Transcript Storyboard Western Node Collaborative April 2008 Winnipeg

Western Node Collaborative
Brandon Regional Health Authority
Medication Reconciliation
Acute Care
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Background
• Brandon Regional Health Authority – covers city of Brandon, MB
and surrounding rural municipalities – ~180,000 people
• 1 regional hospital – 315 beds- serving Brandon RHA and many
outside regions
• Approximately 100 physicians and 14 pharmacies
• Medication Reconciliation project began @ Brandon Regional
Health Centre (BRHC) in May 2006
• Joined Western Node Collaborative of SHN in April 2007
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Aim
• Purpose: To prevent adverse medication occurrences through
medication reconciliation
• To implement the admission, internal transfer, and discharge medication
reconciliation process throughout BRHC
• Aim Statements
– Reduce unintentional discrepancies by 90% on admission to BRHC by
May 2008
– Reduce undocumented intentional discrepancies by 90% on admission
to BRHC by May 2008
– Complete HMIO form for 90% of patients admitted to BRHC by
February 2008
– Incorporate medication reconciliation for discharges from BRHC by
June 2009
– Incorporate medication reconciliation for internal transfers at BRHC by
November 2009
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Team Members
•
•
•
•
•
•
•
Mary Lou Lester – Pharmacist & Team Leader
Kristi Chorney – Quality/Risk Management
Dr. Groves – Physician Liaison
Sheldon Kokorudz – Pharmacy Director
Liliana Rodriguez – Planning/Evaluation
Seema Roberts – Manager ER/ICU
Kim Wallis – Program Educator (Policy &
Procedure)
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Acute Care Working Group
•
•
•
•
•
•
•
•
•
Shelley Yorke – ER Clinical Resource Nurse
Denise Woodland – Surgery Program Educator
Kathy Ward – ICU Clinical Resource Nurse
Claudia Nieradka – Extended Care, Rehab & Palliative Care Program
Educator
Wendy Dryburgh – Geriatric Psych Manager
Janet Petkau – Electronic Health Records
Peggi McKague – Practice Guidelines Facilitator
Suzanne Clark – Medical Floor Clinical Resource Nurse
Jane Lamont – Pharmacy Manager
– Provides us with positive and negative feedback from the frontline staff
– Assists with PDSA cycles and adaptation/modification of forms, policies and
procedures
– Attends all monthly meetings as schedules allow, optional attendance at monthly
teleconferences
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Changes Tested
P
D
A
S
#1: Pilot project
fall of 2006 for all
direct admissions
to medical floor &
knee replacement
patients in POAC
using Admission
Medication Order
(AMO) form
P
D
A
S
#2: Trial of the
“Home
Medication and
Initial Order”
(HMIO) form
(modified AMO
form based on
results from pilot
project) and new
Med Rec policy
in ER in May
P
D
A
S
#3 Completion
rate of HMIO
form followed to
identify areas
that needed to
improve on use
of the form, audit
done by unit
clerks when
chart dismantled
Coming Full Circle: AMI & Med Rec Across the Continuum
P
D
A
S
#4 POAC & preop flagging
completed HMIO
with green
plastic post-it
flag to make the
form more
visible to
surgeons when
writing post-op
orders -- help
identify patients
with an HMIO
available
P
D
A
S
#5 Compare
pharmacy
Centricity
med profile to
nursing MAR
to determine
the accuracy
of pharmacy
profile –
important to
know before
pursuing
electronic
Med Rec at
transfer &
discharge
Western Node Collaborative
Changes Tested
P
D
A
S
#6: audit of
random charts on
surgery unit done
to determine the
accuracy of
completion of the
HMIO
P
D
A
S
#7: BPMH
prompt card &
educational
pamphlet
developed for
staff to use
when
interviewing
the patient –
POAC & ER
trial ongoing
P
D
A
S
#8 Provide a
“You and your
Medication”
booklet to all
patients on
admission
encouraging
them to be more
knowledgeable
about their
medications
Coming Full Circle: AMI & Med Rec Across the Continuum
P
D
A
S
#9: bimonthly audit
of 10 charts
on each unit
to determine
the accuracy
of completion
of the HMIO –
results used
to evaluate
need for
further
education
P
D
A
S
#10: gather
data on
current
discharge
process
Western Node Collaborative
