Transcript Flowsheet of the steps in Implementing Med Rec onto a

Medication Reconciliation in the Medical Floor
A Patient Safety Quality Improvement Initiative
Background
Key Steps continued
• Hospital admission, transfer and discharge are key medication-related
vulnerable moments (history taking & ordering) where patients are at
increased risk of medication discrepancies that potentially can lead to
adverse drug events.
1. Failure Mode Effects Analysis
Step 1
Development of Process
Patient Safety Committee, 2006
Key Steps continued
Key Steps continued
Figure 7. Mean # of Unintentional Discrepancies (Type 3)
Figure 4. Automated Discharge Prescription (Meditech)
Mean Number of Unintentional Discrepancies
Table 1. Summary of Failure Mode Effects Analysis
Hospital Information
2.5
2
Figure 1. Summary of Process Map
TDH Mean #
1.5
Vulnerable
Moment #1
Patient Information
Vulnerable
Moment #4
Vulnerable
Moment #3
Vulnerable
Moment #2
Admission to
Medical Floor
OR
National
0
Return to
Medical Floor
Physician Name
& Signature
ICU = Intensive Care Unit
ER = Emergency Room
Medication reconciliation is defined as a formal process of obtaining a
compete and accurate list of each patient’s current home
medications (including name, dosage, frequency and route and
comparing the physicians admission, transfer and/or discharge
orders to that list.
The process involves:
• Verification (collection of medication history)
• Clarification (ensuring the medications & doses are appropriate)
• Reconciliation (documentation of changes in the orders)
Patient Reminder
Table 2. Failure Mode Summary
Figure 5. Automated Discharge Summary (Meditech)
Disseminated information through
various mediums
Improvement Objectives:
• To decrease the number of undocumented intentional and
unintentional discrepancies for patients admitted to the Medical Floor
from ER by 75% by June 2007.
No Need to Dictate
Medications –
Information Flows
Through to
Discharge Summary
2. Tools Developed
Figure 3. Best Possible Medication History-Baseline Audit Tool
Figure 6. Mean # of Undocumented Intentional Discrepancies (Type 2)
M ean Number of Undocumented Intentional
Discrepancies
Step 3
Evaluation
-Audits
-Success Index
-Hospital-wide roll out
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
TDH Mean #
TDH Goal
Ontario Node
National
Jun-06
3. Baseline Data Collected – Audit Results
Figure 2. Project Plan
Step 3
Evaluation
Medication Reconciliation Success Index
• To increase the number of BPMH completed by nurses, pharmacists,
and physicians admitted to the Medical Floor by 75% by June 2007.
Key Steps
Step 2
Implementation of
Med Rec
• Presentations to TDH Quality Council,
Hospital Board, pharmacists, program core
team, staff meetings
• Inservices to Medical Floor Resource Nurses outlining
process for completing a BPMH & medication reconciliation
• Media campaign (newspaper & television)
• Signage & email
Figure 8. Medication Reconciliation Success Index
(Pre-Implementation)
Goal:
• To develop and implement a Medication Reconciliation process that
incorporates the best possible medication history (BPMH) and
facilitates timely and accurate admission/transfer/discharge orders.
- Develop Team/FMEA
- Design of tools
- Baseline data collection
Jul-06
Evaluation/Discussion
Goals & Objectives
Step 2
Implementation of
Med Rec (Pilot
in Medical
Floor)
Jun-06
Complete List of
Medications
Home
Surgical
Step 1
Development of Process
Ontario Node
1
0.5
ICU
ER
TDH Goal
1.8
1.6
1.4
1.2
1
0.8
0.6
0.4
0.2
0
TDH Mean #
TDH Goal
Ontario Node
National
Jun-06
Jul-06
Jul-06
Chart audits of 20 patients, revealed a mean Success Index of 75%.
This is within the National Mean. This is prior to implementation of the
Med. Rec. Process. Our goal is to improve our success index in 1 year
by 75% of our baseline (95%). We will continue to monitor our success
(on a monthly basis) using the same performance measurement.
We will continue to implement Medication Reconciliation, Test Results,
Spread and Evaluate. We will know this change is an improvement
using our 3 performance measures (compare future changes with
current performance) and by measuring nursing satisfaction, physician
satisfaction, pharmacy satisfaction & patient satisfaction.
Identified Potential Barriers to Success Include:
• No clear owner of process, roles & responsibilities
• Lack of understanding of potential impact
• Use of various forms in various areas/no standardized process