Freeman Health System, a 485-bed, three-hospital system in Joplin, Missouri, serves 450,000 people across Missouri, Arkansas, Kansas, and Oklahoma. It is the #1 hospital in Southwest Missouri and the #4 hospital in Missouri, according to U.S. News & World Report.
Medication reconciliation, the process of creating an accurate list of a patient’s medications—including drug name, dosage, frequency, and route—is critical to reducing adverse events and ensuring patient safety.
Yet it can be a cumbersome and time-consuming undertaking, particularly when nurses are already overburdened. Medication reconciliation is also challenging because patients’ medications change frequently and patients often don’t maintain accurate lists.
“While it’s extremely important to quickly and accurately capture a patient’s medication information, traditional approaches that rely primarily on nurses and EMRs make this very difficult,” said Adrienne Carey, PharmD, BCPS, Clinical Pharmacist and Data Mining Program Manager at Freeman Health System. “We knew there had to be a better way.”
One of the first changes Freeman Health System made was related to staffing. Rather than relying solely on nurses for medication reconciliation, it gradually added medication reconciliation technicians (MRTs) to its team. It now has nearly a dozen MRTs working in the emergency room and other departments. “We started them on the cardiology floor as a pilot and their ability to ease the burden on nurses was so clear that we quickly hired more,” said Carey.
The MRTs meet with patients to go over at-home medication information. Then, they verify that information using another source such as the patient’s doctor or pharmacy, and document it in the EMR. “The MRTs are usually able to meet with patients more quickly than nurses can,” said Carey. “That means faster identification of at-home medications, and smarter medication decision making in the hospital.”
Freeman Health System also uses VigiLanz to support and streamline its medication reconciliation efforts. The pharmacy department worked with the VigiLanz clinical support team to create new rules in the clinical surveillance platform to identify patients needing medication reconciliation. When patients are admitted to the ER or to floors with MRTs, MRTs receive an alert to conduct a reconciliation. “After determining what our organization needed, the VigiLanz clinical support team helped us create rules that make the process much more seamless,” said Carey, noting that the rules took effect in June 2018.
Once the reconciliation is complete, a pharmacy team member reviews it, contacts the physician if there are any problems or errors, and documents the information and/or intervention in VigiLanz. Freeman Health System also uses VigiLanz to create an audit trail of who has made changes. Carey noted that the new workflow is a significant improvement over relying on the EMR, where information is not easily retrievable. “While clinicians can pull up a patient’s record and read the history in the EMR, there is no discrete data to track information such as which medications have changed or what problems nurses have already addressed,” said Carey. “We also use VigiLanz to customize intervention categories so pharmacists can better track the prevention of potential major and minor adverse drug events.”
Adrienne Carey, PharmD, BCPS explains how VigiLanz provides efficiency improvements to Freeman Health
Since adopting the new approach, Freeman Health System has completed an average of 1,400 medication reconciliations monthly. That has prevented nearly 30 potential major adverse drug events and more than 11,000 potential minor adverse events over a one-year period. The health system estimates that it has realized $4.7 million in potential savings from major and minor medication error prevention since July 2018.
“It’s had a huge impact,” said Carey. “We end up making a change to almost every med list that we touch. Those are things that we might have missed if we didn’t have this new system in place.”
In addition to improving care quality and avoiding adverse drug events, VigiLanz’s clinical surveillance platform has trickle-down benefits. “Their data-tracking capabilities help us better recognize our MRTs’ invaluable contributions,” she said. “It helped us make the case for expanding these staff to reach all patients in our facility.”
In addition to using VigiLanz to help avoid adverse drug events and make smarter medication decisions, Freeman Health System uses its clinical surveillance software to flag potential IV to PO conversion opportunities and identify inappropriate medication levels and duration. Overall, the health system estimates that VigiLanz enables it to avoid over $700,000 in monthly costs.
Medication Reconciliation Monthly Totals