Results
1.0 Mean Number of Undocumented Intentional Discrepancies
Education and HMIO
Implementation
1
0.9
0.9
0.8
0.7
0.6
0.5
0.5
Additional Education
to new EMOs
0.4
New EMOs hired
0.3
0.3
0.3
0.2
0.2
0.2
0.2
0.1
0.1
0.1
Goal
0
Baseline
Jul-07
Aug-07
Sep-07
Coming Full Circle: AMI & Med Rec Across the Continuum
Oct-07
Nov-07
Dec-07
Jan-08
Feb-08
Western Node Collaborative
Results
2.0 Mean Number of Unintentional Discrepancies
1.4
Additional Education
to new EMOs
1.3
1.2
1.2
Education and HMIO
Implementation
1.1
1.1
New EMOs hired
1
1
0.9
0.9
0.8
0.8
0.6
0.6
Education for
improving med
history technique to
ER and POAC
Nurses
0.4
0.2
Goal
0
Baseline
Jul-07
Aug-07
Sep-07
Coming Full Circle: AMI & Med Rec Across the Continuum
Oct-07
Nov-07
Dec-07
Jan-08
Feb-08
Western Node Collaborative
Results
3.0 Medication Reconciliation Success Index
100%
90%
87%
90%
88%
86%
88%
87%
Goal
85%
83%
82%
80%
70%
New EMOs hired
Education and HMIO
Implementation
Education for
improving med
history technique to
ER and POAC
Nurses
Additional Education
to new EMOs
60%
50%
40%
30%
20%
10%
0%
Baseline
Jul-07
Aug-07
Sep-07
Coming Full Circle: AMI & Med Rec Across the Continuum
Oct-07
Nov-07
Dec-07
Jan-08
Feb-08
Western Node Collaborative
Results
4.0 Rate of Potential Harm
100%
90%
Education and HMIO
Implementation
80%
73%
70%
60%
53%
50%
43%
41%
41%
38%
40%
36%
35%
27%
30%
20%
Goal
10%
0%
Baseline
Jul-07
Aug-07
Sep-07
Coming Full Circle: AMI & Med Rec Across the Continuum
Oct-07
Nov-07
Dec-07
Jan-08
Feb-08
Western Node Collaborative
Results
5.0 HMIO Completion Rate
100%
Goal
90%
Observation Unit results
excluded from audit
80%
76%
72%
70%
66%
72%
66%
Education and HMIO
Implementation
78%
65%
End of HMIO
Completion Monthly
Audit
61%
60%
Results of HMIO
completion Challenge
by Unit shared
50%
40%
30%
20%
10%
0%
0%
Baseline
Jul-07
Aug-07
Sep-07
Coming Full Circle: AMI & Med Rec Across the Continuum
Oct-07
Nov-07
Dec-07
Jan-08
Feb-08
Western Node Collaborative
Keys to Success and
Barriers
• Major keys to success
– Strong team built
• Well-rounded representation of staff & departments
• Willingness of working group to support data collection
– Support of Executive Management
– 0.6 FTE Pharmacist dedicated to assisting Med Rec project
• Barriers
– Physician education and buy-in
• Difficult to obtain direct contact with most physicians
– Staff education – HMIO being completed, but not always accurately
&/or complete
– Staff outside the working group not readily supporting data collection
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Lessons Learned
•
Organizational skills and dedicated “Med Rec” time necessary for
smooth implementation, continuous growth, and data/report
submission to SHN
– Difficult to be done “part time”
•
Ensure good communication between frontline staff and Med Rec
team
– Ensure positive and negative feedback is addressed and an appropriate
response is made to the staff
•
Do not assume a form has been used correctly just because it was
used!!
•
Request funding for mandatory paid education time for front line staff
on the upcoming implementation of a discharge Med Rec process
– did not have for admission – only 25% of nurses recorded as attending education
inservice which was offered repeatedly over a 2 week period
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Next Steps
• Test revised HMIO form with ER physicians to help obtain a
more complete medication history at admission
• Develop training DVD for frontline staff to assist with obtaining
med history and completing HMIO form
• Expand education to patients regarding the importance of
keeping a current medication list and knowing their medications
through the media as well as to inpatients
• Begin trial of electronic Med Rec discharge process on one unit
using small group of physicians (6 to 8)
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Contact Information
• Mary Lou Lester – Pharmacist & Team
Leader
– [email protected]
• Kristi Chorney – Quality/Risk Management
– [email protected]
Kim Wallis – Program Educator (Policy &
Procedure
– [email protected]
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative