Reducing medication errors has been a top priority over the past month at Texas County Memorial Hospital, board members heard at last week’s monthly meeting.
Wes Murray, TCMH chief executive officer, detailed efforts by hospital staff to make improvements to the medical reconciliation process for patients seeking treatment at TCMH.
“A significant portion of our patient demographic uses multiple medications,” Murray said.
Murray described patients showing up at the emergency department with bags of medications or medication lists that were incomplete or wrong. The patients may or may not take the medications they have in their possession, and the patients may not take those medications correctly.
Hospital visits are compounded by medication history that is contained in a patient’s electronic medical record. The electronic record may also be out of date.
“Medication reconciliation has always been a cumbersome process, and electronic medical records hasn’t made the process easier,” Murray said.
The TCMH medical staff expressed concern about medication errors due to the electronic charting. Doretta Todd-Willis, TCMH chief nursing officer, put together a team of nurse managers, physicians and information technology staff to address and correct issues.
Todd-Willis said changes have already been made in the way staff process medication brought in by patients. Old medication lists are deleted from the patient’s electronic record and new medication lists are started with each patient hospital visit.
“The patient, physician, pharmacy and sometimes the nursing home or family caregivers have to be active participants in the process,” Todd-Willis said.
Dr. Jonathan Beers, TCMH chief of staff, said many times a primary care provider may not know about medications prescribed by a specialist to a patient.
Patient use of multiple pharmacies can also make it difficult for the patient and the patient’s healthcare providers to keep track of medications.
“Many times a patient doesn’t even know why they are on certain medications,” Todd-Willis said.
Beers said large hospitals have staff tasked entirely with medication reconciliation for hospital patients. At TCMH, those providing the patient care are responsible for the medication reconciliation efforts.
“There are countless ways that medication errors can occur, and we are focusing on this issue so that nothing serious occurs,” Murray said.
“This is an ongoing process that will continually need to be looked at and worked on,” Beers explained.
FUNDS OWED BY THE STATE
TCMH has requested help from the Missouri Hospital Association (MHA) to collect $1.2 million from the state of Missouri. The funds are owed to the hospital following Medicaid cost settlements completed for fiscal years 2012, 2013, and 2014.
“Historically, the state has paid the funds when we request them after the cost settlements are complete,” said Linda Pamperien, TCMH chief financial officer.
According Pamperien, the funds that would typically be paid by the state have been frozen by the governor’s office.
The funds being held are for services provided by TCMH to Missouri Medicaid patients. The funds are not dispersed by the state until final cost reports are completed for each fiscal year.
“We aren’t the only hospital waiting to be paid,” Pamperien said.
There is no timeline for when the funds might be paid. MHA is working on behalf of multiple Missouri hospitals to get the funds owed to them.
TCMH is also collecting information regarding medical reimbursement denials for patients with Anthem Blue Cross/Blue Shield insurance.
“Anthem has been denying claims for services provided in the emergency room as ‘non-emergent’,” Murray said. “This puts the burden on TCMH to collect payment from the individuals rather than their insurance company.”
Murray provided two examples of Anthem insurance refusing to cover emergency room service for insured patients: one was hit by a car and one had a stroke. Murray said both would be considered emergency healthcare needs.
“These are not examples from our hospital, but they could have easily happened to insured patients in Texas County, too,” Murray said.
Murray said MHA is seeking information from member hospitals and from patients insured by Anthem that have received denials of coverage for emergency room services.
Turpin, TCMH quality management director, reported TCMH met all five first year milestones set by the Hospital Improvement and Innovation Network (HIIN), a two-year program sponsored by Centers for Medicare Services (CMS).
“We saw either an improvement or no decline in the areas we were measuring monthly,” Turpin said.
The overall goals of the project are a reduction in all causes of patient harm and a reduction in readmission of hospital inpatients less than 30 days since the first admission. Other key areas of the program include antibiotic stewardship, hospital acquired infections, workplace violence, physician leadership, patient engagement and healthcare disparities.
TCMH is one of more than 100 hospitals in the state participating in the program. The MHA collects and compiles data from TCMH and other hospitals in the state. The state data is then collected and compiled into national data by the American Hospital Association Health Research and Educational Trust. The program is planned to last two years with the possibility of a third year.
“Participating in this program is helping us prepare for new CMS guidelines that we will have to follow,” Turpin said.
An $89,000 Federal Emergency Management Association (FEMA) grant request for a new generator to power the surgery department under construction at TCMH has gone to the second round of consideration. Board members unanimously passed a resolution to agree to cover $23,000 of the new generator cost if FEMA approves the request.
Funding for the grant will not be known until next summer.
Construction on the new department, slated for completion in 2018, is located between the Jayson Gentry Community Safe Room and the East wing of the hospital, will have two operating rooms, an endoscopy suite and seven private pre-surgical and post-surgical rooms for patients. The area is 6,091 square feet in size.
Pamperien said inpatient revenues were below budgeted expectations, but outpatient revenues exceeded budgeted expectations for the month. Expenses were also down for the month of October. TCMH finished the month with a positive bottom line of $103,247.38 and a negative year to date balance of $581,880.06.
Present at the meeting were: Murray; Beers; Todd-Willis; Pamperien; Turpin; Joleen Senter Durham, director of public relations; John Hammons, TCMH legal counsel; Texas County Commissioner John Casey and County Clerk Laura Crowley; and board members Dr. Jim Perry, OD, Omanez Fockler, Janet Wiseman and Jay Loveland. TCMH board member Mark Hampton was absent. The county officials met with the board to discuss outstanding medical costs related to inmate care at the Texas County jail.
Due to the Christmas holiday, the next meeting of the TCMH board of trustees is Dec. 19.