Transcript Forensic Psychiatric Hospital and Clinics

Western Node Collaborative
Forensic Psychiatric
Hospital and Clinics
Medication Reconciliation
October 2, 2006
Zaheen Rhemtulla B.Sc. (pharm)
Forensic Psychiatric Hospital
Forensic Clinics
Forensic Psychiatric Hospital
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Secure, 190-bed Forensic Psychiatric Hospital
Serves individuals referred by the Courts for treatment and assessment
Provides treatment and support for those individuals who are deemed to require a secure
inpatient facility due to their risk of harm to self and/or others
Facility consists of nine clinical units (five secure, three closed and one open unit)
Designated mental health facility under the Mental Health Act, which provides for involuntary
admissions for treatment purposes
Forensic Psychiatric Clinics
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6 outpatient clinics with approximately 2000 registered clients
Clinics responsible for the supervision and monitoring of persons found Not Criminally
Responsible on Account of Mental Disorder (NCR-MDs) who are living in the community, and
any persons who are found Unfit to Stand Trial, but have been granted a conditional discharge
by the British Columbia Review Board
Involves monitoring the client's progress in treatment and ensuring that the client is adhering
to the conditions set out in the Disposition Order provided by the BC Review Board
Clinics also conduct assessments that are ordered by the provincial courts of British Columbia
(fitness to stand trial, NCR-MD, pre-sentence, and mental status)
Provide assessment and treatment services for offenders on bail and probation/parole
Background Information
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Forensic Psychiatric Hospital along with Riverview
Hospital first convened a MedRec team June 2005
in response to the Safer Healthcare Now
Campaign and accreditation requirements
Recognizing the differing needs of Forensic
Psychiatric Services, a separate Medication
Reconciliation team consisting of a physician,
nurses, pharmacists, and a Forensic Clinics
Coordinator was formed February 2006
The goal for incorporating a medication
reconciliation process for all transition points of
patient care throughout the Forensic Hospital stay
is December 2006
Project Charter
Based on studies documenting the high percentage
of adverse events occurring in hospitals due to
medication errors, particularly at points of transition,
Forensic Psychiatric Hospital and the Forensic
Clinics are focused on providing the best possible
care to the clients they serve by developing and
implementing procedures and systems that result in
better documentation and eliminate unintentional
medication discrepancies at interfaces of care.
Aims
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Reduce the mean number of undocumented intentional
discrepancies at admission by 75% from new baseline (to be
collected October 2006 once Pharmanet/MARs established) on
the 2 admitting pilot wards (ASH1 and Dogwood East) by
December 2006
Reduce the mean number of undocumented unintentional
discrepancies at admission by 75% from new baseline (to be
collected October 2006) on the 2 pilot wards by December
2006
Increase the medication reconciliation rate (success index) to
100% by December 2006 on the 2 pilot wards
Improve medication information on admission by providing
better access to Pharmanet and transferring agency information
by Oct 2006.
Forensic Psychiatric Hospital
Medication Reconciliation Team
Project Leader:
Zaheen Rhemtulla
[email protected]
Administrative Leadership: Marilynn Macdougall [email protected]
Risk Management:
Peter Owen
[email protected]
Clinical Support:
Jane Dumontet [email protected]
Dr. Nader Sharifi
[email protected]
Dave Wharton
[email protected]
Jonie Pascual
[email protected]
Jennifer Dutton
[email protected]
Forensic Clinics Area
Coordinator
Ellen Haworth
[email protected]
Where are we in the process?
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Admission:
BPMH reconciliation audits on all admissions to two admitting wards.
Applying for all admitting physicians in the Hospital and Clinics to have
Pharmanet access
Working with the health care provider for BC Corrections (99% of hospital
admissions are from Corrections) to consistently provide a same day MAR
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Discharge:
Trialing a pharmacy computer generated discharge profile indicating all
regularly scheduled medications the patient is to be taking upon discharge.
The form is to be verified against current orders and signed by the physician(s)
upon discharge.
PRN medications are to be written in by the physician only if the patient
requires them upon discharge.
Included on the discharge profile is the last given and next due date of any
long-acting injections.
A copy of the current MAR is to be included in the discharge package
1.0 Mean Number of Undocumented Intentional Discrepancies
0.14
0.12
small sample size=8 patients
0.13 represents one undocumented
Intentional discrepancy
0.10
Mean
0.08
0.06
Baseline data
0.04
0.02
Baseline data sample size
very small=4 patients
Month
Actual
Goal
20
06
D
ec
20
06
N
ov
O
ct
20
0
6
20
06
Se
p
20
06
Au
g
00
6
Ju
n
Ju
l2
6
20
0
06
M
ay
20
20
06
Ap
r
06
ar
M
Fe
b
20
20
06
6
Ja
n
20
0
20
05
D
ec
N
ov
20
05
0.00
2.0 Mean Number of Unintentional Discrepancies
0.14
small sample size=8
patients
0.13 represents one
unintentional
discrepancy
0.12
0.10
Mean
0.08
0.06
Baseline data
0.04
0.02
Baseline data sample size
very small=4 patients
Month
Actual
Goal
20
06
D
ec
20
06
N
ov
O
ct
20
0
6
20
06
Se
p
20
06
Au
g
00
6
Ju
n
Ju
l2
6
20
0
06
M
ay
20
20
06
Ap
r
06
ar
M
Fe
b
20
20
06
6
Ja
n
20
0
20
05
D
ec
N
ov
20
05
0.00
3.0 Medication Reconciliation Success Index
120%
100%
60%
Baseline data
40%
20%
Baseline data sample size very
small=4 patients
Month
Actual
Goal
20
06
D
ec
20
06
N
ov
O
ct
20
0
6
20
06
Se
p
20
06
Au
g
00
6
Ju
n
Ju
l2
6
20
0
06
M
ay
20
20
06
Ap
r
06
ar
M
Fe
b
20
20
06
6
Ja
n
20
0
20
05
D
ec
20
05
0%
N
ov
Percentage
80%
Keys to Success and
Lessons Learned
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Successes:
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Leadership buy-in and support, team commitment, funding
Improvement in Pharmanet access for admission history
Improvement in communication and provision of information from
correctional agencies
Barriers:
- Data collection – difficulty accessing previous medication history when
doing BPMH auditing
- Small sample size
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Lessons Learned:
- Need to improve access to medication history in order to proceed
Next Steps
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Admissions:
Continue and expand BPMH audits to all admissions to
determine timely access to medication history through
Pharmanet and current MARs
Identify high risk patients (i.e. Over 40 y.o., more than 3
medications, high risk condition, high risk medication) who need
a more comprehensive medication history
Current data shows that only 25% of admissions are coming in
on medications
Next Steps
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Transfers
Do an internal audit of transfer medication reconciliation.
May not need additional reconciliation as present
procedures involve the patient’s chart with the current MAR
and medication cassette are sent with the patient to the
receiving ward. In addition, the patient is followed by the
same physician throughout their stay in the hospital.
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Discharges
Utilize a “Discharge profile” to document regularly
scheduled medications and prn’s required for discharge.
Physicians will be able to use the form as a discharge
order for pharmacy when discharge medications are
required. Follow-up the process to identify effectiveness.
Process will involve sending a copy of the current MAR to
the receiving facility
Contact Information
Zaheen Rhemtulla
Medication Reconciliation Project Team Leader/Clinical
Pharmacist
BC Mental Health and Addictions Services
2601 Lougheed Highway
Coquitlam, BC
V3C 4J2
604-524-7892
[email protected]