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The following surveys are for reference only

By Megan Freeman,2014-04-22 22:00
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The following surveys are for reference only

The following surveys are for reference only.

    Medication Reconciliation in Emergency Departments

Medication reconciliation is the process of obtaining a complete list of a patient’s current

    medications, updating that list throughout the patient’s transition of care, and then

    communicating any changes to the next healthcare provider of services and to the patient or

    the patient's caregiver in order to avoid duplications, omissions and errors.

We thank you for your participation.

Demographics

Please check the one category that best describes the number of inpatient beds currently set

    up and staffed for use in your hospital.

    ___ Fewer than 100 beds

    ___ 100 to 299 beds

    ___ 300 to 499 beds

    ___ 500 beds and over

Please check the one category that best describes the type of organization that is responsible

    for establishing policy for the overall operation of your hospital. ___ State or local government

    ___ Non-government, not-for-profit

    ___ Investor-owned, for-profit

    ___ Military

    To what branch of the service does your hospital belong?

    ___ Army

    ___ Navy

    ___ Air Force

    ___ Veterans’ Affairs

    ___ US Public Health Service

    ___ Other: ____________________

    Is your hospital one of several hospitals in a larger healthcare system with common ownership

    and/or governance?

    ___ Yes

    How many hospitals comprise your health system?

    ___ 2 - 5

    ___ 6 - 10

    ___ Greater than 10

    ___ No

    Please check the one category that best describes the number of annual Emergency Department (ED) visits for your department.

    ___ Fewer than 7,500

    ___ 7,500 to 15,000

    ___ 15,000 to 25,000

    ___ 25,000 to 50,000

    ___ Greater than 50,000

    What percentage of ED visits result in an admission to your hospital. ___ Less than 10 %

    ___ 10 to 15 %

    ___ 16 to 20 %

    ___ 21 to 30 %

    ___ Greater than 30 %

Please indicate the percentage of patients served by your hospital that do not speak English as

their primary language.

    ___ 0 to 10%

    ___ 11 to 30%

    ___ 31 to 50%

    ___ 51 to 80%

    ___ greater than 80%

Please indicate by percentage the approximate payer mix of patients for your hospital?

    (Percentages should add to 100 %)

    ___ % Private insurance

    ___ % Medicare

    ___ % Medicaid

    ___ % Managed Care

    ___ % Cash

    ___ % Free Care

Does your hospital have a PHYSICIAN residency-training program that has been approved by

    the Accreditation Council for Graduate Medical Education and/or the American Osteopathic

    Association?

    ___ Yes

    In what setting is the physician residency-training program carried out?

    ___ Community teaching hospital

    ___ Academic medical center

    ___ No

Does your ED have a pharmacist assigned on a full- or part-time basis to the department?

    ___ Yes

    How many hours per day?

    ___ Less than 8 hours

    ___ 8 to 12 hours

    ___ 13 to 16 hours

    ___ 24 hours

    ___ No

    Does you hospital have an outpatient or retail pharmacy on campus? ___ Yes

    ___ No

    Is your organization accredited by The Joint Commission? ___ Yes

    ___ No

Survey

    What percentage of patients has a CURRENT and COMPLETE list of their medications when they arrive in the ED?

    ___ Less than 10 %

    ___ 11 to 20 %

    ___ 21 to 30 %

    ___ 31 to 50 %

    ___ Greater than 50 %

    What personnel are primarily responsible for obtaining a CURRENT list of medications on patients seen in the ED?

    ___ Registration staff

    ___ Nurses

    ___ Physicians

    ___ Medical Residents

___ Pharmacists

    ___ Combination of personnel

    ___ Other (please list) _______________________

    Are different personnel (from question #13) responsible for reconciling the current list of medications on patients seen in the ED?

    ___ Yes (Please check from list below)

    ___ Registration staff

    ___ Nurses

    ___ Physicians

    ___ Medical Residents

    ___ Pharmacists

    ___ Combination of personnel

    ___ Other (please list) ____________________

    ___ No

    Are different personnel (from question #14) responsible for reconciling the current list of medications if an ED patient is admitted to the hospital?

