Transcript Moving to Electronic Systems July 6 2010

Implementing Iatrics PDI for Medication
Reconciliation
Veronica Breadner RN
Marie Descent BSc.Phm., RPh.
July 6 2010
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Halton Healthcare Services (HHS) is
comprised of 3 acute care
community hospitals - OakvilleTrafalgar Memorial, Milton District
and Georgetown Hospital
– 420 beds (314 acute/67 CCC/39
Rehab)
– 34,401 surgical procedures
– 20,519 admissions
– 157,793 Ambulatory visits
– 3,519 Deliveries
– 128,873 ED visits
– 3000 staff
– 325 physicians
6/3/2010
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Standardized process across organization
– Patient D/C Instructions
– Electronic documentation
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Promote enhanced utilization of electronic
record system
Enhancement of Med history in EMR across
continuum of care
Increased efficiency of data collection methods
and auditing ability
Med history easily updated
Improved legibility
Utilize existing pharmacy dictionary
6/3/2010
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Screen Appearance
Ease of use and access
Implementation time
Ongoing support & consultation
Training materials
Cost
Extent of experience
Standardized drug names
D/C Prescription
Standardized discharge instructions
6/3/2010
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Met more of evaluation criteria than other two
vendors
Physicians could use the tool in place of CPOE
Generates order sets and DC Rx
Partnered with Micromedex – we were already
familiar with.
Utilizes Meditech programming – HCIS
platform – simplify report writing and
dictionary build
Design screens familiar to staff
Lower cost alternative
Opportunity for Discharge Instructions
6/3/2010
Project Team
• Project Lead
• Director of
Pharmacy
• Manager Clinical
Informatics
• 1 FTE Pharmacy
Analyst
• 1 FTE Nurse Analyst
Project Management
• Consultants
Working Group
• Sponsored by CNO
• Multidisciplinary
team balanced with
Pharmacy and
Nursing
representation,
Physician
representation,
Patient Safety
Coordinator and
Professional
Practice
6/3/2010
Iatrics
training
Communication to
stakeholders
• Physicians
Process
Flow
mapping
• Leadership
• Professional Practice
Installs
• Safety Champions
• Nursing
• Public
Dictionary
builds
Deciding
on Pilot
Units
Form
development
End-User
Training
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Challenges:
• Dual position
• Other responsibilities
• Underestimating need for additional staff
• Physician engagement
Creative use of resources
• Pharmacy Student placement within Emergency
• Secondment of Nursing staff as resources for staff
6/3/2010
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eLearning
Hands on training
MedRec Champion training
Go-Live support for 2 weeks/unit
◦ Ongoing pager support
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Huddles
MedRec Resource Binder
Biweekly Newsletter/Updates
6/3/2010
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Pilot Areas:
◦ Pre-Admission Clinic
◦ Surgical unit
◦ Renal Medicine Unit
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Software Installs handled by Tech team
Testing
Go-Live with Admission, then month later
Transfer and 2 weeks after that Discharge
◦ Form issues – completed by vendor
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Team available days/evenings for end-user
support
◦ PDSA Improvement Cycles
6/3/2010
Audit trails in
Iatrics
Compliance with entering home
med list
Compliance with printing order
forms
Evaluating correct process
utilized
Pharmacy
Audit form utilization by
Physicians
Audit Medication Reconciliation
for submission to Accreditation
Canada and SHN
6/3/2010
% Home Meds Discrepancies
(by Type)
Med Rec Project: Home Meds vs. In-Hospital Meds
on 2 Centre
70.0%
60.0%
% No Discrepancy
50.0%
40.0%
% Intentional Discrepancy
30.0%
20.0%
% Undocumented Intentional
Discrepancy
10.0%
0.0%
Baseline (July
2009)
Jul-09
Feb-10
% Unintentional Discrepancy
6/3/2010
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Admission
Pre-Admission
Transfer
Discharge Rx
Patient Discharge Instructions
Patient Discharge Instructions for LTC
Patient Recorded Home Medications
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Corporate support and communication
Use of Champions is key
Early engagement of pilot units
Increased communication with Physician
groups
Differentiate between personal preferences
and global needs
Impact on other departments
Contracts with Unit Managers
Never under-estimate impact of change
process on affected units/departments
6/3/2010
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Project plan to roll out to remaining OTMH
inpatient units by December 2010
Big Bang rollouts at Georgetown and Milton
sites
Consider concurrent rollout in identified
Outpatient units
6/3/2010
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Maintain momentum
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Raise profile corporately
6/3/2010
Questions?
6/3/2010
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[email protected]
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[email protected]
6/3/2010