Transcript Admission MedRec at Lions Gate Hospital

Admission
Medication Reconciliation
at
Lions Gate Hospital
Lean Transformation Services
Laarnie St-Laurent, Lean Coordinator
Lorelei Grosser, Lean Coordinator
Carissa Looman, Lean Educator
Admission MedRec at Lions Gate Hospital
Objectives:
•What is MedRec?
• Why do MedRec?
•How was MedRec implemented?
 Brief overview of Lean Methodology
 How Lean was used for implementation
•How are we doing now?
 Audit Results
•What are key “lessons learned?”
 Impacts of MedRec
Admission MedRec at Lions Gate Hospital
Ever wondered…
• Right medication?
• Right dose?
• Right time?
Admission MedRec at Lions Gate Hospital
What is MedRec?
Admission MedRec at Lions Gate Hospital
What is MedRec?
“Best
Possible”
Medication
History
Pharmanet
(Prescribed
Drugs)
Reconciliation
(Orders)
Admission MedRec at Lions Gate Hospital
Why do MedRec?
Did you know…
• “40-50% of patients on admission” are at risk of
unintentional medication discrepancies?
 Medication errors may harm patients
 Of these, 6% are at risk of harm serious enough to
increase length of stay from 2-8 days2.
Admission MedRec at Lions Gate Hospital
Why do MedRec?
Some Local Data
• At Lions Gate:
 About 38.8 daily admissions
12.5 patients at risk of unintentional discrepancies
 0.75 patients daily at risk of staying 2 to 8 days longer
 About $246K additional costs per year
(based on average cost of $450/patient/night)
Steps to Achieving Continuous Improvement– sequence to approach the tools
Mistake Proofing
Other tools to
improve flow and
implement pull
And Then:
Repeat!
Visual Controls
Unit Layout/ Cell
Design (Flow)
Standard Work
Rather than thinking specific
tools do not apply, consider
if their concept can provide
benefit.
Observe and
Collect Data
See for yourself & collect objective data
that becomes the starting point for
discussions
Adapted from Virginia Mason
Lean Leader Certification
Materials
VCH Improvement System
Lean Tollgate
Sustainment
Audit/Refine
Implementation/
Go-Live
Future State
Development
Current State
Analysis
Project
Definition
LTS_VCH Improvement System_V1
Admission MedRec at Lions Gate Hospital
How was MedRec implemented?
Observations: Data Collection
Admission MedRec at Lions Gate Hospital
How was MedRec implemented?
Future State Value Stream Map
Triage
MRO
printed
for
certain
areas in
Emerg
Emerg Nurse
Emerg
Doctor
Admission
•BPMH
documented by
RN or
Pharmacist on
•MRP
reconciles
home
medications
•MedRec Order
(MRO) form
processed
Admission MedRec at Lions Gate Hospital
How was MedRec implemented?
Standard Operating Procedures:
Who
What
How
When
Why
Admission MedRec at Lions Gate Hospital
How was MedRec implemented?
Admission MedRec at Lions Gate Hospital
How was MedRec implemented?
Auditing and Breakthrough Lanes:
Did not
meet
MedRec
criteria
Met MedRec
criteria
Admission MedRec at Lions Gate Hospital
How was MedRec implemented?
Auditing and Breakthrough Lanes:
Why did not
meet
MedRec
criteria?
Admission MedRec at Lions Gate Hospital
How was MedRec implemented?
Auditing and Breakthrough Lanes:
Did not meet
MedRec?
Now what????
Admission MedRec at Lions Gate Hospital
How are we doing now?
Organizational Targets
Completion Rate
75%
BPMH Completion
75%
Reduction in unintentional discrepancies
75%
Reduction in undocumented intentional discrepancies
75%
Admission MedRec at Lions Gate Hospital
How are we doing now?
Area
Elective Surgery:
• Implemented on November 2011
Quantitative Results
•100% have complete, accurate
medication histories
•100% receive post-op medication
orders
• 75% reduction in unintentional
discrepancies
• 85% reduction in undocumented
intentional discrepancies
Admission MedRec at Lions Gate Hospital
How are we doing now?
Area
Emergent/Direct Admissions
• Implemented on May 23, 2012
Quantitative Results
•77.5% to 80% reconciliation rate
(exceeded target of 75%)
•47.5% “best possible medication
history” completion rate
•50% reduction in unintentional
medication discrepancies
•55% reduction in undocumented
intentional medication discrepancies
Comparison: Vancouver Coastal
Site
Average Completion Rate
• Since Implementation
Richmond Hospital
60%
Vancouver General
78%
Coastal
Squamish General
60%
St. Mary’s Hospital
65%
Powell River General
TBA
Lions Gate Hospital
78%
Admission MedRec at Lions Gate Hospital
How are we doing now?
Examples of “good saves” and Qualitative
Results…
MedRec Success Stories
Unit
Good saves…
Emergency
MD ordered only one of patient’s home meds at half the dose the patient was
taking. When med history was taken by RN, MD ordered the rest of home
meds (5 pages were missed).
Pediatrics
Patient’s Pharmanet only showed one medication. When BPMH was taken,
patient was taking medication at a different dose than on Pharmanet and was
also taking a number of other medications NOT on the Pharmanet.
Daycare
Surgical patient was seen in PSSU 2 weeks prior to surgery, but had filled
other prescriptions since then. Daycare RN picked up on new meds when
BPMH was done prior to surgery.
Admission MedRec at Lions Gate Hospital
Admission MedRec at Lions Gate Hospital
Reference List:
1
Canada. Accreditation Canada. Required Organization Practice.
Ottawa: Accrediation Canada, 2012. Print.
2 Canada. Optimizing Medication Safety at Care Transitions –
Creating a National Challenge. Toronto: 2011. Print.
Admission MedRec at Lions Gate Hospital
Thank you for listening!
Questions???
Admission MedRec at Lions Gate Hospital
What is MedRec?
Systematic
Partnership
Conversation
February 27, 2013
Admission MedRec at Lions Gate Hospital
How was MedRec implemented?
5 Steps to Lean
Thinking
1
Specify Va lue
2
M a p t he
Va lue St rea m
3
Est a blish
Flow
5
W ork t o
Perfect ion
4
Im plem ent
Pull
Source: James P. Womack. Lean
Thinking.
February 27, 2013
Admission MedRec at Lions Gate Hospital
Medication
Management
Paper flow
Audit & Refine
Implement
February 27, 2013