Medication Therapy Management (MTM)

Goal three by the National Patient Safety Goal for 2014 is to use medicines safely. Many errors occur regularly with medications which is why communication is so important with the doctors, nurses and patients. One process that Joint Commission requires in accredited HCO’s is medication reconciliation “creating the most accurate list possible off all medications a patient is taking, including drug name, dosage, frequency, and route, and comparing that list against the physician’s admission, transfer, and/or discharge orders with the goal of providing correct medications to the patients at all transition points within the hospital (Finkelman & Kenner, 2012, p. 388)”. Ensuring medication reconciliation to the patient, health providers and any new consults that are

The purpose of this paper is to bring forth awareness when it comes to patients and medication errors and further educates health care professionals on the importance of communication especially during transition of care. According to Williams and Ashrcoft (2013) “ An estimated median of 19.1 % of total opportunities for error in hospitals.” Although not all medication errors occur during transition it is the time most prevalent for these errors to occur. As per Johnson, Guirguis, and Grace (2015) “An estimated 60% of all medication errors occur during transition of care. The National Transitions of Care Coalition defines a transition of care as the movement of patients between healthcare locations, providers, or different levels of care within the same location as their conditions and care needs change, [and] frequently involves multiple persons, including the patient, the family member or other caregiver(s), nurse(s), social worker(s), case manager(s), pharmacist(s), physician(s), and other providers.”

Medication errors are the leading cause of morbidity and preventable death in hospitals (Adams). In fact, approximately 1.5 million Americans are injured each year as a result of medication errors in hospitals (Foote). Not only are medication errors harmful to patients but medication errors are very expensive for hospitals. Medication errors cost America’s health care system 3.5 billion dollars per year (Foote).Errors in medication administration occurs when one of the five rights of medication administration is omitted. The five rights are: a) the right dose, b) the right medication, c) the right patient, d) the right route of administration, and e) the right time of delivery (Adams). Medication administration is an essential part of

Organisational policy and procedures should include how to receive and record medication, safe storage, prescribing, dispensing, administration, monitoring and

* All medication should be recorded and signed for by the receiving pharmacist and a proper record maintained in-house.

1. In the workplace there is a generic Medication Management Policy and Procedures for Adult Services (Issue 10, 2012) document. This is kept to hand in a locked cupboard, readily available to read. It requires that all Healthcare Staff are given mandatory training and refreshers are provided. Legislation which surrounds the administration of medication includes The Medicines Act 1968, The Misuse of Drugs Act 1971, The Data Protection Act 1998, The Care Standards Act 2000 and The Health and Social Care Act 2001

The  Medicine Administration Record (MAR) chart should record what is on the box of medication including full name, address and date of birth of the patient to ensure the prescription is correct for that person. It should also have the date to ensure the

The Medication Policy and procedure and Mars Handbook covers assessment of individuals’ needs, administering, storage, recording and disposal of medicines including their effects and potential side effects

It is composed of actively practicing physicians, other prescribers, pharmacists, nurses, administrators, quality improvement managers, and other health care professionals and staff who participate in the medication-use process. The P&T committee should be responsible for overseeing policies and procedures related to all aspects of medication use within an institution. The P&T committee is responsible to the medical staff as a whole, and its recommendations are subject to approval by the organized medical staff as well as the administrative approval process. The P&T committee’s organization and authority should be outlined in the organization’s medical staff bylaws, medical staff rules and regulations, and other organizational policies as appropriate. Other responsibilities of the P&T committee include medication-use evaluation (MUE), adverse-drug-event monitoring and reporting, medication-error prevention, and development of clinical care plans and guidelines. The hospital’s internal policies follow all national standards for how the P&T committee should

When patients are brought back for rooming, the nurse or medical office assistant will review the printed list with the patient prior to documenting in the EMR. During the office visit, we will review polypharmacy and are adding a document to our resources section of the EMR regarding polypharmacy and accurate medication list that will be given to all patients. I have always been aware of the importance of accurate medication list, but was not reviewing this often enough in our patients EMR.

Medication administration record is a system put in place to document the administration of medications order verbally or written by the patient’s physician to prove and organize that a medication was given properly to a patient. Other information documented is allergies and is the responsibility of the registered nurse (RN) or Licensed practical nurse (LPN) (Wager,

In order to evaluate and compare medication compliance the patient’s discharge medication reconciliation were compared to patient’s medication list at time of first office visit. Of the patients in population 1 (N=82), 71 were seen back for follow up and 11 never returned. Of the 71 that returned for follow up 97.18% (N=69) were compliant with discharged core measure medications. Population 2 (N=104), 97 were seen back for follow up with 7 never returned. Of the 97 seen back for office follow up 100% (N=97) were compliant with discharged core measure medications. Statistical analysis of the two population did not find a statistically significant difference (p= 0.0991).

A physician could make mistakes in prescribing, the pharmacy could send the wrong medication, but who actually gave it to the patient is accountable for the consequences. For this reason, it’s our responsibility to implement change in our practice based on the evidence in order to ensure safe patient care.

The reconciliation should be used in every transition in care, where the new medication is prescribed and old mediations are rewritten. The accuracy of the list can prevent many drug effects and interactions; therefore it is important to ensure proper documentation and communication at all levels of care. Also, many errors occur when doctors fail to write out necessary orders such as, “resume pre-op medication.” The use of this “resume pre-op medication” has been prohibited by the Joint Commission due to the many complications it can produce including increasing the chances of adverse effects. Furthermore, it has been discovered that most discharged patients have been found to have insufficient knowledge regarding their medications upon returning home (Joint Commission, 2006). Medical reconciliation provides the patient with crucial information regarding the dosage, route, therapeutic effect, and reason for administration.

Medication therapy management (MTM) is a medical care mainly provided by pharmacists whose aim is to optimize drug therapy and improve therapeutic outcomes for patients. Based on the above definition of MTM, it is very important to offer MTM services to patients as it has at its core the aim of improving therapeutic outcomes for patients through the effective management of their drug therapy. It is important for pharmacist to be at the forefront of leading these efforts with regards to providing MTM because this is a service that is designed to help patients manage their medication. It is also important for pharmacist to embrace this call for the provision of MTM services as its benefits both short-term and long-term includes job security and opportunity, relevance in the healthcare system, revenue source, improving patients’ outcomes, and a chance to justify the call for pharmacists as providers.