Transcript IWK Medication Reconciliation Spread MSNU

Medication Reconciliation:
Spread to MSNU & 4 West PreAdmit Clinic
Origins of Medication Reconciliation
• The Institute for Healthcare Improvement (IHI)
introduced the 100K Lives Campaign in December
2004 to challenge health care providers to join a
national effort to make health care safer and more
effective & ensure hospitals achieve the best
possible outcomes for all patients.
• On April 12, 2005, the Canadian campaign, Safer
Healthcare Now! was created. The IWK Health
Centre is a registered member.
Medication Reconciliation – what is it?
• A formal process for:
– Obtaining a complete and accurate list of each
patient’s current home medications (name,
dosage, frequency, route)
– Comparing the physician’s admission, transfer,
and/or discharge orders to that list
– Bringing discrepancies to the attention of the
prescriber and ensuring changes are made to the
orders, when appropriate
Why?
• Concern over patient safety is growing, both among
the Canadian public and among health care providers
• 2.9-16.6% of patients in acute care hospitals experienced
one or more adverse events
• Greater than 50% of all hospital medication errors
occur at the interfaces of care
– Admission to hospital, Transfer from one nursing
unit to another, Transfer to step-down care,
Discharge from hospital
Why Now?
• It’s the right thing to do……..
– Culture of safety: reduce medication errors &
potential for patient harm
– Key component of seamless care strategies
– Saves time for physicians, nurses, and pharmacists in
the long-term
• Medication Reconciliation is a new Canadian Council
on Health Services Accreditation Standard
• Executive Leadership has endorsed Medication
Reconciliation as a project of high priority
Accreditation
• Patient Safety Area: Communication
– Reconcile medications with the patient/client at referral or transfer
and communicate the patient’s/client’s medications to the next
provider of service….
• Tests for compliance
– Do these processes take place as a shared responsibility, involving the
patient/client, nursing staff, medical staff, and pharmacists, as
appropriate?
– Does the organization have an implementation plan for spread….
• Accreditation should not be seen as the driver for
medication reconciliation.
• Documenting the patient’s best possible medication history
and decreasing discrepancies and adverse events around
medications is a safety goal for health care organizations
nationally.
Stakeholder Support
CAPHC
CCHSA
Executive
Leadership
Team
Quality/ Patient Safety
Team
SHN
Atlantic Node
ISMP
Project Team
SHN
National
Campaign
Medication Reconciliation can…
• Prevent omission of an at-home medication
• Match in-house dose, frequency and route with athome dose
• Assure medications follow the patient from one care
area to another
Potential Impact
• Implementation of medication reconciliation along
with other interventions decreased the rate of
medication errors by 70% and adverse drug events by
15%, over a seven month period.[i]
• Implementation in a surgical population reduced
potential adverse drug events by 80% within three
months of implementation.[ii]
[i] Whittington J, Cohen H. OSF healthcare’s journey in patient safety. Qual
Manag Health Care 2004;13(1):53-59
[ii] Michels RD, Meisel S. Program using pharmacy technicians to obtain
medication histories. Am J Health Syst Pharm 2003;60:1982-1986
Definitions
Type O = No discrepancy
Type 1 = Intentional discrepancy
The physician has made an intentional choice to add, change or discontinue a
medication and their choice is clearly documented.
*considered to be “best practice” in medication reconciliation
Type 2 = Undocumented Intentional discrepancy
The physician has made an intentional choice to add, change or discontinue a
medication but their choice is not clearly documented.
* 25-75% of all discrepancies
Type 3 = Unintentional discrepancy
The physician has unintentionally changed, added or omitted a medication that
the patient was taking prior to admission.
*potential to lead to ADEs
Goal
• SHN Medication Reconciliation ultimate goal:
To prevent Adverse Drug Events by implementing
medication reconciliation in hospitals across Canada.
• SHN Medication Reconciliation primary goal:
To decrease undocumented intentional and unintentional
discrepancies by reconciling all medications at all interfaces
of care for all patients.
http://www.saferhealthcarenow.ca/
Aim & Scope
What is the aim?
• To reduce the number of unintentional and
undocumented intentional discrepancies (Types 2
& 3) for the inpatient population by 75 %.
What is the scope/ boundaries?
• Medication reconciliation will be completed
within 24 hours of admission for all patients
admitted to MSNU who are currently taking
medications.
Responsibilities
BPMH-History taker (can be Pharmacy/ Nursing/ Physicians)
• History taker interviews the patient/family on admission in order to
get the best possible medication history (BPMH)
• Pharmacist or Nurse assumes the history taker role and completes the admission
medication history order sheet, listing all home medications.
*Signs record as the history taker.
Nursing
•
•
Does not duplicate the medication history on the Admission/ Visit Assessment
Record (#7070)… just documents, “See Admission Medication History Order
sheet”
*Ensure that there is an admission medication history order sheet completed
first.
Maintains practice of asking family about medication concerns etc. (Scope of
practice /workload measure)
Ordering Physician
•
Reviews the BPMH list, reconciles with the history taker and signs the sheet.
*The BMPH list then becomes the admission medication orders.
Medication History & Order Sheet
I Have the List, Now What…
Reconciliation
• Review BPMH and confirm each medication listed in the
history with the appropriate source (health record,
community pharmacy, physician, family, etc.).
• Contact the physician to resolve any discrepancies.
Data Submission
• Pharmacy audits the admission orders monthly, identifying
the discrepancy type.
• QIC uses data to complete SHN worksheet/ measurement
tool and submits data to SHN.
• QIC reports data results back to the team.
Key Players for Med Rec Success
Review medication
history, participate in
reconciliation and
signs BPMH as orders
Physicians
Patient/ Family
SHN
Medication
Reconciliation
Participates in
Pharmacy
reconciliation of
BPMH, identifies
discrepancy types,
sends data to QIC
Receives
medication
reconciliation
education and
collaborates with
team to provide the
BPMH
Nursing Participates in collection
and reconciliation of
BPMH on admission, as
part of practice scope
Quality
&
Education
Facilitates and Supports Process
Family Letter
Progress
TEAMS
•
Inpatient Nephrology Unit
•
Inpatient Mental Health
•
Women’s Gynecology
Goal #1:
 To implement use of the admission medication
history order sheet.
Goal #2:
 Medication reconciliation will become the standard
of practice at all admission, discharge and transfer
points, for all patients at the IWK.
PDSA
• Methodology – Conducting small tests of
change for improvement
– Plan the change
– Trial the change
– Observe the results
– Spread the change
Plan
Act
Celebrate successes!
Ensure consistent/ accurate data is obtained
Share knowledge with others!
Ask questions!
Do
Study
MSNU…Next Steps
• Educate
– Pharmacists
– Nurses
– Physicians
• Collect Baseline Data
• Identify which measures will indicate if the changes
will lead to improvement.
• Implement small tests of change (PDSA) to identify
and refine processes, procedures and practices which
will lead to improvement and achieving the aim.
Supporters of this Project
Questions?