Transcript Safety in Practice Safety in Practice Learning Session 3

Safety in Practice
Safety in Practice
Learning Session 3
Silverdale Medical
PHO and Facilitator: WPHO – Andrew Jones
Team members: Kirsty Laws, Allie Waretini,
Mel Lanz, James Recordon
Safety in Practice
Safety in Practice
Medication Reconciliation
Aim:
- To ensure that all medication lists are updated in a
timely manner after hospital discharge, and patients
followed up by phone or in person if indicated.
- To standardise procedure in our large practice.
We chose this audit as a means to first assess, and then
improve, the Secondary to Primary Care interface for our
patients on multiple medications. These are mostly, but
not all, frail elderly.
Safety in Practice
Safety in Practice
Change Ideas
- Set expectations within practice by discussion/progress
reports at Clinical Meetings.
- Share individual cases of benefit/harm to patients
relating to medication reconciliation (or lack of)
- Task reminders to individual practitioners where medrec
not completed
- Audit by provider with name-and-shame (fortunately
didn’t have to go this far!)
Safety in Practice
Safety in Practice
Change Package
Change Tested
All the above approaches
were used simultaneously.
Owing to the small number
of cases each month it
was not viable to break the
data down further.
Outcome / Evidence of
Improvement
Moderate improvement in
individual measures
especially patient contact,
demonstrated on monthly
data collection. Change of
targets during the year
made comparison difficult.
Safety in Practice
Safety in Practice
Prescribing audit cycle
RNZCGP audit of long-term prescribing was used to identify problems
in regular medication lists and/or prescribing.
We found excellent accuracy and compliance on most aspects.
Recording of use of complementary/alternative medications was
infrequent, and difficult to identify even when recorded.
After brainstorming at the practice meeting, we will use the Medical
Warnings tab in MedTech to record these, in the “note” field, so they
will be visible whenever a new prescription is written.
Safety in Practice
Safety in Practice
Measures Summary
We are now measuring:
- Viewing of discharge summary within 7 days of receipt
- Updating of medication list within 7 days of receipt
- Contact made with patient (if appropriate) within 7 days
of discharge.
- Time from discharge to receipt of summary (this remains
at 0 days for around 90%, with a small number markedly
delayed, up to 3 weeks after discharge)
Safety in Practice
Safety in Practice
Achievements to date
Do you have an
-agreed aim – all discharge handling achieves 100% on current
measures
-a change package – continue reporting to monthly meetings
-measurement plan – continue audit of 10 patients at least 3-monthly
to avoid slippage.
Do people on your team know what their responsibilities are and
what is expected of them? – much improved
What has changed and what difference have the changes made?
Main change has been awareness of the better continuity achieved with
consistent process (any doctor or nurse seeing a patient can be
confident the meds list is up to date – although we still check the
discharge summary when the next script is written). Highlighting
changes as “prescribed externally” enhances this.
Safety in Practice
Safety in Practice
Further learning
Completed the trigger tool for 25 patients over 75 on
multiple long-term medications.
Significant harms were found for 3 patients. 1 related to
anticoagulation and another to non-anticoagulation! (This
is also the story of my daily professional life)
Difficulties with anticoagulation had also been a recurring
theme with our medrec patients. On this basis another
team member is now undertaking an audit of all patients
discharged on warfarin or dabigatran.
Safety in Practice
Safety in Practice
Any other achievements?
We do feel we already had a strong quality improvement
focus in the practice. Participating in this programme
helped to reinforce it, and to bring in new ideas.
Silverdale Medical was formed by the amalgamation of 2
existing practices at the beginning of 2013, and working
towards a shared goal helped to unify the team, and to
achieve the standardisation of process that is needed for
safety, especially in a large organisation. The latest Patient
Satisfaction Survey results were very gratifying!
Safety in Practice
Safety in Practice
Highlights and Lowlights
Lowlights – early problems with the audit measures were frustrating
and demoralising. Now fixed and much more usable. With MedRec,
which is a Secondary/Primary transition issue, it would have been
good to have more input and action on problems from the DHB. No
good us reading a summary promptly, if it arrived 3 weeks late.
Highlights - New ideas, contact with other practices, understanding how
our challenges compare with those of other practices and differing
enrolled populations. Learning from this audit fed into ideas for
further CQI activities.
Future – with so many practices working together, could we get some
real information on clinical outcomes? Maybe publishable?