Transcript 09 Apr 15 State of the Nation MR presentation

Preventing Adverse Drug Events (ADEs)
through Medication Reconciliation
State of the Nation – National Teleconference
April 2009
© Institute for Safe Medication Practices Canada 2009®
Objectives
• To provide updates, developments, issues
and learning from the intervention
leadership team:
• Marg Colquhoun, Olavo Fernandes, Brenda Carthy &
Alice Watt
• To encourage measurement appropriate to
your MedRec model
• To celebrate what we have accomplished
© Institute for Safe Medication Practices Canada 2009®
Slide 2
Agenda
• Medication Reconciliation Updates:
•
•
•
•
State of the Nation
Acute Care
Long Term Care (LTC)
Tools
• Measurement Update
• Clarity, Frequency and Duration
• Moving on with Medication Reconciliation……
• Transfer, Discharge, Homecare Pilot, Ambulatory/
Community, High 5’s
• Open Forum : Q & A’s
© Institute for Safe Medication Practices Canada 2009®
Slide 3
What impact has SHN had in
Canada?
“Thousands of practitioners are
collaborating, sharing, learning,
implementing safe practices and
improving safety”
Phil Hassen, CEO CPSI Accomplishment Report
© Institute for Safe Medication Practices Canada 2009®
Slide 4
SHN Medication Reconciliation Teams
As of March 2009
Acute Care: 320
Long Term Care: 84
Home Care: 15
Total = 419 Canadian Teams
© Institute for Safe Medication Practices Canada 2009®
Slide 5
Med Rec Accomplishments
• Dr. Chaim Bell - CIHR research project
• University Health Network – National
Commitment to Care Award
• Vancouver Coastal Health Providence
Healthcare – 3M Healthcare Quality
distinction award
• Send us ones we do not know about!
© Institute for Safe Medication Practices Canada 2009®
Slide 6
Acute Care
• Lilly Hospital Pharmacy National Survey
Results (n=158)
• Seventy-one percent (71%), of
respondents are registered as participating
in the Safer Healthcare Now! medication
reconciliation intervention
© Institute for Safe Medication Practices Canada 2009®
Slide 7
Long Term Care
• Atlantic Node just completed a successful
LTC Collaborative with > 20 teams
• Ontario Node leading a project in fall 2009
with ~ 14 teams
• Kaizen project in Toronto
© Institute for Safe Medication Practices Canada 2009®
Slide 8
What We’ve Learned
• MedRec decreases the potential for ADEs
• MedRec requires training
• Why MedRec?
• Get your own cases, use your own data
• How it is done in your organization
• BPMH training is vital
• People are beginning to expect MedRec
© Institute for Safe Medication Practices Canada 2009®
Slide 9
Accreditation Canada
Evidence of Compliance Changes
• Triage and Clinics
• Currently preparing ROP information for
consultation with content experts
and organizations
• Accreditation Canada views this work as a
priority and that updated information will
be released over the next few weeks
© Institute for Safe Medication Practices Canada 2009®
Slide 10
International Med Rec- High Fives
• CPSI/ ISMP Canada is also collaborating with the
World Health Organization on medication
reconciliation
• ‘Assuring Medication Accuracy at Transition in
Care’ for the WHO/Joint Commission
International High 5s
• Being launched in June 2009
• Will be recruitment of Canadian teams
© Institute for Safe Medication Practices Canada 2009®
Slide 11
Med Rec Communities of
Practice (CoP)
© Institute for Safe Medication Practices Canada 2009®
Slide 12
CoP Membership
The medication reconciliation CoP has garnered over
1,000 members since its launch just three years ago.
© Institute for Safe Medication Practices Canada 2009®
Slide 13
Med Rec COP Usage by Month
The site receives upwards of 18,000 visits per month with numerous members
engaging in helpful discussion threads.
© Institute for Safe Medication Practices Canada 2009®
Slide 14
New Community of Practice
• FAQ’s based on 3
years of experience
• Greater capacity
• Growing pains
• Tutorials
© Institute for Safe Medication Practices Canada 2009®
Slide 15
New CoP Issues
• Login to the new CoP
• If you need help contact Brenda Carthy at
[email protected]
• Reaching our members
• Set an alert for the Announcements.
Instructions are available in the HELP section.
