Process Improvement Paper : Military Treatment Facilities

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

Phansalkar, S., Her, Q. L., Tucker, A. D., Filiz, E., Schnipper, J., Getty, G., & Bates, D. W. (2015). Impact of incorporating pharmacy claims data into electronic medication reconciliation. American Journal Of Health-System Pharmacy, 72(3), 212-217 6p. doi:10.2146/ajhp140082

After decades of paper based medical records, a new type of record keeping has surfaced - the Electronic Health Record (EHR). EHR is an electronic or digital format concept of an individual’s past and present medical history. It is the principle storage place for data and information about the health care services provided to an individual patient. It is maintained by a provider over time and capable of being shared across different healthcare settings by network-connected information systems. Such records may include key administrative and clinical data relevant to that persons care under a particular provider. Examples of such records may include: demographics, physician notes, problems or injuries, medications and allergies, vital

Due to the large number of consumers being prescribed multiple medications, and the complexity of managing those medications, it is of a major safety concern that systems are in place for clinicians to reconcile patients medications to resolve any discrepancies in what the patient is using, or should be using, and newly added ones.

The objective is to successfully convert the United States Army Medical Department from EMR to AHLTA. There are trainers that are set in place to ensure that the staff receives their full attention and that they also feel comfortable with the software. The outcome of this would be to have the ability to easily communicate electronically regarding

Medication Reconciliation is defined by the Joint Commission as the process of checking and rechecking a patient’s current medication list to the patient’s orders. Within a MedRec program, three steps must be followed to ensure patients have the correct medications at admission and discharge: Verification, Clarification, and Reconciliation (Greenwald et al., 2010; Ruggiero et al,. 2015). MedRec should not occur once, but multiple times especially when a patient moves from department to department. The more a patient moves, the more liable they are for a medication error due to poor communication. MedRec is done for the simple reason of catching those medication errors and correcting them before they can do any harm (The Joint Commission, 2006). Medication errors effect nearly 1.5 million people who enter the hospital setting in the USA. At least every patient has one medication discrepancy between admission and discharge, which leads to rehospitalizations due to hospital-setting medication errors (Institute of Medicine as cited by Wilson et al,. 2015). With nurses at the forefront of a patient’s medication regime, pressure is put on them to provide the necessary education and safety to prevent medication related rehospitalizations. Included in the causes for medication errors is miscommunication between departments taking care of the same patient (Allison et al., 2015). Many medication errors are preventable by the implementation of electronic orders. The use of electronic

The clinical documentation is very complex and detailed as the input from different departments, clinicians, physicians, consultants and providers of patient care are all integrated into a single episode-of-care documentation. While EHR is becoming more advanced they became the link to each internal department. The Ambulatory EHR system would work well if it was in a web-based environment. The records would be portable and accessible from anywhere. The information would be able to move between staff members as messages rather than orders.The order that is standard in an inpatient chart does not exist in ambulatory records. In advocating both EHR web-based systems they would have to provide proof of value, reliability, acceptability, difficulty of usage, and make changes and adjust. For EHR there are some elements that are common to both ambulatory and acute care systems like privacy and security standards keeping problems list, medication and allergies list. Ambulatory EHR need to be capable of electronic prescribing to outside pharmacies; acute care systems do not their medications are all in house and is handled through CPOE rather than

Adoption of EHR can derive a great amount of benefits in clinical outcomes such as patient safety and quality of care. Qualtiy of care can be measured with different dimensions such as patient safety, effectiveness, and efficiency. Patient safety is defined as ‘avoiding injuries to patients from the care that is intended to help them’(Menachemi and Collum, 2011, p. 49). Often times, lack of time can contribute to omission of asking patients important questions such as drug allergy information and confirming important patient identifiers such as addresses/phone numbers. Improvement of medication error is a well-noted benefit of EHR as seen in numerous researches. According to a study, researchers found that a CPOE system was contributory in reducing serious medication errors by 55% in the hospital setting (Bates, 1998). Many other studies have reported similar findings in patient safety improvement. When e-prescribing is used, prescriptions can be checked for any drug interactions with

Thomas Philpott's article “Military Update: DoD Medical Records Seen as a Hurdle for VA Care” expresses a message that the DoD is so focused on their database and their agenda to the point where they have lost focus on the people who are entitled to their service. The digitized health care system the DoD currently uses is called AHLTA; the IT system has been a “problem for the VA and for veterans because, in fact, it doesn’t allow electronic record transfers outside the military network” (Philpott, 2006). The article is biased in the sense that it places all of the blame of the DoD without any counter-argument as to why the DoD chooses not to expand to a shared system; however, the problem still stems back to the ineffective

There are many challenges during the process of medication reconciliation. Some patients are taking herbal supplements that they forgot to mention during the interview, some of them do not take all medications that are on their list for different reasons, and errors made during transfer of care reconciliation, are just a few examples how this problem is serious and can cause potential harm, even death in some cases.

E prescribing can be a part of the EHR in Epic, which would include patient data, and not just prescription information. When e prescriptions are utilized in Epic, the medication is checked for interactions with the patient’s other medications and allergies. Check systems within Epic look for drug-allergy, drug-drug, and how the medication reacts with the disease. In a case study of 17 physicians in an ambulatory clinic conducted by Abramson et al., error rates from prescribing decreased from 35.7 per 100 prescriptions to 12.2 per 100 prescriptions in a year of e-prescribing as reviewed in this study. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 stated that healthcare providers would have access to EHRs to ensure the meaningful use standards per the Centers for Medicaid and Medicare Services (CMS). Meaningful use is attained by increasing the quality of patient outcomes by having access to the medication data, the patient’s history, and diagnosis by the prescriber. Prescribing is safer, when the provider is aware of the patient’s history, current medications, and allergies, therefore better patient outcomes. In the United States, the HITECH Act and the meaningful use standards stated by CMS have increased the use of e-prescribing per Friedman (2009). The CMS made e prescribing a

An Electronic Health Record is a computerized form of a patient’s medical chart. These records allow information to be readily available to authorized providers during a patient’s encounter with the healthcare system. These systems do not only contain medical histories, current medications and insurance information, they also track patients’ diagnoses, treatment plans, immunization dates, allergies, radiology images and lab tests/results (source). The fundamental aspect of EHRs is that they are able to share a patient’s information quickly across service lines and even between different healthcare organizations. Information is at the fingertips of lab techs, primary care physicians, pharmacies, clinics, etc. The

Medication Reconciliation is “the process of creating the most accurate list possible of all medications a patient is taking” (IHI, 1). This list would include name, dosage, frequency, route, possible side effects and interactions, drug-food interactions, and the importance of taking the medications exactly as

According to the Institute for Healthcare Improvement, “Medication reconciliation is the process of creating the most accurate list possible of 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” (Institute For Healthcare Improvement, n.d). This process includes three steps: collecting the medication history, ensuring that the medications and dosages are appropriate for the patient, and documenting the changes in the orders. This occurs when the patient is admitted, transferred and discharged from the hospital (Institute for Healthcare Improvement, 2011). The purpose is to avoid any duplications, incorrect

Electronic medical records had a great impact in the ushering in of the age of Nursing Informatics. (Himss, 2010)EMRS present healthcare professionals with the ability to retrieve and organize data in a quick and efficient approach. With information so readily available, patient safety increases and we know that patient cost goes down. This happens because patient medications, allergies, history, demographic, and treatment information is more collectively available.