward within 24-48 hours to 75-100% within the first six months of the project.

The project team used Clinical Practice Improvement methodology to map the existing process of medication reconciliation for patients transferred to the pilot ward within the electronic medication system.

Diagnostic workshops were held and several techniques suggested, including a simplified medication list for patients to fill in upon arrival at the ward; a patient interview with a pharmacist or medical team member within 24 hours of admission; and continuous medication reconciliation training among all teams, including how to record medication histories in the electronic medication system.

Also suggested were ongoing audits and data collection to study how the new form was used and the quality of such reconciliations; regular progress reporting and a reward program for staff.

The results were “amazing,” Ms Ibrahim said.

The new system saw a jump “from 10% to 100% of best possible medication history within only two months of project launch, through ongoing training and multidisciplinary team work”.

Now, all patients transferred to the pilot ward are actively involved in their medication management.

Ms Ibrahim says she hopes similar initiatives could be carried out elsewhere, as they “could improve medication safety in other wards and in other hospitals”.

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