Transcript Saskatoon Health Region Story Board

Western Node Collaborative
Saskatoon Health Region
Medication Reconciliation
Background
• Saskatoon Health Region:
– largest health region in Saskatchewan
– provides services to almost 300,000 local residents and
thousands of others from across the province who come
to Saskatoon for specialized health services.
– On any given day, approximately 35% of hospital care in
Saskatoon is provided to people living outside the
Health Region.
– As an academic health sciences centre, the Health
Region provides learning opportunities to future health
care providers and participates in research that will build
knowledge and improve care.
SHR Medication Reconciliation Project Structure
Advisory Committee
Steering Team
Jean Morrison (Executive Sponsor),
Sandra Blevins, Brenda Thiessen, Janet Harding, Candice Bryden
Project Co-Chairs
Jackie Mann
Barb Evans
Team
Leads
P
St. Elizabeth’s
Monique Bollefer
(Lead)
Russom Ockbaghzi
Ellen Kachur
Yvonne Berscheid
Brenda Hantke
Bev Weyland
RUH Pediatrics
Bernie McDonald
(Lead)
Garth Bruce
Val Gerlach
Shelley Peacock
Margo Elmgren
r
o
Quality Services
Candice Bryden
Gerry Belton
j
e
c
t
SPH 6th Medicine
Barb Kirkland (Lead)
Cheryl Fransoo
Carmen Hampton
Trina Mucha
Susie Hoeppner
Donna Strilaef
Caroline Westman
Joy MacLaughlin
Norma Engele
Karen Wormsbecker
Maureen Preston
Holly Mansell
Judy Klassen
Joanne Kappel
T
Janice Seeley
Marlene Strenger
e
a
m
Physician
Champion
(vacant at present)
s
RUH 5000
Lilah Weinberger
(Lead)
Leah Gilmore
Doris Smith
Eva Lehnert Thiel
Noelle Rohatinsky
Kathy Bue
Renee Kennedy
Crystal Richter
SCH 4300
Jane Richardson
(Lead)
Mark Sheridan
Audrey Sereda
Tess Gieg
Nadine Clarke
Marie Gifford
Shannon Stone
Background
• Pilot sites for medication reconciliation
project include:
– Surgery 5000, Royal University Hospital
– Pediatrics, Royal University Hospital
– Gynecology / PAC, Saskatoon City Hospital
– 6th Medicine, St. Paul’s Hospital
– St. Elizabeth’s Hospital, Humboldt (rural site)
Background
• Rationale for improving
– Enhanced patient safety
• What are you trying to improve?
– Clarity and completeness of medication
histories and orders from admission to
discharge
– Reduce medication history and ordering
workload
Background
• Important dates:
– Start date: October / November 2005
– Region wide target implementation dates:
• Admission: December 2006
• Transfer and discharge: Spring 2007
• Link with SK Health Pharmaceutical Information
Program (PIP): June 2007
Background
• Why?
–
–
–
–
Evidence for improving patient safety is compelling
Requirement for CCHSA accreditation
CEO and Senior Leadership completely endorses
Enhances efficiencies; eliminates duplication of
workload
– Key component of seamless care strategies
• Resources:
– No dedicated resources
– Group of interested, enthusiastic health care
professionals agreed to participate
Aim
• Purpose: Improve patient care by reducing adverse drug
events through medication reconciliation
• Scope and Boundaries:
– Pilot areas selected. Focus on admission process initially.
• Improvement Objectives (Admission):
– Overall: To reduce adverse drug events and patient harm through
the implementation of medication reconciliation on admission
throughout SHR.
– Pilot Aims:
• Reduce # unintentional discrepancies by 75% in 12 months
• Reduce # undocumented intentional discrepancies by 75% in 12
months
• Increase overall success at reconciling medications by increasing the
Medication Reconciliation Success index by 75% in 12 months
Goals
• Admission to Discharge:
– Develop 1 form for admission medication reconciliation
for use in SHR.
• Form to serve dual purpose of physician’s order form and
medication history documentation tool.
– Develop 1 process for admission medication
reconciliation in SHR.
