Medication Safety Champion, CHI Franciscan

This month’s ongoing Medication Safety Champion blog series, features Faylynn Auston and Sue West of Franciscan, St. Joes Medical Center.

Q: What have been the biggest advancements in the medication safety work being done at your organization?

A:  In 2010, CHI Franciscan launched the Medication Reconciliation Technician (MRT) pilot program in the Emergency Department at St. Joseph Medical Center. The program was started with two technicians, each covering ten hour shifts seven days per week. After seeing the benefit of staffing MRTs in the ED at St. Joseph, we have further expanded our program to our sister hospitals in the region including St. Clare Hospital, St. Anthony Hospital and St. Frances Hospital. Each of these facilities currently staff two technicians each covering ten hours per day, seven days a week in their Emergency Department. Since the launching of the program, St. Joseph’s Medical Center has not only added two more MRT positions in the Emergency Department covering evening hours but has also expanded into the surgical centers creating two more MRT positions.

It is an exciting time at CHI Franciscan with the expansion of the MRT program. There are great benefits to adding these new positions, first and foremost being patient safety. Having a dedicated team of MRTs for medication reconciliation allows nursing staff to focus more on direct patient care and minimizes the risk of wrong medications/doses being entered into the patient’s chart. Through the expansion of the program, our goal is to have all admitted patients’ medications reconciled by MRTs and reviewed by pharmacists, resulting not only in a more accurate list but potentially preventing adverse drug events.

The medication reconciliation process is considered complete when the patients’ medications are verified through two steps. First, we obtain medication history from a reliable source such as pharmacy or their insurance company. Then, the medication list is verified by going over each medication with the patient or the primary caregiver. Here at CHI Franciscan we use the electronic health record program EPIC. This program gives us the capability to link with other non-CHI facilities that also use EPIC allowing MRTs to view patients’ records from multiple facilities. EPIC also has the capacity to pull records from outpatient prescription history showing what medications were filled at local pharmacies; this information includes, pharmacy name, location, medication, dose, quantity and day supply. This allows us to gather accurate medication records in a timely manner and reconcile any discrepancies. In addition to interviewing the patients/caregivers and inputting data into Epic, MRTs must have a broad knowledge of medications, indications and common doses. They must also be familiar with the limitations of these sources that are being utilized. For example, we cannot always rely on outpatient prescription records provided by third parties for medications that are paid out of pocket. Four dollar prescription plans are the perfect example of these limitations, because they bypass the prescription insurance company.  Along with this knowledge, our technicians must have excellent interview skills. When interviewing, many patients do not think to disclose their use of herbal supplements and over the counter medications because they are unaware of potential side-effects and drug interactions.

We feel this is only the beginning of the benefit from the medication reconciliation program and are looking to actively engage the MRT in helping reduce medication related readmissions through identification of patients with uncertainty of the medications.

Falynn Auston CPhT

Sue West  CPhT

CHI Franciscan-St. Joseph Medical Center