The Key to Achieving National Patient Safety Goal #8
Medication Reconciliation: Addition of Transplant Pharmacists in the Clinic Setting

Suzanne Reed, RN, BSN, CPTC, CCTC, UCSD Center for Transplantation, San Diego, CA

Purpose

It is estimated that 44,000 to 98,000 people die annually in the United States from healthcare associated mistakes. In order to improve the safety and quality of healthcare, The Joint Commission has implemented National Patient Safety Goals. Goal #8 demands the accurate completion of medication reconciliation across the continuum of care. Studies have shown that this can be especially challenging in the transplant setting, since patients must comply with complex regimens, which if taken incorrectly, can result in significant adverse events including hospitalizations and failed allografts.^1,2 In a prospective, randomized controlled study, compliance with transplant medications was improved when pharmacist counseled patients during routine clinic visits compared to no pharmacist counseling.³ Additionally, a 12 month review by an academic medical center regarding medication errors in the transplant outpatient setting identified the most common error type as patient error, followed by prescription, delivery, availability and reporting errors.² In order to improve the safety and quality of care in this high risk population, and to meet the National Patient Safety Goal # 8, our center added a transplant pharmacist to the clinic setting.

Methods

Our center performs on average approximately 160 transplants annually which include liver, kidney, pancreas and lung transplants. In 2005, the medical center hired a 0.5 FTE pharmacist to cover the abdominal transplant programs. Within two years, this was increased to 2.5 FTEs with expansion to the cardiothoracic program.

Results

The following table summarizes the benefits of adding the transplant pharmacist to our solid organ transplant programs and the process of medication reconciliation:

INITIATIVE	ACTION	BENEFITS
MedActionPlan™	Pharmacist inputs initial medication information into the MedActionPlan™ data base	Medication Reconciliation requirements met On-line access to up-dated medication list for transplant team members On-line access for the transplant patients Printable medication list with pictures, exact timetables and purpose Available in English or Spanish Facilitates patient teaching Easily up-dated Printable daily log pages Helpful reminders on cover page including transplant center contact information
Improved Service from Hospital Pharmacy	Transplant Pharmacist is liaison for transplant patients.	Able to track compliance when prescriptions filled at the University Facilitates insurance authorizations that outside pharmacies may refuse to do Manages prescription issues during clinic
Patient Education	Transplant Pharmacist provides post transplant medication education prior to discharge from the transplant and at clinic visits.	Post transplant teaching is more comprehensive Resource for transplant specific questions (ex. vaccination, herbs, drug interactions or substitutions)
Improved Communication and Team Synergy	Pharmacist covers patients in house and out-patient. If patients are re-admitted, they are notified (transition points in care)	Pharmacist communicates with transplant team and is aware of resources provided by each team member Transplant team more aware of resources that can be provided by the pharmacy Used as resource to determine what medications may be causing complications such as thrombocytopenia & renal insufficiency

Conclusion

The addition of the transplant pharmacist has improved the safety and quality of care for our transplant patients. The pharmacists have identified dosing time errors, and compliance issues. They assist with prescriptions needs during clinic and are available for delivery or authorization issues. They monitor the medications across the continuum of care in our University, and since present in clinic, we are 100% compliant with National Patient Safety Goal # 8.

References: 1. American Journal of Transplantation: 2007; Vol 7, Issue 11: 2561-2566 2. Arch Surg. 2007; 142: 278-283 3. Clin Transplant 2001: 15: 330-336

Suzanne Reed, RN, BSN, CCTC, CPTC, Ashley Feist, PharmD, Linda Awdishu, PharmD, Alex Aussi, BSN, RN, MBA, Stephanie Osborne, RN, BSN, CCTC, Gordon Yung, MD