Transcript Jo Dunderdale - Canadian Patient Safety Institute

Vancouver Island Health Authority
Home & Community Care
Medication Reconciliation
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Background
Site: Cowichan Valley Home & Community Care
(HCC)
Patient Population: HCC clients moving to Duncan
Manor or returning from Cowichan District Hospital
Rationale: High incidence of hospitalizations and
emergency room encounters in this population
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Background
Significance
 VIHA: highest % of people with chronic
disease(s) in BC 1
 89% of HCC clients were admitted with a dx of
chronic disease
 People with chronic diseases more likely to have
multiple prescriptions and complex drug regimes
1 Center for Health Services and Policy Research Feb 2005
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Background
What Are We Trying To Improve
Purpose: To improve client care by reducing adverse drug
events through medication reconciliation on
admission/return to Home Care.
Timelines: May 2007 – May 2008.
 Begin with clients in Duncan Manor
 Spread to West Team (Duncan) clients
Resources: Current HCC resources with some additional
funding to support attendance at Learning Sessions
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Aim
To increase the % of completed BPMH for HCC
clients
To decrease the time for HCC clinicians to
complete a BPMH
To increase the % of completed medication
reconciliations for HCC clients
To decrease the time taken to complete medication
reconciliation for HCC clients
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Team Members
 Clinical Leaders: Darcie Wolfe (Nursing), Holly
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Sulsbury (Pharmacist), Beth Langford (Home Support),
Merry-Jo Levers (CNS – Seniors Health)
Day to Day Leader: Jo Dunderdale
Frontline Clinician: Julie Ferguson (CM), Tracy Stone
(Leader)
Pharmacist Partner: Jim Potts
Administrative Leader: Margaret Harris
Evaluation: Margaret Kun
QI Advisor: Rosanne Beuthin
Pilot Site Manager: Lois Cosgrave
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Changes Tested
 Development and trial of a BPMH form combined
with a Notice of Medication Administration form
 Development and trial of a combined BPMH and
Medication Reconciliation form
 Obtaining an accurate list of medications from Acute
Care via Liaison Case Manager
 Obtaining an accurate list of all Duncan Manor clients
admitted to hospital or going to emergency
 Obtaining Pharmacare printout as source of info for
BPMH
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Results
Percentage of Appropriate Clients with BPMH
100%
Percentage
90%
80%
Began backlog reduction
70%
60%
50%
40%
30%
20%
Julie on
Holiday
10%
0%
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Month
% of appropriate clients with completed BPMH
Goal
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Results
Minutes
Time to Complete BPMH
100
90
80
70
60
50
40
30
20
10
0
N=5
N=2
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Month
Average Time
Goal
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Results
Percentage of Clients in Target Population with a Reconciled
Medication List Within 1 Week
100%
Began backlog
reduction
Percentage
80%
60%
40%
20%
N=2
THE JOURNEY
CONTINUES!
Julie on
Holiday
0%
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Month
% of clients in target population with a reconciled medication list within 1 week
Goal
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Results
Time to Resolution of Discrepancies
Average Number of
Days/Client
30
25
20
15
10
N=1
5
N=4
0
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Month
Average days to resolve discrepancies
Goal
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Results
Percentage of Discrepancies Resolved
100%
90%
Introduced letter to
Physicians
Percentage
80%
70%
60%
50%
40%
30%
20%
10%
0%
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Month
% of Discrepancies Resolved within 1 Week
Goal
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Keys to Success and
Lessons Learned
Keys to Success:
 Senior Leadership support
 A great team
 committed to quality improvement
 share responsibility for work
 communicate effectively
 Support from Safer Healthcare Now! Advisors
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Keys to Success and
Lessons Learned
Barriers:
 Staff coverage over summer vacations
 Lack of availability of team members over
summer
 No physician on team
 Lack of additional resources
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Keys to Success and
Lessons Learned
Lessons Learned:
 Be patient – we won’t get it right the first time – it
will take several PDSAs
 Need to involve all stakeholders – staff,
Pharmacists, Physicians, acute care, and clients
 Learning is progressive – build on what you
learn
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Next Steps
 Obtain Pharmacare printout from acute care
and utilize as one source contributing to
BPMH
 Engage Physicians – develop a letter/fax
cover sheet explaining the Med Rec process
and attend Family Practice rounds and review
process
 Personal Medication List to support self
management
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Contact Information
Jo Dunderdale – [email protected]
Margaret Kun – [email protected]
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative