Transcript Central Okanagan PALLIATIVE MED REC

Central Okanagan
PALLIATIVE
MED REC
Home and Community Care
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Background
• Palliative Clients who are admitted to
Hospice for Pain and Symptom
Management (PSM).
• Patient risk = loss of pain control;
anxiety around uncertainties in
medication also causes increased pain
levels
• Hospice temporarily located within a
Residential setting until stand- alone site
is ready
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Background
• Multidiscliplinary team – Community, Acute,
Residential, and Cancer Centre
• Goals are to:
– Expedite transitions
– Prevent Adverse Drug Events in transitions
• Project started just prior to Learning Session
1 in Saskatoon
• Project charter draft written prior to LS1
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Aim #1
4 Aim Statements:
1. Create Best Possible Medication History
(BPMH) for 95% of the identified
Palliative group within 24 hrs of
admission to Hospice, and identify the
discrepancies. The target date is Apr.
30, 2008.
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Aim #2 & #3
•
•
Reconcile 100% of the identified
discrepancies within 48 hrs of admission,
by Apr. 30, 2008.
Create a Best Possible Medication
Discharge Plan (BPMDP) for 95% of
patients transitioning back to the
Community, by Apr. 30, 2008.
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Aim #4
4. Reduce Edmonton Symptom
Assessment System (ESAS) score for
symptom management by 50% by Apr.
30, 2008.
(ESAS scores nine symptoms – pain, tiredness,
nausea, depression, anxiety, drowsiness,
appetite, wellbeing and shortness of breath on a scale from 0 to 10, with 10 being the
worst possible symptom score. A reduced
score would show improvements in symptom
management.)
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Team Members
• Community Care Manager
• Director, Residential Services
• Clinical Practice Consultant, Home Care Nursing
(HCN)
• Clinical Resource RN’s (Acute, Hospice & HCN
Palliative Care)
• Cancer Centre RN
• Pharmacists (Clinical & Community)
• Family Practitioner
• Quality Improvement (SHN) Rep
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Changes Tested
Who is completing BPMH?
Clinical resource nurse.
•
Tested may different forms, only to fine
tune an already existing form created
in our acute care setting.
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Changes Tested
2. Tested best timing to complete BPMH to
have an accurate completed Med Rec
done.
a) BPMH within 48hrs of admission with a
goal of 1 week to Med Rec by Physician.
b) BPMH within 24hrs of admission with a
goal of 1 week to Med Rec by Physician
c) BPMH on admission with Med Rec within
24 hrs of admission.
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Results
1. Forms tested….. Ours fine tuned. Tested
6 forms.
2. Timing….. We found doing a BPMH on
admission to unit resulted in physicians
completing the reconciliation soon after
admit, with physician cooperation
completing the Med Rec with
appropriate, accurate orders.
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Results
3. Clients are often admitted to unit when
CRN is not available. The target group is
not always having a Med Rec completed
with in the target timeframe.
4. Process Map prior to Med Rec created.
•
Process map and limited data follows…
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Process Map
Prior to Med Rec
Med Rec for the Palliative Client in the Central Okanagan - PROCESS BEFORE INSTITUTION OF MED REC
ADMIT to COK Palliative
Program
GP, Oncologist, PSM
Physicians
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Meds listed in chart
DNR Document
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Med Hx
PharmaNet
Patient
Family
Meditech
CSI Pharmacist
Consultation Notes
(GP)
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CSI RN
Health Assessment Form
Medication Record (form)
Acute (KGH)
BCCA
CSI
Physician
Palliative Client
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Medication Profile*
Private-Practice
Community
Pharmacist
Accesses drug info from
PharmaNet
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Residential
(Douglas Fir
[DF])
Community
CSI Pharmacist
Accesses drug info from
PharmaNet
Patient
Family
MRP
Discharge Orders
MAR (Meditech)
Med bottles
CSI List
Community
Pharmacy
Pixalere
Community RN
Med Hx
Patient
Family
Previous health records (Meditech)
PharmaNet
Acute RN
(through ER or Direct Admit to
Ward)
EHS List
CSI List (faxed to ward M-F, 0800 –
1600 hrs only)
Palliative Response
Team
(24 hr Physician
Response)

Hospice RN/ LPN
Med Hx
Transfer information
only
NO REVIEW
OF MEDS
ON ADMISSION
NOTES
1. PSM = Pain & Symptom Management
2. MEDITECH = one system common to all intake points for clients
3. Community Medication Profile contains information on:
dose, route, frequency, start date, physician, pharmacy,
and who administers the medication
Patient Discharge
(Stable / Expiry)
Coming Full Circle: AMI & Med Rec Across the Continuum
PRE MED REC Process Map
prepared by:
H. Morgan, QI Dept
Sept 18, 2007
Western Node Collaborative
Results
June:
incomplete data ; CRN away.
BPMH complete = 1
July (after July 23)
P&SM admits = ?
BPMH complete = 0
August
P&SM admits = ?
BPMH complete = 4
September (to date)
P&SM admits = ?
BPMH complete = 2
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Results
Run Charts of your Key Measures
• Insert your run charts here
(More than one slide may be necessary)
• Annotate your run charts with specific changes you’ve
tested
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Western Node Collaborative
Example of Annotated Graph:
Improved Access
(delete this slide before saving)
45
40
35
30
25
20
15
Began backlog
reducion
Reduced Appt types
Provider Back from
Vacation
Cross Trained Staff Protocols
Protocols Tested
10
5
0
May-02 Jun-02 Jul-02 Aug-02 Sep-02 Oct-02 Nov-02 Dec-02
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Keys to Success and
Lessons Learned
• We need to expand our team educate
and include bedside nurses in the
process with 1 or 2 to take on the role of
champions when the CRN is not available
to complete the BPMH.
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Keys to Success and
Lessons Learned
• One person completing the BPMH is too
heavy a load!
• Persistence! We need to persevere with
follow up to get the physicians
understand the importance of completing
the med rec.
• Process takes longer than anticipated;
but well-designed form shortens and
smoothes out the process.
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Next Steps
• We are aiming for hospice staff buy in and
participation in creating a BPMH for each
pain and symptom management client
admitted to the hospice unit.
• Adopt a BPMH/Med Rec form that
includes our measurement components.
• Include ESAS (Edmonton Symptom
Assessment Scale) measurements on
admit and discharge for all the Med Rec
clients.
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Contact Information
• Dianne Stockwell (Clinical Resource Nurse)
[email protected]
(250) 862-4109
• Faye Burch (Director, Residential Services)
[email protected]
(250) 870-5784
• Holly Morgan (Clinical QI Coordinator)
[email protected]
(250) 862-4300 Ext 7210
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative