Transcript Providence Health Residential BC Med Rec

Western Node Collaborative
Providence Health Care
Medication Reconciliation
Residential Team
Learning Session 3 Storyboard
Pharmacy Services
Providence Health Care - Residential
Five Residential care sites
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Holy Family Hospital ECU
Langara
Mount Saint Joseph Hospital ECU
Brock Fahrni Pavillion
Youville Residence
Home to 697 residents
Admissions to Residential Care via Priority Access
• 40% of PHC residential admissions came from PHC acute sites
• Other 60% from:
– Other acute care facilities
– Other residential care facilities
– Direct from the community
– Readmissions
Pharmacy Services
Residential Team Members
• Lynette Best (Sponsor)
• Pam Kelly, Residential Section Head, Pharmacy
Services (Team Lead)
• Fruzsina Pataky, Regional Medication Safety Coordinator
• Sue Higginbotham, Clinical Nurse Leader, Holy Family
• Julia Duda, QI Specialist
• Jody Burrell, Pharmacist Youville
• Lisa James, Pharmacist Brock Fahrni
• Barb Laurillard, Pharmacist Langara
• Ron Wall, Coordinator, Pharmacy IS
• Nick Groves, Project Leader - Primary
Health Care Transition Fund
Pharmacy Services
Aim Statements
1. Reduce the mean number of undocumented
intentional discrepancies on residents moving into
Residential Neighbourhoods by 75% by October
2006
2. Reduce the mean number of unintentional
discrepancies on residents moving into Residential
Neighbourhoods by 75% by October 2006
3. Increase our Medication Reconciliation Success
Index (MRSI) by 75% by October 2006
Pharmacy Services
Baseline Data
Measure
Baseline
Undocumented
Intentional
Discrepancies
1.4 per resident
Unintentional
Discrepancies
0.9 per resident
Success Index
82%
Pharmacy Services
Objectives
• To streamline the medication reconciliation
process
• To examine all moving in processes related to
medications
• To minimize transcription
• To ensure that medications are not overlooked
Pharmacy Services
Streamlined Processes:
Pharmacy Services
Moving In Medication Orders - MIMO
Pharmacy Services
Changes Tested
P D
A S
PDSA 1
Jan-Feb 06
Implemented
MIMO at
Holy Family
ECU
P D
A S
PDSA 2
Mar 06
Evaluation of
HFH MIMO
Implementation
PDSA 3 Nurse
Satisfaction
PDSA 4 Posted
RN Instructions
P D
A S
P D
A S
PDSA 5
Apr 06
Developed Rx
spreadsheet to
track MIMOs
PDSA 6
Implemented
MIMO at
Langara
Residence
PDSA 7
May 06
Implemented
MIMO at MSJ
ECU
PDSA 8
Implemented
review of
stopped
orders
Pharmacy Services
P D
A S
PDSA 9
Aug 06
Implemented
MIMO at Brock
Fahrni
Medication Reconciliation Indicators
PHC Residential Care Admissions
1.60
100%
90%
1.40
1.00
MIMO
Implemented
at 1st Site
Holy Family
MIMO
Implemented
at 2nd Site
Langara
0.80
MIMO
Implemented
at 4th Site
Brock Fahrni
80%
70%
60%
50%
One outlier
n=9
40%
0.60
30%
0.40
20%
0.20
10%
0.00
0%
Jan-06
Feb-06
Mar-06
Undocumented Intentional Discrepancies
(per patient)
Target (0.21 per patient)
Apr-06
May-06
Jun-06
Jul-06
Target (0.35 per patient)
Medication Reconciliation
Success Index
Pharmacy
Services
Aug-06
Sep-06
Oct-06
Unintentional Discrepancies
(per patient)
Target (96%)
Success Index
Rate (per patient)
1.20
MIMO
Implemented
at 3rd Site
Mount St.
Joseph
Undocumented Intentional Discrepancies
Upon Admission
1.6
Baseline
1.4
1.2
MIMOs
Implemented
Rate
1
0.8
Undocumented
Intentional
Discrepancies
(per patient)
0.6
Target (0.35 per
patient)
0.4
0.2
0
Jan-06
Feb-06
Mar-06
Apr-06
May-06
Jun-06
Jul-06
Aug-06
Pharmacy Services
Sep-06
Oct-06
Unintentional Discrepancies
Upon Admission
0.90
Baseline
0.80
One outlier
n=9
0.70
0.60
0.50
Rate
MIMOs
Implemented
0.40
Unintentional
Discrepancies
(per patient)
0.30
Target (0.21 per
patient)
0.20
0.10
0.00
Jan-06
Feb-06
Mar-06
Apr-06
May-06
Jun-06
Jul-06
Pharmacy Services
Aug-06
Sep-06
Oct-06
Medication Reconciliation Success Index
Upon Admission
120%
100%
Baseline
80%
60%
Medication
Reconciliation
Success
Index
MIMOs
Implemented
40%
Target (96%)
20%
0%
Jan-06
Feb-06
Mar-06
Apr-06
May-06
Jun-06
Jul-06
Pharmacy Services
Aug-06
Sep-06
Oct-06
One Resident’s Story
• TW,
75 year old female
Home
VGH
UBCH
Langara
May 8
May 19
June 13
• 5 drugs omitted on initial admission from home
• At least 3 opportunities for medication
reconciliation
• Undetected until admitted to Langara
Pharmacy Services
Leadership Support
• Organizational commitment to best practice and
evidence based care
• Early engagement with the Institute for Healthcare
Improvement Collaboratives
– 2001 Quantum Leaps in Patient Safety
• Patient Safety Leader Position created 2004
– Patient Safety Officer Training – IHI
• Joined Safer Healthcare Now! Campaign in 2005
implementing all 6 initiatives
• Participation in SHN Med Rec Collaborative
Pharmacy Services
Keys to Success
• Team Accelerators
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Team Leader - Early Adopter
Physician advocate
Resources allocated to do the work
Quality Support
Small Tests of Change
Nurse and Physician Buy In – What’s in it for me?
• Rolling out – implementing across program
– Involving key stakeholders – CNL, UC, Rx
– Education
– Timely follow-up - communication
Pharmacy Services
Lessons Learned
• RNs need to be reminded of their role in reconciling the
medication list with the residents current/previous medications
prior to faxing MIMO to physician’s office
• Generating MIMO’s more than 24hr prior to the arrival of the
resident results in confusion and duplication of work.
• Nurses need to be reminded to NOT have the physician fax the
completed form back to them. The reconciliation needs to take
place over the phone in order for Pharmacy to receive a clean,
legible copy of the orders
• Standing orders tend to be omitted by the nursing staff (bowel
protocol) on the MIMO. Pharmacy automatically enters these
orders now.
Pharmacy Services
Next Steps
• Complete MIMO implementation at final PHC
Residential Care site
• Develop implementation plan for PharmaNetbased Admission Medication Orders to be used
at PHC Residential Care sites for admissions
from the community
• Adapt printed discharge orders from other VCH
Acute Care facilities as admission
orders to PHC Residential Care
Pharmacy Services
Contact Information
For more information contact:
Pam Kelly, Team Leader
Phone:
Email:
(604) 322-2601
[email protected]
Pharmacy Services