Transcript Presentation for Team Meeting Nov 12A

Medication Reconciliation in Home Care:
Measures for Pilot
Olavo Fernandes PharmD, ISMP Canada
SHN ! Medication Reconciliation Home Care Pilot Nov 12, 2008
Creating the most “up to date” medication
record (best possible medication history)
Compare:
Medication
Information from all
other sources
Patient and
Family Interview
Examples:
•Medication vial inspection
•Referral record
“medication
discrepancies that
•Community pharmacy
•Hospital Discharge
Summary
require clarification”
document
Review and follow
up where indicated
“up to date”
medication
record (BPMH)
Process For Identifying “Medication Discrepancies That
Require Clarification” In Home Care
Creating the most “up to date” medication record (best possible
medication history)
Compare :
• Patient / Family Interview ( a systematic and
comprehensive, medication history interviewrepresentation/ snapshot in time of what medication the
client is actually taking)
Vs.
• all other available sources of medication information
(home care referral records, inspection of medication vials/
samples, community pharmacy information, hospital
medication discharge summaries, unfilled prescriptions etc)
• IDENTIFY: Medication Discrepancies That Genuinely
Require Clarification”
Process For Identifying “Medication Discrepancies That
Require Clarification” In Home Care
Note process must include patient/ family
medication history interview
• Reconciliation process allows for clinician
professional judgment to discern which
“discrepancies genuinely require
clarification “
• Herbals/ Non-prescription
•
(over-the counter drugs)- will not classify as a
discrepancy requiring clarification – unless
prescribed by physician (or other prescriber)
SHN! Home
Care Pilot Measures
1. Percentage of Eligible Clients with a Best
Possible Medication History (BPMH)
conducted by a Home Care clinician
2. Time to complete Best Possible
Medication History (BPMH) in Home Care
3. Percentage of Eligible clients with at least
one discrepancy that requires clarification
4. Classification or characterization of actual
discrepancies that require clarification
•
Also serves as a communication and documentation tool to
other clinicians
1. Percentage of Eligible Clients with a Best
Possible Medication History (BPMH) conducted
by a Home Care clinician
• The percentage of “eligible” clients
receiving a formal BPMH
• “Eligible”
= discharged from acute care + Kelly’s patients
risk assessment tool positive
• This is a measure of the percentage of
clients eligible for medication reconciliation
in this month's sample who actually had a
BPMH completed within one week
following transfer to home care.
1. Percentage of Eligible Clients with a Best
Possible Medication History (BPMH) conducted
by a Home Care clinician
• Numerator: Total number of clients with a
completed BPMH.
• Denominator : Total number of clients in
this month's sample eligible for medication
reconciliation.
• Goal/ Target:
– 80% Practical Team Target (95% Ideal Goal)
2. Time to complete Best Possible Medication
History (BPMH) in Home Care
• The elapsed time in minutes from the initial
review of medications from client referral
(including preparation time), interview with
the client and/or the family to the time when
all sources of information have been
gathered and the Best Possible Medication
History (BPMH) has been completed,
recorded and ready to be sent to the Most
Responsible Physician (MRP) or Nurse
Practitioner (NP).
2. Time to complete Best Possible Medication
History (BPMH) in Home Care
– This is a measure of the mean or average time for
this process to be completed for the clients in
each month's sample.
– Note: this does not include time for actual
reconciliation and clarifying discrepancies
– does include time to document the BPMH and
investigate and identify all “readily available”
sources of information (readily available includes
patient sources, vials in home prior to making
external contacts such as community pharmacy,
discharging hospital or primary care physician)
2. Time to complete Best Possible Medication
History (BPMH) in Home Care
• Enter Time:
– Total amount of time (sum) in minutes to
complete the BPMH for all clients in this
month's sample
• Enter Patients in Sample:
– Total number of clients in this month's sample
with a completed Best Possible Medication
History
• Final result is a mean time per patient
• Goal/ Target:
– Variable according to patient
3. Percentage of Eligible clients with at least one
discrepancy that requires clarification
• The percentage of the “eligible”
clients with at least one medication
discrepancy which required
clarification with a healthcare
practitioner.
