Medication Management
Patient and Family Engagement in Primary Care
Slide 1: Medication Management
AHRQ Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families
Slide 2: Speaker
Kelly Smith, PhD
Scientific Director, Quality & Safety
Co-PI, AHRQ Guide to Improve Patient Safety in Primary Care Settings by Engaging Patients and Families
kelly.m.smith@medstar.net
No financial conflicts of interest to disclose.
Slide 3: Objectives
- Review the key threats to patient safety in primary care settings and interventions to engage patients and families to improve safety.
- Describe the role and value of the Medication Management strategy in improving patient safety.
- Identify strategies for implementing the Medication Management strategy in primary care settings.
Slide 4: Guide – Project Goals
- Meaningful engagement with patients and families in ways that impact safety, not just quality.
- Based on evidence.
- Tools that are easy to use.
- Tools for practices who have not done much in this area.
Slide 5: Key Project Deliverables
- Environmental Scan.
- Four Case Studies of Exemplar Practices.
- Four Interventions to Improve Safety by PFE.
- Final Guide.
Slide 6: Key Threats & Promising Interventions
Threats to Patient Safety
- Breakdowns in communication.
- Medication management.
- Diagnosis and treatment.
- Fragmentation and environment of care.
Promising Interventions
- Shared Decisionmaking.
- Patient and Family Advisory Councils (PFAC).
- Team-based Care.
- Medication Management.
- Family engagement in care.
- Structured communication tools.
Slide 7: Patient & Family Engagement in Primary Care
Image: Circle diagram with triangle in center demonstrating how strategies to engage patients and families can link the patient, clinicians, and practice staff together in a resilient relationship. The figure also shows that external factors such as the health care system, culture, community, and environment also play a role.
Slide 8: Four Interventions
- Teach-Back
- Be Prepared to be Engaged
- Medication Management
- Warm Handoff
Slide 9: What is the Medication Management Strategy?
- Develop a complete & accurate medication list
- Patients and family members bring all their medications – OTC and prescriptions.
- Complete medication reconciliation using the accurate medication list
- Identify & correct safety issues.
Slide 10: Why Use the Medication Management Strategy?
- 2.3 billion prescriptions are prescribed by primary care clinicians each year (CDC).
- Adverse drug events result in as many as 4.5 million ambulatory visits each year.1
- Medication reconciliation improves patient safety and reduces adverse drug events:
- prescribing errors, medication contraindications, overprescribing, under-prescribing, and patient adherence.
Slide 11: Medication Management – Safety Checks
- Challenges in how the patient is taking the medication
- Possible interactions with other medications or over the counter medicines
- Overdoses
- Appropriateness as a treatment
- Avoidable regimen complexity
- Avoidable side effects9
Slide 12: Getting Started
- Step 1 - Identify a Champion and get Leadership Buy-in.
- Step 2 - Develop processes for using Medication Management Tools.
- Step 3 - Train team members and initiate implementation.
- Step 4 - Introduce Medication Management Materials to patients.
- Step 5 - Evaluate and refine.
Slide 13: Step 1. Leadership Buy-in
- Identify a Medication Management practice champion.
- Obtain leadership buy-in and support.
- Identify a process improvement team
- Engage a patient or two in developing your plan.
Slide 14: Step 2. Design Implementation
- Identify a team to help design processes for each of the Medication Management strategy tools.
- Identify resources for implementation.
Slide 15: Design Support
- Before Appointment.
- Rooming the Patient.
- During the Exam.
- Electronic Health Record.
Slide 16: Reviewing the Medicines
- Detailed process for engaging patients in medicine review.
- Supported by additional checklists.
Slide 17: Step 3. Orient Practice Staff
- Information about the Medication Management Strategy for:
- Practice Staff
- Clinicians
- Provide overview of tools and how to use to enhance engagement.
Slide 18: Medication List
Image: Medication list to be used by practice staff to engage patients and families in creating a medication list for prescribed medications.
Slide 19: Checklist for Staff
- Checklist to help support adoption.
- Supplements procedure guide.
- Can be used at the point of care every time staff conduct medicine review.
Slide 20: Common Barriers Fact Sheet
- Aids clinicians in discussing barriers & facilitators of medication:
- Filling
- Adherence
- Available in
- Full page
- Pocket size version
Slide 21: Step 4. Orient Patients
- Orient the patient to the Medication Management Strategy
- Patient Fact Sheet.
- Discuss why it is important.
- Reinforce the need for patients to engage in discussions about their medicines.