    ___ Yes (Please check from list below)

    ___ Registration staff

    ___ Nurses

    ___ Physicians

    ___ Medical Residents

    ___ Pharmacists

    ___ Combination of personnel

    ___ Other (please list) _______________________

    ___ No

    For what percentage of patients do ED personnel contact community pharmacies to obtain a patient’s CURRENT medication information (e.g., drug, dose, frequency)?

    ___ Less than 10 %

    ___ 11 to 20 %

    ___ 21 to 30 %

    ___ 31 to 50 %

    ___ Greater than 50 %

    How would you rate the understanding of primary physicians, physician practice personnel, and community pharmacists on the process of medication reconciliation? (Use the following key: 1 = total understanding; 2 = partial understanding; 3 = not familiar with medication reconciliation)

    ___ Primary Physicians

    ___ Physician Practice Personnel

    ___ Community Pharmacists

    How would you rate the quality of communication with local community pharmacies when ED personnel contact them for a patient’s CURRENT medication information (e.g., drug, dose,

    frequency)?

    ___ Excellent open communication and able to obtain information needed if available. ___ Very good communication and usually able to obtain information needed if available. ___ Good communication and often times able to obtain information needed if available. ___ Poor communication and seldom able to obtain information needed if available.

Does your ED have electronic connectivity in order to obtain a listing of a patient’s medications?

    ___ Yes (please check all that apply)

    ___ With physician owned practices of the healthcare organization.

    ___ With the outpatient clinics and pharmacies of the healthcare organization. ___ With a vendor connected with insurers and local community pharmacies. ___ No

    ___ Do not know

    What are the MAJOR barriers to performing medication reconciliation in the ED? Please check only those you perceive to be a major barrier.

    ___ Patients do not keep a record of all the medications (Prescription and OTC) they are receiving.

    ___ Handwritten or community pharmacy generated medication lists that patients or their caregivers supply are incomplete, difficult to read or not current.

    ___ Difficult to obtain needed information from physician practices.

    ___ Patient uses more than one pharmacy (may include mail order service) to obtain prescription and other medications; difficult to reach all of them for verification. ___ Difficult to obtain information from community pharmacies.

    ___ Community pharmacy is usually closed.

    ___ Community pharmacy is unable to locate patient in the pharmacy computer system. ___ Lack of time or staff to perform a complete review of the patient’s medications.

    ___ ED does not have sufficient communication technology to receive outside information (fax or e-connectivity).

    ___ Other (please list)_____________________________

    Have ED personnel experienced community pharmacies unwilling to share information regarding a patient due to perceived HIPAA violations?

    ___ Yes

    ___ No

    Have ED personnel experienced physician practice personnel unwilling to share information on a patient due to perceived HIPAA violations?

    ___ Yes

    ___ No

    Do you and personnel in your ED consider it a violation of HIPAA regulations to share a patient’s medication profile with community pharmacies or physician practices for the purpose of medication reconciliation?

    ___ Yes

    ___ No

    Does your hospital leadership or corporate personnel consider it a violation of HIPAA to share a patient’s medication profile with community pharmacies or physician practices for the purpose of medication reconciliation?

    ___ Yes

    ___ No

    ___ Do not know

    Does your ED provide a list of CURRENT medications to patients when they are discharged

    from the ED?

    ___ Yes

    ___ Handwritten

    ___ Computer generated

    ___ No

    Does the computer-generated medication list provided to patients include the dosage, route, frequency and time of last administration for each medication listed?

    ___ Yes

    ___ No

    ___ Not applicable

    What is your ED/hospital planning to do to address the barriers to medication reconciliation? Please check all that apply

    ___ Incorporate electronic connectivity with an outside vendor

    ___ Add personnel within the ED

    ___ Assign the process to personnel outside the ED

    ___ Proactive communication with area community pharmacies to include up-to-date 24-hour

store listings

    ___ Not aware of or not planning to implement anything at this time ___ Other:___________________________________

    If you have any additional comments, suggestions or plans to make changes to your practice in regards to Medication Reconciliation, please record them here:

Horn D, et al. Med Reconciliation: Community Pharmacies and EDs

    Appendix 1 Emergency Department Survey

Medication Reconciliation in Community Pharmacy

    Medication reconciliation is the process of obtaining a complete list of a patient’s current

    medications, updating that list throughout the patient’s transition of care, and then

    communicating any changes to the next healthcare provider of services and to the patient or

    the patient's caregiver in order to avoid duplications, omissions and errors.

