Transcript Medication Reconciliation in the Community Laying the Foundation!

Medication Reconciliation in the Community
Laying the Foundation!
Marie Owen
What is Medication Reconciliation?
• Medication Reconciliation is a formal process in which
healthcare professionals partner with patients to ensure
accurate and complete medication information transfer at
interfaces of care
• In Home Care this involves getting information from clients and
comparing it to orders, medication calendars, labels, vials and
other sources of information, resolving discrepancies,
communicating and documenting
Safer Healthcare Now!
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History of Medication reconciliation
What we’ve learned
Why we are proud
Why we don’t give up!
Cross Canada Check-Up
http://www.ismp-canada.org/medrec/map/
Medication Reconciliation:
What it Does…
Resolves Potential Errors such as:
• Failure to continue clinically important home medications while in the
hospital
• Missed or duplicated doses resulting from inaccurate medication records
• Failure to clearly specify which home medications should be resumed and
/ or discontinued at home after hospital discharge
• Duplicate therapy at discharge
What was the problem?
• Clients returning home from hospital at risk
for falls, ER visits and hospital readmits due to
medication adverse events
• No standardized approach to medication
management
• Clients being asked for the same information
by multiple care providers
• Information not shared between various care
and service providers, e.g., Meds Check
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The Need
• Required a standardized process for medication
management in the community
• Sustainable process that generates quality data to
track changes / improvements in clients’ outcomes
• Responsible for reporting to Central Local Health
Integration Network (funders of the project)
• Develop a system easy to use
• Internally – align with organization’s strategy to
provide quality care = safety, science, service
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What can the client/caregiver expect?
Example procedure of a Community Service in Ontario
First visit:
• The nurse or pharmacist completes a medication inventory
– Best Possible Medication History (BPMH)
• Makes recommendations
– Preventive medicine is used and prescribed appropriately (e.g., Vitamin D, EC ASA)
– Blister pack or dosette system, visual reminders
– Increased PSW hours for reminders, OT assessment, referral to a community support
agency
• Summary completed identifying discrepancies and
recommendations; nurse/pharmacist send letter(s) to
client’s physicians
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Indications are appropriately treated after feedback from physician(s)
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What can the client/caregiver expect?
Example procedure of a Community Service in Ontario
Second visit:
• Education to the client/caregiver
– Administration techniques appropriate
• Provides client/caregiver with medication schedule
• A copy of the medication schedule is forwarded to
the family physician and service providers
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Examples of Limitations Identified
Example procedure of a Community Service in Ontario
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Physical
Cognitive (forget to take medications)
Accessibility (cannot get to pharmacy or family physician)
Adherence (clients may refuse to take medications due to
side effects)
• Safety
• Knowledge gap (many clients do not understand what their
medication is, how to take it, why they require it, and what
the side effects are)
• Storage and Organization
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How have the clients/caregivers benefited?
Example procedure of a Community Service in Ontario
• Enables nurse and pharmacist to:
– Create a complete and accurate inventory of all medications
• Prescribed/over-the-counter/herbal
• Assess for Safety, Simplicity and Correctness
– Compare the current medications with medications prescribed
– Identify any discrepancies or medication related problems
• Bring it to the attention of the prescribing physician
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Have we made a difference?
Example procedure of a Community Service in Ontario
• Population Health
– 1420 clients received medication reconciliation between April 2010 –
March 2011
– After MMSS 43% rated ability to self-manage medications as excellent,
before MMSS it was 15%
– 49% improvement in self-management
– 96% rated ability to self-manage as good or excellent
– Only 4% of clients rated fair/poor
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Have we made a difference?
Example procedure of a Community Service in Ontario
• Population Health (cont’d)
– On average, 3-5 discrepancies/medication related problems
identified/client
– 85% of discrepancies resolved
– 86% of medication related problems resolved
– Reduction in .5-1 medication/client
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Interfaces in the Medication Information
Transfer Process
What We’ve Learned
• It IS worth the effort - successful teams would not go back to
the old way
– There can still be a surprising amount of resistance
– It requires new processes
– It is more complicated than it sounds
• BPMH training is required
• Patient must be at the centre
• The answers are local
This Action Series
• Canada is a leading country!!
• Create more experience, successful new approaches
and reliable processes in home care
• Measure success
• Learn from others and spread the learning
Question: The Problem
Do you have a sense of what the problem is?
Do you believe that there is a problem in the
home care environment?
Yes?
No?
A Medication Reconciliation
Allegory/Metaphor!
By Mark Kearney, Pharmacist,
Queensway Carleton Hospital
You come into the hospital
wearing size 32 black pants,
a blue shirt,
a black belt
and cowboy boots…
You leave the hospital
…wearing a green dress
A blue shirt …
Red shoes
No belt
… and a cowboy hat!
What Happened?
Discrepancies:
• Ordered a cowboy hat instead of cowboy boots
• Forgot to reorder your belt
• Got the blue shirt right
• Replaced the black pants with a red dress
Before
After
Medication Reconciliation in Home
Care
• How do we do it?
• When do we do it?
• Who does it?
How?
Step
One
• Identify and target
Step Two
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Interview
Compare
Identify
Document
Step Three
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Resolve
Identify
Communicate
Document
Step Four
• Confirm
• Communicate
• Verify
Question
How are you Feeling?
Question
What step do you feel will be the
biggest change to your current
process?
Use your pointer
Does the process work?
“As a nurse who is always aghast when the client hands me a shoebox full of pill
bottles, with no recourse but to just put them on the medication list, I am so
thrilled to have a formal method to deal with these medications. Very often this
shoebox contains every medication the client has taken for the past 10 years,
many of them mixed together or missing labels.
Recently, a client was discharged on parenteral anticoagulant therapy. Without
medication reconciliation, he would have continued to take the oral anticoagulant
he had been on before his hospital stay. The nurse discovered this issue through
the application of medication reconciliation and a potentially dangerous situation
was avoided.”
Cheryl Prest RN
Can Care Health Services
Pilot Team Leader
When?
Who?