Transcript Story board rvh2

Western Node Collaborative
RIVERVIEW HOSPITAL
Medication Reconciliation Project
Phase One: Admitting
June 19, 2006
Zaheen Rhemtulla B.Sc. (pharm)
Riverview Hospital (RVH)
As part of British Columbia Mental Health and Addiction Services and
governed under the Provincial Health Services Authority, Riverview
Hospital provides specialized tertiary mental health services under 3
core programs:
- Adult Tertiary Psychiatric Program (225 inpatient beds + 20 ICU beds)
specialized tertiary acute care and rehabilitation services to adults living with a serious
mental illness
- Geriatric Psychiatric Program (145 inpatient beds)
assessment and treatment services for inpatients as well as outpatient consultation
services to patients who often have needs relating to end-stage dementing illness with
severe chronic psychiatric and medical conditions
- Neuropsychiatry Program (49 inpatient beds)
care to a specialized group of individuals who have cognitive, affective, and psychotic
symptoms associated with brain injuries or disease that are beyond the capacity of
acute care hospitals and community-based settings
Background Information

Recognizing that Medication Reconciliation is an evidence-based
intervention that can prevent a high percentage of medicationrelated adverse events, Riverview Hospital first convened a MedRec
team June 2005 in response to the Safer Healthcare Now Campaign
and accreditation requirements.
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Having supportive executive sponsorship and leadership buy-in,
the project now has a committed team of over 15 members from
various disciplines including physicians, nurse clinicians, unit
managers, pharmacists, and administrative staff as well as a new
funded project leader. The team meet on a monthly basis to
discuss the progress of the project which is being piloted on 5
wards throughout the hospital.

Goal for completion for the admission part of the medication
reconciliation process is October 2006.
Project Charter
Based on studies documenting the high percentage
of adverse events occurring in hospitals due to
medication errors, particularly at points of transition,
Riverview Hospital is focused on providing the best
possible care to the patients it serves by developing
and implementing procedures and systems that
result in better documentation and eliminate
unintentional medication discrepancies at these
interfaces of care.
Importance
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Efficient transitions in care
Better documentation
Better communication
Better safety
Fewer hospitalizations
Decreased costs
Better patient care
Reason to adopt
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To provide the best possible care to a very
vulnerable patient population (e.g. pt’s with
psychosis/Dementia)
Create standardization with all other health-care
providers in order to provide “seamless care”.
Aims
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Reduce the mean number of undocumented intentional
discrepancies at admission by 90% from baseline by October
2006 on the 5 pilot wards (2 geriatric wards, 2 adult tertiary care
wards, 1 ICU)
Reduce the mean number of undocumented unintentional
discrepancies at admission by 90% from baseline by October
2006 on the 5 pilot wards
Increase the medication reconciliation rate (success index) by
90% from baseline by October 2006 on the 5 pilot wards
Provide a process to identify high risk patients (> 5
medications, co-existing medical conditions, potentially toxic
medications) that may need additional collateral to achieve the
Best Possible Medication History (BPMH)
Where are we in the process?
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Collecting baseline data on 5 pilot wards (2 geriatric
assessment wards, 2 adult tertiary care wards, ICU). This
has already resulted in better documentation and
decreased the number of undocumented intentional
discrepancies
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Starting with the Sunnybrook Hospital Admission Form and
testing on a one-patient-one-physician basis, we are trialing
the third draft of our own form
1.0 Mean Number of Undocumented Intentional Discrepancies
2.50
No new data
collection for
December/
January
2.00
Decrease due to better
documentation
Mean
1.50
1.00
Month
Actual
Goal
20
06
D
ec
20
06
N
ov
O
ct
20
0
6
20
06
Se
p
20
06
Au
g
Ju
l2
6
20
0
n
Ju
M
ay
20
20
06
Ap
r
06
ar
M
Fe
b
20
20
06
6
Ja
n
20
0
20
05
D
ec
20
05
N
ov
06
No new
data
collection
for April
2006
00
6
Includes
data for
May-June 15
2006
0.50
0.00
Better documentation
(charting) still needed to
reach goal of 90%
decrease from baseline
2.0 Mean Number of Unintentional Discrepancies
2.50
No new data
collection for
December/January
2.00
Mean
1.50
1.00
No new
data
collection
for April
2006
0.50
Includes
data for
May-June
15 2006
Target Goal (90% less than
baseline) has been met
Month
Actual
Goal
20
06
D
ec
20
06
N
ov
O
ct
20
0
6
20
06
Se
p
20
06
Au
g
00
6
Ju
n
Ju
l2
6
20
0
06
M
ay
20
20
06
Ap
r
06
ar
M
Fe
b
20
20
06
6
Ja
n
20
0
20
05
D
ec
N
ov
20
05
0.00
3.0 Medication Reconciliation Success Index
100%
Target Goal achieved
90%
No new data
collection for
April 2006
No new data
collection
80%
Includes
data for
May-June 15
2006
for December/
January
70%
50%
40%
30%
20%
10%
Month
Actual
Goal
20
06
D
ec
20
06
N
ov
O
ct
20
0
6
20
06
Se
p
20
06
Au
g
00
6
Ju
n
Ju
l2
6
20
0
06
M
ay
20
20
06
Ap
r
06
ar
M
Fe
b
20
20
06
6
Ja
n
20
0
20
05
D
ec
20
05
0%
N
ov
Percentage
60%
Keys to Success and
Lessons Learned
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Successes: Leadership buy-in, team commitment, funding for
project leader, funding for event attendance
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Barriers: Time constraints, individual preferences of methods for
documentation, established ward admission procedures, varying
needs on individual wards
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Lessons Learned: Do as many; Plan, Do, Study, Act (PDSA)
cycles as possible to work out “wrinkles”
Next Steps
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Design a flowchart to capture “high need” patients
requiring more collateral for BPMH
Do more PDSA cycles to fine tune Admissions Form
Trial form, to determine if it is universal for all
patients admitted to RVH.
Educate staff how to use to utilize form
Implement form on all wards
Collect data to see results
Medication Reconciliation Team
Contact Information
Riverview Hospital
2601 Lougeed Highway
Coquitlam, BC
(604) 524-7000
Project Leader:
Administrative Leadership:
Zaheen Rhemtulla
Marilyn Macdougall
Francis Hu
Peter Owen
[email protected]
[email protected]
[email protected]
[email protected]
Clinical Support:
Jane Dumontet Pharm.D.
Dr. Heather Cherneski
Dr. Meagan O’Keefe
Riola Crawford
Gail Ancill
Lesley Bushell
Richard Sanassy
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
Program Support:
Ruby Virani
Tin Au
Valerie Eggen
Linda Edwards
[email protected]
[email protected]
[email protected]
[email protected]
Forensic Representatives
Ellen Haworth
Dave Wharton
[email protected]
[email protected]
Risk Management: