Freeman Health System Uses VigiLanz to Improve Patient Safety While Cutting Costs

Medication reconciliation, the process of creating an accurate list of a patient’s medications – including drug name, dosage, frequency, and route – is critical to reducing adverse events and ensuring patient safety.

Yet it can be a cumbersome and time-consuming undertaking, particularly when nurses are already overburdened. Medication reconciliation is also challenging because patients’ medications change frequently and patients often don’t maintain accurate lists.

“While it’s extremely important to quickly and accurately capture a patient’s medication information, traditional approaches that rely primarily on nurses and electronic health records make this very difficult,” said Adrienne Carey, PharmD, BCPS, Clinical Pharmacist and Data Mining Program Manager at Freeman Health System. “We knew there had to be a better way.”

Medication non-adherence exacts a heavy toll, both on patients and the broader healthcare industry. According to a review in the Annals of Internal Medicine, 20-30% of medication prescriptions are never filled, and approximately 50% of medications for chronic disease are not taken as prescribed. Each year, this lack of medication adherence is estimated to cause 125,000 deaths and at least 10% of hospitalizations, costing the American healthcare system $100-$289 billion.

One of the first changes Freeman Health System made was related to staffing. Rather than relying solely on nurses for medication reconciliation, it gradually added medication reconciliation technicians (MRTs) to its team. It now has nearly a dozen MRTs working in the emergency room and other departments. “We started them on the cardiology floor as a pilot, and their ability to ease the burden on nurses was so clear that we quickly hired more,” said Carey.

The MRTs meet with patients to go over at-home medication information. Then, they verify that information using another source such as the patient’s doctor or pharmacy, and document it in the electronic health record (EHR). “The MRTs are usually able to meet with patients more quickly than nurses can,” said Carey. “That means faster identification of at-home medications, and smarter medication decision making in the hospital.”

Freeman Health System also uses VigiLanz Pharmacy Surveillance to support and streamline its medication reconciliation efforts. The pharmacy department worked with the company’s clinical support team to create new rules in the clinical surveillance platform to identify patients needing medication reconciliation. When patients are admitted to the ER or to floors with MRTs, the MRTs receive an alert to conduct a reconciliation. “After determining what our organization needed, the clinical support team helped us create rules that make the process much more seamless,” said Carey, noting that the rules took effect in June 2018.

Once the reconciliation is complete, a pharmacy team member reviews it, contacts the physician if there are any problems or errors, and documents the information and/or intervention in the tool. Freeman Health System also uses VigiLanz software to create an audit trail of who has made changes. Carey noted that the new workflow is a significant improvement over relying on the EHR, where information is not easily retrievable. “While clinicians can pull up a patient’s record and read the history in the EHR, there is no discrete data to track information such as which medications have changed or what problems nurses have already addressed,” said Carey. “We also use the software to customize intervention categories so pharmacists can better track the prevention of potential major and minor adverse drug events.”