• Send feedback to [email protected]
© Institute for Safe Medication Practices Canada 2009®
Slide 16
CoP Help
© Institute for Safe Medication Practices Canada 2009®
Slide 17
SHN Mentorship Program
• Mentorship program links successful teams to teams
that require assistance with their programs
• Facilitates a one-on-one institution partnerships with
teams/ institutions that have learnings/ successes they
can share to mentor other teams
• Call for mentors and mentees
• Mentorship program links successful teams to teams
that require assistance with their programs
• CoP has information
• Contact us if you are interested in participating
© Institute for Safe Medication Practices Canada 2009®
Slide 18
Tools and Resources
© Institute for Safe Medication Practices Canada 2009®
Slide 19
New Wallet Card Coming Soon
Medications: More Than Just Pills!!!
Over-The-Counter Medicines
AND
Prescription Medicines
These include anything you can only obtain with a doctor’s
order such as heart pills, inhalers, sleeping pills.*
*These include things that can be purchased at a pharmacy
without an order from the doctor such as aspirin, Tylenol,
laxatives, other bowel care products, herbs like garlic and
Echinacea or vitamins and minerals like calcium, B12 or iron.
DON’T FORGET THESE TYPES OF MEDICATIONS
Eye/Ear Drops
Inhalers
Nasal Spray
Patches
Liquids
Injections
Ointments/Cream
Prompt the patient to include medicines they take every day and also ones taken sometimes such as for a cold, stomachache
or headache.
Adapted from
Additional Tools
• BPMH training
• Frequently Asked
Questions: FAQ’s
• E learning packages
under consideration
• Medication
reconciliation
introduction packages
See the Community of
Practice
© Institute for Safe Medication Practices Canada 2009®
Slide 24
Measurement
© Institute for Safe Medication Practices Canada 2009®
Slide 25
MedRec Teams Reporting to
Central Measurement Team
National Statistics:
• Average of 100 teams reporting every
month to Central Measurement Team
© Institute for Safe Medication Practices Canada 2009®
Slide 26
Measurement Activity
Activity Level by Intervention
Medication Reconciliation - Sept 2008
100%
80%
60%
34%
40%
33%
18%
15%
20%
0%
At Goal
Active
Inactive
© Institute for Safe Medication Practices Canada 2009®
No Data
Slide 27
•
© Institute for Safe Medication Practices Canada 2009®
Slide 28
Over a 16-month period, the average
rate of undocumented intentional
discrepancies dropped from 0.77 to 0.48
and has been sustained for an additional
20 months.
© Institute for Safe Medication Practices Canada 2009®
Slide 29
Measurement Learning from Teams
Several similar interdisciplinary practice models or
processes possible
Important to distinguish for measurement
purposes
1. Proactive Reconciliation
2. Retroactive Reconciliation
3. Hybrid model of 1 and 2
© Institute for Safe Medication Practices Canada 2009®
Slide 30
Proactive Medication
Reconciliation Process
1. Create the BPMH
2 Using the BPMH, Admission medication orders (AMOs) are written by
the prescriber.
3. Verify that the prescriber has assessed every medication on the
BPMH, identifying and resolving any outstanding discrepancies with
the prescriber, if any.
STEP 1
STEP 2
STEP 3
Verify every
LEADS TO
medication in
Admission
BPMH
Orders
BPMH has
been assessed
by prescriber.
PROACTIVE MEDICATION RECONCILIATION MODEL
© Institute for Safe Medication Practices Canada 2009®
Slide 31
Retroactive Medication
Reconciliation Process
1.
Primary medication history is taken
2.
Admission medication orders are written by prescriber
3.
Create the BPMH
4.
Compare the BPMH against the patient’s admission medication
orders, identifying and resolving any discrepancies with the
prescriber.
STEP 1
Primary
Medication
HIstory
LEADS TO
STEP 2
STEP 3
Admission
Orders
BPMH
RETROACTIVE MEDICATION RECONCILIATION MODEL
© Institute for Safe Medication Practices Canada 2009®
STEP 4
Compare
BPMH with
AMOs and
resolve any
discrepancies
Slide 32
Measurement Learning
• Everyday reconciliation process and
measurement process are actually distinct
and different activities
• After baseline, team needs to measure
after reconciliation in order to measure
the improvement
© Institute for Safe Medication Practices Canada 2009®
Slide 33
When should you measure ?
© Institute for Safe Medication Practices Canada 2009®
Slide 34
When to measure?
