Transcript David Thompson Health Region

Western Node Collaborative
David Thompson Health Region
Medication Reconciliation Project
Background
Patient Population: Adult medical patients admitted
through ER with 5 or more home medications
Improvement: Simplify the flow from Medication History
to Admission orders and to provide a tool for more accurate
Medication History
Start Date = April 2006 End Date = Jan 2008
Purpose: To decrease adverse drug events and improve
communication about medications at transition points
Resources: Team Members, Pharmacy, ER Department,
Health Records
Aim
To develop and implement a regional Medication
Reconciliation and Physician Admission form that
incorporates the best possible medication history
(BPMH) and facilitates timely and accurate
admission orders
Improvement Objectives
To decrease the number of undocumented
intentional discrepancies for patients admitted to
RDRHC medical units from ER by 75% by
September 30, 2006
To have ER nurses complete BPMH on 25% of
patients with home medications by September 30,
2006.
To increase the number of BPMH completed by
nurses, pharmacists, and physicians admitted to
medical unit 33, RDRHC by 30 per month by
December 31, 2006.
Team Members
Steve Freriks - ER Pharmacist
Elaine Berard - ER/Project Nurse
Dr. Brian Lang-Hodge - ER Physician
Celina Colegrave - Medication Safety Officer
Annamarie Fuchs - Utilization Manager
Linda Poloway - Patient Safety Coordinator
Changes Tested
PDSA #1- Change made to the home
medication record
 tested by nurse and pharmacist on two patients
 adopted form with changes
PDSA #2 - Extended function of form to include
physicians’ admission orders to cover and
reconcile home medications
 adopted form with changes
Changes Tested
Continued
 PDSA #2a (change concept = culture of safety - continuing education for staff)
Staff education package distributed:
 Posters
 individual learning packet for each staff member
 medical staff newsletter
 PDSA #2b (change concept = culture of safety - continuing education for staff)
Staff education continued:
 one-one-one training sessions
 group in-services to ER department, Unit Managers and
ER physicians
Changes Tested
Continued
PDSA #3 (change concept = taking care of business - standardize a document)
 Implementation of new Form
 Testing the usefulness and reliability of the new Form
PDSA #4 (change concept = culture of safety - providing training and education)
 Survey of Physicians and Nurses regarding education
package and posters about the Medication Reconciliation
Record and Order Form
 continue with further educational sessions
 continue with one-on-one training sessions
Changes Tested
Continued
PDSA #5,6,7,8 (change concept = Administrative System: Optimize
inspection and use affordances)
 Calculate compliance rates for completing Forms
(Nursing staff #5; Physicians #6)
 Determine accuracy of completed Forms
(Nursing staff #7; Physicians #8)
 Feedback results to nursing staff and physicians
 Repeat PDSA 5-8 in one month after feedback results
Results
Compliance Data
10-Sep-06
#
# patients
13-Sep-06
%
#
38
%
44
# forms completed
10
26%
18
41%
6
60%
11
61%
5
83%
11
100%
# patients admitted
# forms used by
physician
Results
Accuracy of Forms
Patient Label
Ht/Wt
Allergies
Sources
Verified 2+
RN Initials
RN Date
RN Time
Page _ of _
Pharmacy Info
Drug Name
Drug Dose
Drug Route
Drug Interval
MD Check box
MD Comments
Blank Lines
Ruled Out
MD Signature
MD Date
MD Time
10-Sep-06
#
%
10
100%
0
0%
10
100%
13-Sep-06
#
%
14
88%
3
19%
15
94%
0
9
10
2
5
2
8
9
7
9
5
4
0%
90%
100%
20%
50%
20%
80%
90%
70%
90%
100%
100%
2
14
15
3
13
7
15
15
16
14
10
8
13%
88%
94%
19%
81%
44%
94%
94%
100%
88%
91%
80%
2
5
4
1
40%
100%
80%
20%
5
10
9
7
45%
91%
82%
64%
Results
1.0 Mean Number of Undocumented Intentional Discrepancies
0.60
Baseline Data
0.50
0.30
0.20
Month
Actual
Goal
20
06
D
ec
20
06
N
ov
20
06
ep
S
A
ug
20
06
00
6
Ju
l2
20
06
Ju
n
20
06
ay
M
pr
20
06
A
ar
20
06
M
20
06
Fe
b
20
06
Ja
n
20
05
D
ec
20
05
0.00
20
06
compliance/
accuracy
data
collected
tested form,
no
education
sessions Implemented Satisfaction PDSA
new form
survey
in Aug
O
ct
0.10
N
ov
Mean
0.40
Results Continued
2.0 Mean Number of Unintentional Discrepancies
2.50
basline data
2.00
Mean
1.50
1.00
satisfaction
survey
0.50
tested form,
education
sessions
implemented
new form
no PDSA
in Aug
0.00
v
No
05
20
c
De
05
20
n
Ja
06
20
b
Fe
06
20
M
06
20
ar
6
00
r2
p
A
M
ay
06
20
n
Ju
06
20
l2
Ju
Month
Actual
Goal
6
00
g
Au
06
20
compliance/
accuracy
data
collected
06
06
0
2
20
p
ct
e
O
S
v
No
06
20
c
De
06
20
Results Continued
3.0 Medication Reconciliation Success Index
120%
implemented
new form
100%
compliance/
accuracy
data
collected
baseline
data
80%
Percentage
satsifaction
survey
60%
40%
20%
no data
collected
no PDSA in
Aug
0%
v
No
05
20
c
De
05
20
n
Ja
06
20
b
Fe
06
20
M
06
20
ar
6
00
r2
p
A
M
ay
06
20
n
Ju
06
20
l2
Ju
Month
Actual
Goal
6
00
g
Au
06
20
p
Se
06
20
ct
O
06
20
v
No
06
20
c
De
06
20
Keys to Success and
Lessons Learned
Focus on developing functional form
Enlist multidisciplinary champions working within
the ER department who have already established
working relationships
Support by nursing administration to facilitate
timely, expeditious form development
Remain sensitive to nursing & physician workload
when introducing a new initiative
Keys to Success and
Lessons Learned
Onsite daily support by the team to reinforce the
information
Repeated reinforcement by multiple team
members and multiple formats (email, mailbox,
verbal) helps to get buy-in from staff
Bribery with ice cream helps increase response
rate to surveys!!!!
Keys to Success and
Lessons Learned
Staff/physicians return to “old habits” - need to
continue with ongoing education
Give positive feedback to staff as well as review
poorly written Forms
Next Steps and
Plans for Spread
Sept
 presentation to Regional P&T and Quality Council
 In-service to Pharmacy Department RDRHC
 In-service to Drumheller Site staff and physicians
 Trial Meditech Discharge Prescription report on 1 unit
Oct
 In-service to staff and physicians on compliance and accuracy
data
 Team members to Learning Session #3
Nov
 spread to ER & pre-op admits at Drumheller (first rural site)
 Presentation to Regional Nursing Leadership
 Articles in Medical Staff Newsletter
 Display posters on all nursing units
Next Steps and
Plans for Spread
Life after LS3
 Develop plan for spread throughout RDRHC site and
then all rural sites
 Develop plan for link to Community (i.e. link to Meditech
Discharge Prescription Report; close the loop
admission/discharge/readmission)
Contact Information
Celina Colegrave
Medication Safety Officer
[email protected]
Tel: 403-357-5195