– Utilize PIP to generate on-line admission medication
reconciliation form
– Modify the current business process to integrate the
preadmission data with patient’s acute care medication
profile
– Develop a new process where automation will generate
a patient medication profile on transfer and discharge
Changes Tested
• Preadmission Medication List Physician Order Form
– Focus groups (Pharmacy, Nursing, Physicians)
– Satisfaction survey with each PDSA cycle
– Changes made to content and design based on feedback
• Medication reconciliation process
– Focus groups
– Satisfaction survey with PDSA cycle #1
• Test effectiveness of and reaction to medication
reconciliation form
– Survey
– Missing information check-list
– BPMH
Results: Run Charts of Key Measures
Pediatrics – Includes OTCs and Herbal Products (n=6)
Dec
2006
Nov
2006
Oct
2006
Sep
2006
Aug
2006
Jul
2006
Jun
2006
May
2006
Apr
2006
Mar
2006
Feb
2006
Jan
2006
Dec
2005
1.20
1.00
0.80
0.60
0.40
0.20
0.00
Nov
2005
Mean
1.0 Mean Number of Undocumented Intentional Discrepancies
Month
Actual
Goal
2.0 Mean Number of Unintentional Discrepancies
0.60
Mean
0.50
0.40
0.30
0.20
0.10
Month
Actual
Dec
2006
Nov
2006
Oct
2006
Sep
2006
Aug
2006
Jul
2006
Jun
2006
May
2006
Apr
2006
Mar
2006
Feb
2006
Jan
2006
Dec
2005
Nov
2005
0.00
Goal
Month
Actual
Goal
Dec
2006
Nov
2006
Oct
2006
Sep
2006
Aug
2006
Jul
2006
Jun
2006
May
2006
Apr
2006
Mar
2006
Feb
2006
Jan
2006
Dec
2005
120%
100%
80%
60%
40%
20%
0%
Nov
2005
Percentage
3.0 Medication Reconciliation Success Index
Results: Run Charts of Key Measures
Pediatrics – OTCs and Herbal Products Removed (n=4)
1.0 Mean Number of Undocumented Intentional Discrepancies
0.80
Mean
0.60
0.40
0.20
Dec
2006
Nov
2006
Oct
2006
Sep
2006
Aug
2006
Jul
2006
Jun
2006
May
2006
Apr
2006
Mar
2006
Feb
2006
Jan
2006
Dec
2005
Nov
2005
0.00
Month
Actual
Goal
2.0 Mean Number of Unintentional Discrepancies
0.60
0.50
Mean
0.40
0.30
0.20
0.10
Month
Actual
Goal
Month
Actual
Goal
Dec
2006
Nov
2006
Oct
2006
Sep
2006
Aug
2006
Jul
2006
Jun
2006
May
2006
Apr
2006
Mar
2006
Feb
2006
Jan
2006
Dec
2005
120%
100%
80%
60%
40%
20%
0%
Nov
2005
Percentage
3.0 Medication Reconciliation Success Index
Dec
2006
Nov
2006
Oct
2006
Sep
2006
Aug
2006
Jul
2006
Jun
2006
May
2006
Apr
2006
Mar
2006
Feb
2006
Jan
2006
Dec
2005
Nov
2005
0.00
Results: Run Charts of Key Measures
6th Medicine – Includes OTCs and Herbal Products (n=2)
Dec
2006
Nov
2006
Oct
2006
Sep
2006
Aug
2006
Jul
2006
Jun
2006
May
2006
Apr
2006
Mar
2006
Feb
2006
Jan
2006
Dec
2005
3.00
2.50
2.00
1.50
1.00
0.50
0.00
Nov
2005
Mean
1.0 Mean Number of Undocumented Intentional Discrepancies
Month
Actual
Goal
2.0 Mean Number of Unintentional Discrepancies
2.50
Mean
2.00
1.50
1.00
0.50
Dec
2006
Nov
2006
Oct
2006
Sep
2006
Aug
2006
Jul
2006
Jun
2006
May
2006
Apr
2006
Mar
2006
Feb
2006
Jan
2006
Dec
2005
Nov
2005
0.00
Month
Actual
Goal
Month
Actual
Goal
Dec
2006
Nov
2006
Oct
2006
Sep
2006
Aug
2006
Jul
2006
Jun
2006
May
2006
Apr
2006
Mar
2006
Feb
2006
Jan
2006
Dec
2005
120%
100%
80%
60%
40%
20%
0%
Nov
2005
Percentage
3.0 Medication Reconciliation Success Index
Results: Run Charts of Key Measures
Gynecology / PAC – includes OTCs and Herbal Products (n=4)
1.0 Mean Number of Undocumented Intentional Discrepancies
Mean
2.50
2.00
1.50
1.00
Dec
2006
Nov
2006
Oct
2006
Sep
2006
Aug
2006
Jul
2006
Jun
2006
May
2006
Apr
2006
Mar
2006
Feb
2006
Jan
2006
Dec
2005
Nov
2005
0.50
0.00
Month
Actual
Goal
2.0 Mean Number of Unintentional Discrepancies
2.50
Mean
2.00
1.50
1.00