We thank you for your participation.

Demographics

    Please check the one category that best describes your pharmacy. ___ Independent pharmacy

    ___ Retail chain pharmacy

    ___ Supermarket pharmacy

    ___ Mass merchandise pharmacy

    ___ Other (explain) _____________

Please check the one category that best describes how many pharmacies are in your company.

    ___ 1 to 3 pharmacies

    ___ 4 to 9 pharmacies

    ___ 10 to 49 pharmacies

    ___ 50 to 99 pharmacies

    ___ 100 to 499 pharmacies

    ___ 500 or more pharmacies

What is the approximate number of prescriptions dispensed per week in your pharmacy?

    ___ 700 or less

    ___ 701 1,500

    ___ 1,501 3,000

    ___ 3,001 6,000

    ___ 6,000 or more

    What are the normal weekday hours of operation for your pharmacy? ___ Up to 12 hours

    ___ 13 to 23 hours

    ___ 24 hours

    What are the normal weekend hours of operation for your pharmacy? ___ Up to 12 hours

    ___ 13 to 23 hours

    ___ 24 hours

Is your pharmacy owned by a healthcare system?

    ___ Yes

    ___ No

Please indicate the percentage of patients served by your pharmacy that do not speak English

    as their primary language.

    ___ 0 to 10 %

    ___ 11 to 30 %

    ___ 31 to 50 %

    ___ 51 to 80 %

    ___ Greater than 80 %

Please indicate by percentage the approximate payer mix of patients for your pharmacy.

    (Percentages should add to 100 %)

    ___ % Private insurance

___ % Medicare

    ___ % Medicaid

    ___ % Managed care

    ___ % Cash

    ___ % Free care

Survey

    Are you and your staff familiar with the term medication reconciliation? ___ Yes

    ___ No

    Do you routinely ask patients for a CURRENT list of medications when they arrive in your pharmacy?

    ___ Yes, for all patients

    ___ Yes, but only for select patients

    ___ Rarely

    ___ Never

    What percentage of patients has a CURRENT and COMPLETE list of their medications when they arrive in your pharmacy?

    ___ Less than 10 %

    ___ 11 % to 20 %

    ___ 21 % to 30 %

    ___ 31 % to 50 %

    ___ Greater than 50 %

Is your pharmacy computer system capable of printing a list of CURRENT prescription

    medications for patients on demand?

    ___ Yes

    ___ No

    ___ Do not know

Does your pharmacy routinely provide a list of CURRENT medications to patients?

    ___ Yes (please check all that apply)

    ___ Handwritten

    ___ Computer generated

    ___ No

Does the computer-generated medication list provided to patients include the dosage, route,

    frequency, and time of last refill for each medication listed? ___ Yes

    ___ No

    ___ Not applicable

Does your pharmacy computer system have the ability to document, as part of the patient’s

    current medication profile/list, OTC drugs, herbal products, and prescription medications

    dispensed at other pharmacies (not part of a common data base)? ___ Yes, and they print on the list of the patient’s current medications.

    ___ Yes, but they do not print on the list of the patient’s current medications.

    ___ No

    ___ Do not know

Does your pharmacy computer system have electronic connectivity in order to obtain and

    share a listing of a patient’s medications?

    ___ Yes (please check all that apply)

    ___ With local physician practices.

    ___ With area hospitals and emergency departments. ___ With other pharmacies sharing a common database/owner. ___ With other pharmacies NOT sharing a common database/owner.

___ No

    ___ Do not know

    Does your pharmacy perform medication reconciliation for patients at your practice site? ___ Yes, for all patients

    ___ Yes, but only for select patients

    ___ Only when requested by patient or prescriber

    ___ Rarely

    ___ Never

    What are the MAJOR barriers to performing medication reconciliation at your practice site? Please check only those you perceive to be major barriers.

    ___ Patients not aware of all the medications they are receiving.

    ___ Handwritten or printed medication lists that patients or their caregivers supply are incomplete.

    ___ Difficult to obtain needed information from physician practices.

    ___ Difficult to obtain information from hospitals and Emergency Departments after patients are discharged.

    ___ Hospital discharge forms are confusing, difficult to read, or incomplete. ___ Inability to locate and contact appropriate Emergency Department personnel to obtain information regarding a patient’s medications.

