This week, we had a new voice join our group: Maureen Layden, the Greater Boston Area - Director of VA Medication Reconciliation at Department of Veterans Affairs. She is very interested in making sure that the patient's interests are being served, as well as raising awareness of the pharmacist's role in positive outcomes and reduced hospital admissions. Many of her concerns revolve around the fact that the pharmacist is not recognized as a co-equal member of the health care team, and that their input and efforts to protect patients by raising red flags about possible interactions or misprescribed drugs or dosages do not make it back to the patient's record, closing the loop and preventing reoccurrences. The prevailing view has resulted in crippling the ability of pharmacists to do thorough medication reconciliations with their customers because they are not allowed to charge (or be reimbursed through Medicare or other insurance) for the (considerable) time they spend verifying the data and communicating with both patients and their other providers.
Another aspect to this lack of recognition and reimbursement is that the VA and other healthcare organization are beginning to have difficulty attracting and retaining the highly skilled, highly educated and motivated people needed to fill this essential role.
The takeaway for the OSEHRA community is that the tools developed for patients and clinicians need to include an efficient way for the pharmacist to communicate with both, and to be able to verify that errors and omissions in the patient record are corrected and acknowledge by all parties. One such effort is the VA's PBM PhARMD Clinical Reminder Tool, which is being piloted at 9 VA sites and used by nearly 70 pharmacists. Maureen has agreed to report back to the group in a few weeks after she attends a demonstration.
Medication reconciliation has been found to be a powerful tool in ensuring patient safety, improving outcomes and reducing readmission. Bob Cook and Maureen have provided several references covering this critical part of patient care:
- Transitions of Care: Pharmacy Technicians Assisting in Reducing Readmissions - a continuing pharmacy education activity was planned to meet the needs of pharmacy technicians practicing in a variety of practice settings http://ashpmedia.org/symposia/lms/content/transitions/.
- Transitions of Care Press Release (http://www.ashp.org/menu/AboutUs/ForPress/PressReleases/PressRelease.aspx?Source=Press&Type=Rss&Id=741) has additional referances and resources.
Medication Reconciliation Basics - a list of resources for pharmacists and others interested in this topic
ASHP Medication Reconciliation (Med Rec) Toolkit - tools, references, and recommendations as well as ideas and examples of success stories and lessons learned.