3. Percentage of Eligible clients with at least one
discrepancy that requires clarification
• Numerator:
– Total number of the clients with at least ONE
medication discrepancy that requires
clarification with a clinician.
• Denominator :
– Total number of clients with a completed Best
Possible Medication History (BPMH).
• Goal/ Target:
– Variable (more linked to medication
information transfer process of your referring
service)
Classification or characterization coding:
“actual discrepancies that require clarification”
• The classification of each medication
as a discrepancy and the assignment of
the discrepancies to a classification
category or code
• Allows teams to learn most common
patterns of discrepancies or potential
causes in your local practice
Classification or characterization coding:
“actual discrepancies that require clarification”
• When selecting categorization code each
medication order will have only one
discrepancy categorization. Clinicians can
select whichever one they think is the most
important.
• It is often helpful to defer to the
alphabetical classification order
– for example is for a medication order there may
be an incorrect medication, an incorrect dose and
an incorrect route…the clinician can select code :
A drug
DATA ENTRY &
SUBMISSION
Please open the Power Point
Titled “ Measurement for Med
Rec Home Care 081112
Medication Reconciliation in
Home Care
Pilot Project
Communities of Practice
Ann MacLaurin
July 20, 2008
Overview on the use of the
Communities of Practice
INTRODUCTION
A Community of Practice (CoP) is an
intuitive web-based online application
that enables group collaboration and
knowledge management. *
* CoP Info Guide 27 Jan 2006
Overview on the use of the
Communities of Practice
A CoP provides teams with the means to instantly establish
online areas for:
1. group collaboration - temporary or ongoing
2. facilitate group interaction
3. share text content, images and files
4. enable real-time communication via chat and instant
messaging
CoP Info Guide 27 Jan 2006
To access the Community of
Practice (CoP)
• Go to the SHN home page
• http://www.saferhealthcareno
w.ca/Default.aspx
• On the left hand menu there
is a link to the Community of
Practice.
CoP: Information Guide
On the bottom
of this page
you will find a
link to the CoP
information
guide
CoP: Information Guide
http://www.saferhealth
carenow.ca/Default.as
px?folderId=124
COMMUNITIES
OF
PRACTICE
To Join the Medication
Reconciliation CoP
http://www.saferhealthcarenow.ca/Defaul
t.aspx?folderId=124
It is free and easy to join.
To become a member fill in all
the required information and hit
the Join button
Login
Login
There are files for Acute
Care and Long Term Care
Upon entering the CoP, you see the
“What’s New” page. This page
provides a summary of all new and
recently added content and access
to on-going opinion polls and the
most recent note board posting.
Home Care Folder
Medication Reconciliation In
Home Care Pilot Project
Getting Started Tool Kit!
Debbie Conrad RN
November 2008
CONTENTS
• Highlights: Team commitment to the
Project
• High lights: Criteria for Population
Selection
• Important dates
• SHN Frame work for Medication
Reconciliation in Home Care
• Measurements
• Tools
• Quick Reference Guides
• Past Power Point Presentations
TOOLS
• Team Charter
• Medication Risk Assessment
(MedRAT)
• Best Possible Medication History
(BPMH)
• Interview Guide/Tips
• Data Collection Tools
• Data Submission
• PDSA Tool
TOOLS
• Narrative for each tool
• Basic tool for team development
( Narratives & samples included in
some)
• Sample Tools from Western
Collaborative
• Tool Templates
QUICK REFERENCES
Quick Reference Guide for Data
Collection
Quick Reference Guide for Getting
Started
Power point Presentations
• SHN Pilot-Getting Started in Home
Care Sept 11’08
• Medication Reconciliation in Home
Care Oct’14 Meeting
• Presentation for Team Meeting Nov
12A
• Measurement for Med Rec Home
Care -081112 Nov 12 B
POINTS TO REMEMBER
• Lessons Learned from Western
Collaborative
• Testing Measures, Tools,
Processes
• Small tests of change
• You are the experts!
• Keep it Simple!