Transcript Match Toolkit Presentation

Medication Reconciliation “Office Hours”
Using the MATCH Toolkit
“Presented to”
GHAREF Hospital Engagement Network
In Partnership with the Georgia Foundation for Medical Care
Kristine Gleason, MPH, RPh - Clinical Quality Leader, Northwestern Memorial Hospital
Vicky Agramonte, RN, MSN - Project Manager, Healthcare Quality Improvement Program , IPRO
Today’s Objectives
1. Provide an overview of the MATCH Toolkit to implement a
robust medication reconciliation process, highlighting a one
“source of truth.”
2. Link medication reconciliation with other safety / quality
initiatives to achieve synergies.
3. Review “Frequently Asked Questions” from the Regional
Meetings and available MATCH customizable tools for a
successful improvement project.
4. Share and discuss best practices and solutions to common
medication reconciliation issues among HEN participants.
YOUR Mission (to implement a successful med rec
process) if YOU Choose to ACCEPT It
Webinar 1
July 11
Webinar 2
July 31
Regional Meetings
August 20 OR August 27
Office Hours
Call # 1
September 24
Office Hours
Call # 2
October 24
DEFINE
MEASURE
ANALYZE
IMPROVE
CONTROL
Build the
Project
Foundation
Establish a
Measurement
Strategy
Design/
Redesign the
Process
Implement the
Process
Assess and
Evaluate
Identify Team
Members
Data
Collection Plan
Flow Chart
Implementation
Plan
Monitor
Performance
Process Map
Collect Data
Pilot Test
Develop a
Charter
Identify Key
Drivers
Address low
compliance
Gap Analysis
Process
Design
Education /
Training
Sustainability
“Levels” of Medication Reconciliation
Are We at the Beginning or Nearing the End?
1. Obtaining and reconciling list of patient’s current medications
to orders to identify/correct unintended discrepancies and
repeating process at discharge to prevent patient harm.
2. Reconciling medication regimen to patient’s condition(s) (e.g.,
purpose).
3. Reconciling medication regimen to recommended evidencebased therapies.
4. Adjusting medications based on patient characteristics (e.g.,
renal or liver function, age) and/or interactions (e.g., drugdrug, drug-food).
5. Optimizing medication therapy based on patient response /
outcomes.
Dynamic
process
that
involves
ongoing
assessment,
monitoring
and patient
education.
“Bundling” Medication Reconciliation
with Current Initiatives
Care Transitions
ED
Admission
Intrahospital
Transfer
Discharge
PostDischarge
Phases of Medication Management
Med
History,
Reconcile
Order,
Transcribe,
Clarify
Procure,
Dispense
Deliver
Administer
Monitor
Monitor
Educate,
Educate,
Discharge
Discharge
Measurement / Analysis
Harm Estimate/Evidence from Literature
Harm Estimate/Evidence from Organization
Prioritize / Implement Evidence-Based Interventions
Measure Improvements / Monitor for Sustainability
A Step-by-Step Guide to Improving the
Medication Reconciliation Process
MATCH Toolkit, with
customizable, actionable
information, is available
at:
http://www.ahrq.gov/qual
/match/match.pdf
Build the Project
Foundation
Assemble Your Team and
Construct a High Level Process Map
Steps
1. Get Team together - include all stakeholders
2. Define and agree to a process
3. List all participants of the process – depts., mgrs, and job
performers
4. Define beginning and end points
5. Brainstorm key process steps
6. Determine order of process steps
7. Validate by physically walking through process
Example: High Level Process Map
A High Level Process Map is a simple picture of a complex process
represented by 4-8 key steps. It is essential to better understand the process
being improved and to gain agreement on project scope.
Physician places discharge order
Physician writes new prescription
Physician prepares d/c instructions
Nurse collects the d/c instructions and
prescription and counsels the patient
Patient discharged
Develop a Charter
Strategic Linkage
• Clearly ties the project to organizational goals
Problem Statement
• Concise description of the issues
Goal
Scope
• Describes planned accomplishments
• Area to be covered – avoid scope creep
Deliverables
• Tangible end-products, must align with goal
Resources
• Necessary requirements for project success
Metrics
Milestones
• Objective measurement of progress
• Used to monitor progress and maintain focus
“One Source of Truth”
•
Medication reconciliation process design should center on a single
list - “One Source of Truth” - to document patient’s current
medications.
•
All clinicians should be working from the same centrally located,
easily visible medication list, regardless of format.
•
List becomes reference point for ordering decisions, screening and
reconciliation.
• Each discipline should have the ability to update the home
medications as new or more reliable information becomes
available.
Establish a
Measurement
Strategy
Data Collection Plan
Caution: Jumping into data collection without a clear plan wastes time,
energy, resources, etc.
Operational Collection
Sampling Plan
What to
Definition
Measure
Method
What
Where
When
How Many
Question the
Specific
System,
Elements to Physical Timing and Number of
data will
Definition existing forms, be collected location frequency data points
answer
new
of collection
to be
handwritten
collected
forms, etc.
Was an
“Medication
Manual
Copy of AtGI Lab 2-weeks all All visits
updated
instructions collection from Home Meds
shifts.
medication list
were
existing forms List form,
August 15 provided to the reviewed
reasons for
31
patient and
with the
nonreviewed at
patient”
compliance.
discharge? checked on
Use Med Rec
At-Home
audit form
Meds List
form
Collect Data
1.
Work with the team and
staff to identify potential
drivers and build a data
collection form.
2.
Seek assistance from the
team and staff in
collecting the data to
increase buy-in.
3.
Observe the data
collection process
periodically to identify
issues, errors.
4.
Graph the data you
intend to collect to (1)
confirm how you plan to
use the data and (2)
identify any missing data
elements.
Identify Key Drivers
The backside of the baseline data collection form:
Identifying
(& addressing)
the problematic
issues that
drive outcomes
will lead to
lasting
improvement
Involvement of Frontline Staff is KEY
Design/Redesign
the Process
Flow Charting and
Gap Analysis
A flowchart outlines current
workflow and helps
identify:
1. Successful medication
reconciliation practices.
2. Current roles and
responsibilities for each
discipline.
3. Potential failures
4. Unnecessary
redundancies and gaps
in the process
Implement the
Process
18
Implementation Plan
Improvement Planning
To implement solutions successfully, five areas must be
carefully considered and planned for:
1. Interventions
2. IT
Be sure to always include…
• Detailed actions
3. Communication
• Team member assignments
4. Training
• Completion dates
5. Measurement
50% of the work begins now
Educational Tools
Assessment and
Process Evaluation
21
Monitoring
Performance
Questions and Discussion
Vicky Agramonte, RN, MSN
Project Manager
Healthcare Quality Improvement Program
Island Peer Review Organization, Inc. (IPRO)
Albany, NY 12211-2370
(518) 426-3300 X115
[email protected]
Kristine Gleason, MPH, RPh
Clinical Quality Leader
Northwestern Memorial Hospital
Chicago IL 60611
312.926.9172
[email protected]
THANK YOU!
If you want to learn more about IPRO, please visit our website at: http://www.ipro.org
If you want to learn more about Northwestern Memorial Hospital, please visit our website at http://www.nmh.org