0.50
Dec
2006
Nov
2006
Oct
2006
Sep
2006
Aug
2006
Jul
2006
Jun
2006
May
2006
Apr
2006
Mar
2006
Feb
2006
Jan
2006
Dec
2005
Nov
2005
0.00
Month
Actual
Goal
100%
80%
60%
40%
Month
Actual
Goal
Dec
2006
Nov
2006
Oct
2006
Sep
2006
Aug
2006
Jul
2006
Jun
2006
May
2006
Apr
2006
Mar
2006
Feb
2006
Jan
2006
Dec
2005
20%
0%
Nov
2005
Percentage
3.0 Medication Reconciliation Success Index
Results: Run Charts of Key Measures
St. Elizabeth’s Hospital – includes OTCs and Herbal Products (n=1)
1.0 Mean Number of Undocumented Intentional Discrepancies
Mean
1.50
1.00
0.50
Dec
2006
Nov
2006
Oct
2006
Sep
2006
Aug
2006
Jul
2006
Jun
2006
May
2006
Apr
2006
Mar
2006
Feb
2006
Jan
2006
Dec
2005
Nov
2005
0.00
Month
Actual
Goal
2.0 Mean Number of Unintentional Discrepancies
2.50
Mean
2.00
1.50
1.00
0.50
Month
Actual
Dec
2006
Nov
2006
Oct
2006
Sep
2006
Aug
2006
Jul
2006
Jun
2006
May
2006
Apr
2006
Mar
2006
Feb
2006
Jan
2006
Dec
2005
Nov
2005
0.00
Goal
Month
Actual
Goal
Dec
2006
Nov
2006
Oct
2006
Sep
2006
Aug
2006
Jul
2006
Jun
2006
May
2006
Apr
2006
Mar
2006
Feb
2006
Jan
2006
Dec
2005
120%
100%
80%
60%
40%
20%
0%
Nov
2005
Percentage
3.0 Medication Reconciliation Success Index
Results: Run Charts of Key Measures
Surgery 5000 – includes OTCs and Herbal Products (n=11)
Dec
2006
Nov
2006
Oct
2006
Sep
2006
Aug
2006
Jul
2006
Jun
2006
May
2006
Apr
2006
Mar
2006
Feb
2006
Jan
2006
Dec
2005
1.20
1.00
0.80
0.60
0.40
0.20
0.00
Nov
2005
Mean
1.0 Mean Number of Undocumented Intentional Discrepancies
Month
Actual
Goal
2.0 Mean Number of Unintentional Discrepancies
2.50
Mean
2.00
1.50
1.00
0.50
Dec
2006
Nov
2006
Oct
2006
Sep
2006
Aug
2006
Jul
2006
Jun
2006
May
2006
Apr
2006
Mar
2006
Feb
2006
Jan
2006
Dec
2005
Nov
2005
0.00
Month
Actual
Goal
Month
Actual
Goal
Dec
2006
Nov
2006
Oct
2006
Sep
2006
Aug
2006
Jul
2006
Jun
2006
May
2006
Apr
2006
Mar
2006
Feb
2006
Jan
2006
Dec
2005
120%
100%
80%
60%
40%
20%
0%
Nov
2005
Percentage
3.0 Medication Reconciliation Success Index
Keys to Success & Lessons Learned
• Major Keys to Success
– Enthusiastic and committed Advisory, Steering, and Ward team
members
– 1:1 and small group educational sessions with staff
– Increasing number of staff engaged in the process
• Barriers
–
–
–
–
Dedicated resources
Staff buy-in on certain pilot areas
Process – obtaining a complete and accurate medication history
Timelines – balance between Safer Healthcare Now / Quality
Improvement Methodology and Accreditation deadline
– PDSA cycle turn around time
Keys to Success & Lessons Learned
• Lessons learned to date about these changes
– Large scale change in process required. Not as easy
as anticipated.
– Preadmission Medication List Physician Order Form
appears to be working well.
– Medication reconciliation process requires further
development.
• Further education on “How to Perform a Medication History”
required
– Education sub-committee formed
Next Steps
• Changes we are planning on testing to help us
achieve our goals:
– Effect of a standardized method for providing education
– Ability of staff to take a complete and accurate
medication history
– Use of PIP to generate on-line Preadmission
Medication List Physician Order Form
– Use of automation to generate a patient medication
reconciliation and order form on transfer and discharge
Contact Information
• Barb Evans
– [email protected]
– Phone: 306-655-2268
• Jackie Mann
– [email protected]
– Phone: 306-655-7946
• Janice Seeley
– [email protected]
– Phone: 306-655-6832
Process Map – Pre-Assesssment Clinic