    ___ Lack of time to perform a complete review of the patient’s medications.

    ___ Other (please list)_____________________________

    Are you and your staff familiar with the requirement of hospitals to obtain a current list of medications for each patient that enters the Emergency Department or is admitted? ___ Yes

    ___ No

    How often do Emergency Department personnel contact your pharmacy to obtain current medication information (e.g., drug, dose, frequency) for a patient they are treating? ___ Very often (several calls per day)

    ___ Often (more than 5 calls per week)

    ___ Somewhat Often (more than 5 calls per month)

    ___ Rarely (less than 2 to 3 calls per month)

    ___ Never

    What pharmacy personnel typically provide requested patient medication information to Emergency Department personnel? (please check all that apply)

    ___ Pharmacist

    ___ Pharmacy Student

    ___ Pharmacy Technician

    ___ Other personnel (please list) _______________________

    ___ Do not provide information to Emergency Department personnel

    How would you rate the quality of communication with local Emergency Departments when Emergency Department personnel contact you for current medication information (e.g., drug, dose, frequency) for a patient they are treating?

    ___ Excellent open communication and able to give information needed if available. ___ Very good communication and usually able to give information needed if available. ___ Good communication and often times able to give information needed if available. ___ Poor communication and seldom able to give information needed if available. ___ Not applicable

    What are the MAJOR barriers to sharing information with Emergency Department personnel so that they can perform medication reconciliation? Please check only those you perceive to be major barriers.

    ___ Pharmacy staff perceives sharing information with Emergency Department personnel may violate HIPAA.

    ___ Pharmacy staff is reluctant to share information unless the identity of Emergency Department personnel can be verified.

    ___ Pharmacy cannot provide information on prescription medications dispensed at other pharmacies (not part of a common database), OTC drugs, and herbal products as the pharmacy computer system only tracks medications dispensed within the store or common database.

    ___ Pharmacy cannot locate patient in the pharmacy computer system.

    ___ Lack of time to perform a complete review of the patient’s medications.

    ___ Unable to print a patient’s current medication profile, including quantity, directions for

    use, and date of last fill, and transmit it electronically or by fax to the Emergency Department. ___ Other (please list)_____________________________

    Has your pharmacy experienced hospital Emergency Department personnel who are unwilling to share information regarding a patient due to perceived HIPAA violations? ___ Yes

    ___ No

    ___ Not applicable

    Has your pharmacy experienced physician practice personnel who are unwilling to share information regarding a patient due to perceived HIPAA violations?

    ___ Yes

    ___ No

    ___ Not applicable

    Do you and personnel in your pharmacy consider it a violation of HIPAA to share a patient’s medication profile with hospitals for the purpose of medication reconciliation? ___ Yes

    ___ No

    Does your district or corporate personnel consider it a violation of HIPAA to share a patient’s medication profile with hospitals for the purpose of medication reconciliation? ___ Yes

    ___ No

    ___ Do not know

    ___ Not applicable

    In the last 12 to 18 months has your pharmacy experienced an increase, decrease, or no change in the following: (please use the following key for this question: I = Increase; D = Decrease; N = No change)

    ___ Patients requesting an up-to-date, printed list of their current medications. ___ Physician practices requesting a current listing of a patient’s medications or information on a specific medication (e.g., dose, frequency) for a patient.

    ___ Calls from hospital and Emergency Department personnel requesting a current listing of a patient’s medications or information for a specific medication (e.g., dose, frequency) for a patient.

    Which of the following do you plan to do to help patients maintain an up-to-date and complete list of their medications? (please check all that apply)

    ___ Provide the patient a medication card on which prescription and over-the-counter medications as well as herbal products can be recorded.

    ___ Review a patient’s medication profile with the patient when a medication is dispensed.

    ___ Provide the patient with a list of medications that appear in their profile. ___ Provide education to patient’s on the importance of maintaining and sharing their medication lists with each healthcare provider they encounter.

    ___ Not aware of or not planning to implement anything at this time.

    If you have any additional comments, suggestions or plans to make changes to your practice in regards to Medication Reconciliation, please record them here:

Horn D, et al. Med Reconciliation: Community Pharmacies and EDs

Appendix 2 Community Pharmacy Survey

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