Transcript Accreditation Canada & ISMP Canada

DRIVING QUALITY HEALTH SERVICES
Accreditation Canada & ISMP Canada
ISMP Community of Practice
Medication Reconciliation
October 15, 2008
ACCREDITATION CANADA
AGRÉMENT CANADA
Accredited by ISQua
Outline
 Background
 Answers to common questions
 Additional questions
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Background
Required Organization Practices
(ROPs)
 ROPs are
 Evidence-based expectations to enhance
patient/client safety and minimize risk
 Requirements for organizations in accreditation
 Relevant to organizations across the continuum of
care
 Incorporated into the accreditation program in
2006, and now integrated within Qmentum
standards
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Required Organization Practices
(ROPs) cont’d
 ROPs were developed in collaboration with
 Key stakeholders
 Institute for Safe Medication Practices Canada
 Canadian Patient Safety Institute
 Canadian Medical Protective Agency
 Canadian Institute for Health Information
 Healthcare Insurance Reciprocal of Canada
 Content experts on Accreditation Canada
Patient Safety Advisory Committee (PSAC)
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Patient Safety Required
Organization Practices (ROPS)
ROPs organized in several important patient safety areas:
1. Culture
2. Communication
3. Medication Use
4. Worklife
5. Infection control
6. Falls prevention
7. Risk assessment
More information about all ROPs is available at
http://www.accreditation-canada.ca/default.aspx?page=355&cat=30
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Patient Safety Required
Organization Practices (ROPS)
Medication reconciliation represents 2 Communication ROPs
Communication : Improve the effectiveness and coordination of communication among
care/service providers and with the recipients of care/service across the continuum.
Required Organizational Practices:
1.
2.
3.
4.
5.

Inform and educate patients/clients about their role in patient safety (written and verbal communication)
Employ effective mechanisms for transfer of information at interface points
Implement verification processes and other checking systems for high risk care/service activities
Reconcile the patient’s/client’s medications upon admission to the organization, and with the
involvement of the patient/client.
Reconcile medications with the patient/client at referral or transfer, and communicate the
patient’s/client’s medications to the next provider of service
More information available at
http://www.accreditation-canada.ca/default.aspx?page=355&cat=30
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What is Medication
Reconciliation?
 Medication reconciliation is the collection and
communication of accurate client/patient
medication information
 Medication reconciliation is important for continuity
of patient/client medications to
 Reduces likelihood of medication errors
 Potentially uncover medication errors that may
harm patients/clients
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Medication Reconciliation for
2008 and 2009
 To promote consistent practice and evaluation, Accreditation
Canada has established the following expectations for
medication reconciliation for organizations being surveyed
in 2008 and 2009
 Medication reconciliation is considered implemented, when the
organization has:
 a formal process for medication reconciliation at admission in at
least one unit/ service area/ site, and
 a formal process for medication reconciliation at transfer or
referral in at least one unit/ service area/ site, and
 a documented plan that includes timelines for implementation of
medication reconciliation across all units/ services areas/ sites.
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Medication Reconciliation
beyond 2009
 Accreditation Canada is reviewing information from the field
and results from accreditation surveys to determine
medication reconciliation expectations for organizations
being surveyed in 2010
 Accreditation Canada anticipates organizations will remain
committed to patient safety by continuing to implement
medication reconciliation
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Common Questions
Medication Reconciliation
Indicator
 Do we only have to collect information on the
number of patients that receive medication
reconciliation on admission?
Answer:
 Yes, that is the only indicator for medication
reconciliation at this time
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Medication Reconciliation
Indicator cont’d
 How often do we collect the indicator?
Answer:
 The data is to be collected on a continuous
basis
 The requirement for reporting is annually but
the data are entered in fields that reflect
quarters
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Medication Reconciliation
Indicator cont’d
 What is the numerator and denominator?
Answer:
 Denominator: Total number of patients
admitted to the unit of service at the
organization for the measurement period
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Medication Reconciliation
Indicator cont’d
 Numerator: number of patients who receive
formal medication reconciliation
 If criteria are used to identify who receives
medication reconciliation, the criteria need to
be identified
 e.g. patients on 4 or more pre-admit
medications, patients > 75 years old, etc.
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Medication Reconciliation
Indicator cont’d
 An explanation should be provided for why
criteria are being used to select individuals for
medication reconciliation
 Organizations enter the information in the
comment box in portal under the medication
reconciliation indicator
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Medication Reconciliation at
Transfer
 Does Transfer include discharge?
Answer:
 Yes, discharge is meant to be included in
“transfer to another setting, service, service
provider or level of care within or outside the
organization”
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Medication Reconciliation in
Emergency
 Do all triaged patients in ED need to receive
medication reconciliation?
Answer:
 Yes, currently this is how the standard is written
 Based on feedback from the field this requirement
is being reviewed
 Results from the review will be communicated to all
organizations
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Medication Reconciliation in
Ambulatory Care
 Ambulatory care and clinics do not always include
admission or care related to medications; is it
necessary to do medication reconciliation?
Answer:
 Based on feedback from the field the details and
requirements of the ROP for outpatient settings is
currently being reviewed
 Results from the review will be communicated to
organizations
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Medication Reconciliation in
Ambulatory Care cont’d
 Still important for safety of outpatient services to
reconcile medications (such as outpatient surgery,
dialysis facilities, outpatient oncology clinics, and
family practice areas)
 The process for reconciling medications in
outpatient settings is different than the process for
inpatient transitions
 A medication list is collected to know what
medications a patient is taking or receiving prior to
the outpatient visit in order to provide quality care
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Medication Reconciliation in
Ambulatory Care cont’d
 At the end of the outpatient visit, two things should
be verified:
 Based on what occurred in the visit, is any medication
that the patient was taking or receiving prior to the visit
being discontinued, altered, or held pending consultation
with the prescriber?
 Have any new prescriptions been added?
 Based on the answers to the these questions
reconciliation and follow up can occur
 More information is available from ISMP
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Medication Reconciliation in
Home care
 Homecare services do not always involve
medications; is it necessary to do medication
reconciliation?
Answer:
 It is important for homecare services to do
medication reconciliation when they are
involved in a medication management with
clients
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Pharmacist Role in Medication
Reconciliation
 What is the role of a pharmacist in
medication reconciliation?
Answer:
 Pharmacists play a key role in assisting with
medication reconciliation
 Accreditation Canada specifies in the test for
compliance that medication reconciliation is
a shared responsibility involving the
pharmacist
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Medication Reconciliation for
Respiratory Therapy
 As a RT company we only deliver oxygen to clients;
do we need to do medication reconciliation?
Answer:
 Yes, medication reconciliation remains an important
part of safe services
 Accreditation Canada requires RT organizations
review medications for possible interactions or
contraindications with oxygen
 More details are available on the Accreditation
Canada website
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Service area / site / unit
 What is the difference between these terms?
Answer:
 All three terms were used to reflect how different
organizations are structured and where medication
reconciliation may take place
 Common meanings are:
 Site is facility you work for, e.g. hospital, long term care home ,
home care agency
 Service could be the specialty where you work, e.g. medicine ,
surgery
 Unit is the specific unit where you work, e.g. Medicine 4D
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Best Possible Medication
History
 For the comprehensive list of medications can it be
the BPMH – for Safer Healthcare Now?
Answer:
 Yes, it is one kind of process that can be used
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Part 3
Additional Questions
Accreditation Canada Resources
 Accreditation Canada Accreditation Specialist
 Accreditation Canada Technical Support
 Accreditation Canada’s Website:
www.accreditation-canada.ca
 Organization Portal
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