(unintentional and undocumented intentional discrepancies)
• Done after the team has completed its normal or
standard reconciliation processes
• Second person
• Independent of clinician who has done the main reconciliation
• Resource requirements - meant to be low intensity
• Performed on a very small sample (subset of patients) monthly for a
finite period of time only
• Can be from same clinical area, different clinical area, quality / patient
safety staff member
• Aim is to measure the quality of medication reconciliation
• To ensure medication discrepancies have all been identified (no need to
count discrepancies team has identified and are in the process of being
resolved)
• Look at all available patient information - no need to repeat BPMH,
clarify with team as necessary
© Institute for Safe Medication Practices Canada 2009®
Slide 35
When to Stop/ Change Frequency of
Measuring Unintentionals?
•
Reached its 1) measurement goal (original relative
target definition) or 2) reached 0.3 unintentional
discrepancies per patient (absolute target- average
75th percentile for MedRec 2 for calendar 2008)
•
Held its gains for 3 consecutive data points (months)
in a 3-6 month period is considered to be “At Goal”.
•
Teams at goal can start/ continue to measure % of
patients with formal reconciliation at admission
(regularly)
•
Should then ensure quality is maintained by reinstituting
discrepancy measurement twice/year
© Institute for Safe Medication Practices Canada 2009®
Slide 36
New Measure for Admission
Medication Reconciliation
• Added to align / synchronize with
Accreditation Canada performance
indicators (same definitions)
• % patients receiving formal medication
reconciliation on admission
• Denominator is total admissions (can be
by unit or institution)
© Institute for Safe Medication Practices Canada 2009®
Slide 37
Moving On
• Transfer medication reconciliation
• Discharge medication reconciliation
• E-learning
• Ambulatory care
• Homecare
© Institute for Safe Medication Practices Canada 2009®
Slide 38
MedRec at
Transfer and Discharge
• Feedback from teams: many have started and
moved toward sustaining admission med rec and
are now earnestly focused on transfer and
discharge
• National Calls Upcoming – revisit principles,
processes and tips on these interfaces
• Teams sharing their successes, lessons learned
and processes
• Studies completed and in progress
© Institute for Safe Medication Practices Canada 2009®
Slide 39
For Consideration: Ambulatory Medication Reconciliation Model
Creating the most “up to date” medication record (BPMH)
(From SHN Home Care Pilot)
Compare:
Medication
Information from all
other sources
Patient and
Family Interview
Examples:
•Medication vial inspection
•Referral record
“medication
discrepancies that
•Community pharmacy
•Hospital Discharge
Summary
require clarification”
document
Review and follow
up where indicated
“up to date”
medication
record (BPMH)
Medication Reconciliation Homecare
• Evidence shows significant issues with
medication errors in home care.
• SHN! is exploring the issue in the home
and community care realm in a pilot
project
© Institute for Safe Medication Practices Canada 2009®
Slide 41
Aim of Pilot Project
• Develop/validate framework to aid
homecare providers in the
implementation of medication
reconciliation into care delivery
processes.
• This framework is to take into consideration
the unique challenges of the homecare
delivery setting in Canada.
• This is being done by exploring developing
and testing medication reconciliation
strategies for implementation in the
homecare setting.
© Institute for Safe Medication Practices Canada 2009®
Slide 42
What are the teams doing?
• Applying a structured medication reconciliation
process to targeted client populations
• Testing tools, guides and measures to determine
what works and what does not work in the
home care setting.
• Collecting data in order to identify processes for
improvement throughout the pilot
• Identifying the challenges that are unique to
applying medication reconcilation processes in
this sector
© Institute for Safe Medication Practices Canada 2009®
Slide 43
Early Successes
• Positive impact on clinicians
• Clinicians are beginning to spread the word
outside the pilot that this is best practice
• Success with strategies for physician
engagement
• With familiarity, process time is decreasing
• Preliminary data demonstrates that
medication reconciliation is needed in the
homecare sector
© Institute for Safe Medication Practices Canada 2009®
Slide 44
OVERALL VIEW: Measure Three
Percentage of Discrepancies that require clarification
Discrepancy Rate
120%
Percentage of Discrepancies
100%
80%
Atlantic
60%
Ontario
Western
40%
20%
0%
Pilot Teams
© Institute for Safe Medication Practices Canada 2009®
Slide 45
OVERALL VIEW: Measure Two
Time to Complete the BPMH
Time to Complete the BPMH in Minutes
120
Time in Minutes
100
80
Atlantic
60
Ontario
Western
40
20
0
Pilot Teams
© Institute for Safe Medication Practices Canada 2009®
Slide 46
© Institute for Safe Medication Practices Canada 2009®
Slide 47
• Please contact Brenda Carthy for CoP
issues [email protected]
• Please send your email address to
Brenda Carthy [email protected]
© Institute for Safe Medication Practices Canada 2009®
Slide 48