Slide 22: Appointment Reminder Card
Images: Front of card to remind patients to bring all their medications to their next appointments.
Back of card to remind patients of their next appointment.
Slide 23: Step 5. Evaluate & Refine
- Observations.
- Team debriefs.
- Simple counts.
Slide 24: How can the AHRQ PFE Guide help practices achieve success?
Image: Logic model showing PTN PFE performance dashboard domains and practice assessment tool PFE metrics. Strategy categories such as Etool, shared decision making, health literacy, patient activation, medication management, and support for patient voices can affect four PFE domains: internal PFE structure, spread to practices, PFE success stories, and innovation. There are two PFE metrics: practice can demonstrate that it encourages patients and families to collaborate and practice has a formal approach to obtaining patient and family feedback.
Slide 25: How Can I Get Started?
Image: Step chart illustrating steps to implement the Medication Management intervention.
Slide 26: Questions?
Questions?
Slide 27: Other Resources
- Brown Bag Medication Review: Tool #8 from the Agency for Healthcare Research and Quality’s Health Literacy Universal Precautions Toolkit.
- Help Patients Remember How and When to Take Their Medicine: Tool #16 from the Agency for Healthcare Research and Quality’s Health Literacy Universal Precautions Toolkit.
- Brownbag Tool Kit from the Ohio Patient Safety Institute.
Slide 28: References
- Centers for Disease Control and Prevention [Internet]. Atlanta, GA: National Center for Health Statistics. Therapeutic Drug Use. [updated 2016 July 6; cited 2016 Aug 1]. Available from: http://www.cdc.gov/nchs/fastats/drug-use-therapeutic.htm
- Lainer M, Vogele A, Wensing M, Sonnichsen A. Improving medication safety in primary care. A review and consensus procedure by the LINNEAUS collaboration on patient safety in primary care. Eur J Gen Pract. 2015;21 Suppl:14:18. doi: 10.310913814788.2015.1043124.
- Garfield S, Barber N, Walley P, Willson A, Eliasson L. Quality of medication use in primary care – mapping the problem, working to a solution: a systematic review of the literature. BMC Med. 2009;7(1):50. doi:10.1186/1741-7015-7-50.
- Kwan JL, Lo L, Sampson M, Shojania KG. Medication reconciliation during transitions of care as a patient safety strategy: a systematic review. Ann Intern Med. 2013;158:397-403. doi:10.7326/0003-4819-158-5-201303051-00006.
- Keers RN, Williams SD, Cooke J, Ashcroft DM. Prevalence and nature of medication administration errors in health care settings: a systematic review of direct observational evidence. Ann Pharmacother. 201;47(2):237-56.
- Sarkar U, López A, Maselli JH, Gonzales R. Adverse drug events in U.S. adult ambulatory medical care. Health Serv Res. 2011;46(5):1517-1533. doi:10.1111/j.1475-6773.2011.01269.x.
- Agency for Healthcare Research and Quality [Internet]. Rockville, MD: Agency for Healthcare Research and Quality; 2015. Health Literacy Universal Precautions Toolkit, 2nd Edition, Conduct Brown Bag Medication Reviews: Tool #8; 2015 Feb [cited 2016 Aug 1]. Available from: http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/healthlittoolkit2-tool8.html
- Agency for Healthcare Research and Quality [Internet]. Rockville, MD: Agency for Healthcare Research and Quality; 2015. Health Literacy Universal Precautions Toolkit, 2nd Edition, Help Patients Remember How and When to Take Their Medicine: Tool #16; 2015 Feb [cited 2016 Aug 1]. Available from: http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/healthlittoolkit2-tool16.html
- Ohio Hospital Association [Internet]. Columbus, OH: Ohio Patient Safety Institute. Medication Safety; [cited 2016 Aug 1]. Available from: http://ohiohospitals.org/Patient-Safety-Quality/Ohio-Patient-Safety-Institute-OPSI/Professional-Resources/Medication-Safety.aspx
- NYC Health [Internet]. New York City, NY: New York City Department of Health and Mental Hygiene. Medication Adherence Action Kit; [cited 2016 Aug 1]. Available from https://www1.nyc.gov/site/doh/providers/resources/public-health-action-kits-medication-adherence.page
- Health Research & Educational Trust [Internet]. Chicago, IL: Health Research & Educational Trust, Institute for Safe Medication Practices, and Medical Group Management Association; 2008. Pathways for Patient Safety: Creating Medication Safety [cited 2016 Aug 1]. Available from: http://www.hret.org/quality/projects/resources/creating_medication_safety.pdf