Transcript Thunder Bay - Medication Reconciliation

Thunder Bay Regional
Health Sciences Centre (TBRHSC)
Medication Reconciliation
Background
• Is a 375 bed academic health
science centre with a mission to
advance world-class Patient and
Family Centred Care in an academic,
researched-based acute care
environment.
• We provide service to Northwestern
Ontario with a population of
250,000 residents scattered over a
geographical area the size of France.
• Rationale – Improve patient safety
by developing a consistent approach
to obtain BPMH and reconcile
medications upon admission and
transfer
Aim
• Educate critical care staff on the medication
reconciliation process (in three to four months)
• Ensure a best possible medication history (BPMH) is
obtained and documented for all critical care
patients (in 12-months)
• To reconcile and document all medication
discrepancies on admission and transfer from critical
care (in 12-months)
3
Team Members
•
•
•
•
•
•
•
•
Adam Vinet, Manager – Emergency Department
Cece Girard, Critical Care Staff Nurse
Chad Johnson, Clinical Nurse Specialist – Critical Care
Katrina Niemi, Critical Care Staff Nurse
Larry Bertoldo, Pharmacist
Lisa Beck, Director – Trauma Program
Marios Roussos, Intensivist
Wendy Winslow, Manager – Critical Care
4
Results PDSA #1
Question
Result
Have you completed the MEDRec
course on MEDworxx?
Do you have any questions or
require clarification on current
process?
How many BPMHs have you
completed in Medi-Tech with 24hours of admission?
14/14 staff completed the course
1/14 staff required clarification
9/14 staff completed the BPMH
in Medi-Tech
5
Results PDSA #1 (continued)
Question
Result
If you were expected to complete the
BPMH but could not complete, please
indicate factors/barriers that inhibited
completion
“No caregiver/family available to assist
with BPMH.” (9)
“Patient was non-verbal.” (10)
“No access to other resources to complete
BPMH.” (5)
“Workload issues.” (3)
“Not familiar with certain medications.” (1)
For all the BPMHs that you have
completed, list all sources used to
complete BPMH
Patient (9)
Written medication list/medication bottles
(9)
Caregiver/partner in care/family (9)
Local pharmacy (3)
Ontario Drug Profile Viewer (1)
6
Results PDSA #2
Question
Result
How many admissions occurred in
ICU over the trial weekend?
4 days (27 admissions)
How many BPMHs were completed
in Medi-Tech within 24-hours of
admission over the trial weekend?
17
Indicate factors/barriers that
inhibited completion
Did not know to repeat BPMH on admission
Patient unstable (workload)
Family did not know medication history
Patient condition (unstable, confusion, etc.)
In doing follow-up with staff was
there common themes to barriers or
areas for improvement?
Late admissions
Patient condition, workload, family not aware of
medication history
7
Changes Tested
• PDSA #1
– Implementation of nurse driven BPMH, a change
from the pharmacist lead model
• Nursing staff completed an e-learning module to learn
how to obtain a BPMH and clinical tools were
developed to assist nursing staff to obtain the BPMH
8
Changes Tested
• PDSA #2
– Tested the current weekend process of RNs
completing the BPMH while pharmacist is off
• Nurses are expected to complete BPMH on weekends
when pharmacist is off to ensure a 24/7 process that is
not fully reliant on one pharmacist
• Want to ensure that current process is “process driven”
and not individual dependant
9
Lessons Learned
• PDSA #1
– Need to focus and follow-up individually with nursing staff
to asses why BPMH were not completed (identify barriers
in completing)
• PDSA #2
– Following up individually provided more details:
• Why the BPMH was not obtained
• Exposed ongoing barriers and questioned the expected BPMH
time to completion
• Need to consider having BPMH completion time extended to 48hours
10
Next Steps
• Evaluate quality of BPMH
– Currently we are focusing on quantity, getting nursing staff
in the habit of completing/obtaining a BPMH
• Medication reconciliation at transfer
– Develop process
– Get buy-in from intensivist group
11