Transcript Home Care storyboard Closing Congress Winnipeg April 2008

Brandon Regional Health Authority
Home Care
Medication Reconciliation
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Background
• Brandon Regional Health Authority – covers city of
Brandon, MB and surrounding rural municipalities
– services to ~ 180,000 people
• 1 regional hospital – 315 beds- serving Brandon
RHA and many outside regions
• 5 Long Term Care facilities (PCH) and 1 Primary
Access Center
• Public Health, Home Care, and Mental Health
programs/services
• Approximately 100 physicians and 14 pharmacies
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Background
• Home Care working group developed in May 2007
• Purpose - implementation of medication
reconciliation in the Home Care program
• Decision to focus on clients admitted to the service
of medication assistance for the Medication
Reconciliation process
– new or existing clients
• Plan to provide education for all home care clients
regarding the importance of preparing &
maintaining a current medication list
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Aim
Purpose:
• To prevent adverse medication occurrences, through the
process of medication reconciliation, for Home Care clients
receiving medication assistance
• To promote various tools for all clients to maintain their own
current medication list
Aim Statements:
• Conduct a BPMH and reconcile discrepancies on 100% of
clients receiving medication assistance by April 2008
• Develop a system where 6 month medication reviews
occur on 100% of clients receiving medication assistance
by October 2008
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Team Members
• Mary Lou Lester – Pharmacist and Team Leader
• Dolores McGregor – Manager Home Care
• Dianne Strock/Donna McIntyre Hunt – Nursing
Resource Managers
• Kylie Robinson – Case Coordinator
• Leslie Hayward – Intake Coordinator
• Kristi Chorney – Quality/Risk Management
• Liliana Rodriguez – Planning/Evaluation
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Changes Tested
P
D
A
S
#1: Compare
medication list
obtained at
admission to
Home Care for
next 5 patients
to DPIN and/or
inpatient profile
(if recently
discharged)
P
D
A
S
#2: Trial using
Home Care
BPMH and
Reconciliation
form when
collecting new
client
medication list
or updating
existing client
medication list
P
D
A
S
#3 Trial use of
Universal
Medication Form
with 5 regular
users of PCH
Respite. Evaluate
potential benefit of
this form as a tool
for all clients to
maintain their own
current medication
list
P
D
A
S
#4 Contact
Community
Pharmacies
to inform
them of our
work and why
they may
receive calls
from home
care staff to
clarify client’s
medication
lists
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
P
D
A
S
#5 Develop a
BPMH
prompt tool
to aid staff in
obtaining the
most
accurate
medication
history from
the client
Changes Tested
P
A
D
P
D
A
S
P
D
A
S
P
D
A
S
S
#6 Provide a
“You and your
Medication”
booklet to all
clients
encouraging
them to be more
knowledgeable
about their
medications
#7 Work with
Procura to
attempt to use
electronic
program for
gathering data,
incorporate
Med Rec
process into
Procura
profiles
#8 Work with
Procura to make a
user-friendly med
list printout that
can be given to the
patient and their
physician
#9 Use BPMH
to complete
medication
list updates
with existing
med assist
clients and
formulate a
way to flag
each client
for ongoing 6
month
reviews
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
P
D
A
S
#10 Look at
options for
BRHC to have
access to med
list in Procura
system (mainly
ER and POAC
for admissions)
Results
Minutes
Time to Complete BPMH
100
90
80
70
60
50
40
30
20
10
0
Change on methodology to count
time to gather medication list and
revised f orm and procedure given
to staf f
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Month
Average Time
Goal
Average Number of Days/Client
Tim e to Resolution of Discrepancies
Increase on
w orkload due to
updates being
completed
16
14
12
1 outlier w ith
43 days to
resolution
10
8
6
4
2
0
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Month
Average days to resolve discrepancies
Goal
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Mar
Apr
May
Results
Percentage of Clients in Target Population with a Reconciled Medication List Within 1 Week
120%
Percentage
100%
80%
60%
Increase on
w orkload due to
updates being
completed
40%
20%
0%
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Month
% of clients in target population with a reconciled medication list within 1 week
Goal
Percentage of Discrepancies Resolved w ithin 1 w eek
120%
Percentage
100%
80%
60%
Increase on
w orkload due to
updates being
completed
40%
20%
0%
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Month
% of Discrepancies Resolved within 1 Week
Goal
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Mar
Apr
May
Keys To Success
• Good communication with all stakeholders prior to and
during implementation of medication reconciliation project
is critical
– suggest sending letter to local pharmacies and physicians prior to
implementation explaining the project
• Gather baseline data and report to your team on the
current situation prior to implementation to help motivate
• Develop easy to follow procedures for the use of new
forms
• Create an updated process map so staff can see “the
whole picture” of Med Rec once a process is developed
• Ongoing feedback from staff regarding what is working
and what is not to assist with revisions as needed
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Lessons Learned
•
Our provincial DPIN database cannot be the sole source to reconcile
medications; in our region it should be used in conjunction with the
pharmacy and then physician
•
The entire process of medication reconciliation takes time, but is worthwhile,
as discrepancies are present even in blister pack medications
•
Our greatest source of discrepancies is often on hospital discharge
•
The universal medication form (or other medication list tools) may not work
for all clients (needs a motivated client or caregiver), but is a worthwhile tool
to share with all new referrals to program
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Next Steps
• Continue to work on ways to gather data for our
indicators by electronic process (Procura)
• Work with Procura to create a user-friendly
medication list that can be printed and shared with
the client and their physician
• Promote use of various medication list tools to all
clients along with “You and Your Medications” book
– UMF (Universal Medication Form)
– blue Medication Record booklet
– provincial “It’s Safe to Ask Med List” (available June 2nd)
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative
Contact Information
• Mary Lou Lester – pharmacist
– [email protected]
– Phone: 204-578-4249
• Dolores McGregor – Home Care Manager
– [email protected]
– Phone: 204-571-8420
Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative