Transcript Victoria Sep 2007 presentation Brandon RHA Home Care Teams in

Brandon Regional Health Authority Home Care
Medication Reconciliation
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Background
• Brandon Regional Health Authority – covers city of
Brandon, MB and 3 surrounding rural
municipalities – population of 49,750.
• 1 regional hospital – 315 beds- serving Brandon
RHA and many outside regions
• 5 Long Term Care facilities (PCH) and 1 Primary
Access Center
• Public Health, Home Care, and Mental Health
programs/services
• Approximately 100 physicians and 14 pharmacies
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Background
• Home Care working group developed in May 2007
• Purpose - implementation of medication
reconciliation in the Home Care program.
• Decision to focus on two trial areas:
– use of a BPMH form for all clients admitted to the
service of medication assistance (new or existing
clients)
– use of Universal Medication Form for clients
• Initial trial done with a small controlled group of clients
being transferred into Respite Care (temporary bed in Long
Term Care facility) where the LTC staff can give us
feedback on the accuracy of the form at admission
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Aim
Purpose:
• To prevent adverse medication occurrences, through the
process of medication reconciliation, for Home Care clients
receiving medication assistance
• To promote the use of a Universal Medication Form as a
tool for all clients to maintain their own current medication
list
Aim Statements:
• At admission, to reduce medication discrepancies (types
TBD) for the target group by 75% by April 2008
• Conduct a BPMH and reconcile discrepancies on 100% of
clients receiving medication assistance by April 2008
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Team Members
• Mary Lou Lester – Pharmacist and Team Leader
• Jayne Troop – Program Manager Home Care
• Dianne Strock/Donna McIntyre Hunt – Nursing
Resource Managers
• Kylie Robinson – Case Coordinator
• Leslie Hayward – Intake Coordinator
• Kristi Chorney – Quality/Risk Management
• Liliana Rodriguez – Planning/Evaluation
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Changes Tested
P
D
A
S
#1: Compare
medication list
obtained at
admission to
Home Care for
next 5 patients
to DPIN and/or
inpatient profile
(if recently
discharged)
P
D
A
S
#2: Trial using
Home Care
BPMH and
Reconciliation
form when
collecting new
client
medication list
or updating
existing client
medication list
P
D
A
S
#3 Trial use of
Universal
Medication Form
with 5 regular
users of PCH
Respite. Evaluate
potential benefit of
this form as a tool
for all clients to
maintain their own
current medication
list
P
D
A
S
#4 Contact
Community
Pharmacies
to inform
them of our
work and why
they may
receive calls
from home
care staff to
clarify client’s
medication
lists
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
P
D
A
S
Forms Sample
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Results – BPMH form
• Total BPMH completed: 9
• Average medications per patient: 11
• Mean number of discrepancies per patient:
2.3
• Most common discrepancy: Medication
omitted from home care list
• Main source used for reconciliation:
Community Pharmacy
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Results
Time to Complete BPMH (minutes)
Minimum: 10 minutes
Maximum: 120 minutes
100
Minutes
90
80
70
60
57
50
40
30
20
10
0
Jun
Jul
Aug
Se
Oct
Nov
De
Jan
Feb
Month
Average Time
Goal
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Mar
Apr
May
Results
Minimum: Same Day
Maximum: 22 days
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Results
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Results
Percentage of Discrepancies Resolved within 1 week
100%
90%
80%
Percentage
70%
60%
50%
43%
40%
30%
20%
10%
0%
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Month
% of Discrepancies Resolved within 1 Week
Goal
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Mar
Apr
May
Results Respite Trial
• Total Reconciliations completed: 12
• Percent of clients with UMF at admission
present and current: 67% (33% of forms were
faxed by home care to PCH)
• Main source used for reconciliation: Physician,
followed by Pharmacy and Family
• Average medications per patient: 5
• Mean number of discrepancies per patient: 0.9
• Percent of patients with 1 or more discrepancies:
33%
• Most common discrepancy: Incorrect frequency
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Keys To Success
• Good communication with all stakeholders prior to and
during implementation of medication reconciliation project
is critical
– suggest sending letter to local pharmacies and physicians prior to
implementation explaining the project
• Gather baseline data and report to your team on the
current situation prior to implementation to help motivate
• Develop easy to follow procedures for the use of new
forms
• Ongoing feedback from staff regarding what is working
and what is not
– be prepared to make revisions as needed (benefit of your
planning cycles)
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Lessons Learned
• Our provincial DPIN database is not the best source to reconcile
medications; in our region a better source for Home Care is
pharmacy and then physician
• The entire process of medication reconciliation takes time, but is
worthwhile, as discrepancies are present even in blister pack
medications.
• Our greatest source of discrepancies is often on hospital discharge
• The universal medication form may not work for all clients (needs a
motivated client or caregiver), but is a worthwhile form to share with
all new referrals to program.
• Selecting indicators that are easily measured will be a challenge
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Next Steps
• Determine and finalize our indicators for
success
• Make any final revisions in our forms and
procedures based on feedback from users
• Begin planning how we will keep the BPMH
current
• Promote use of Universal Medication Form
for all clients
– Include our seniors groups in getting this form
and message out to the public.
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Contact Information
• Mary Lou Lester – pharmacist
– [email protected]
– Phone: 204-578-4249
• Jayne Troop – Home Care Program
Manager
– [email protected]
– Phone: 204-571-8420
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative