Transcript Match Presentation

GHAREF HEN
Welcome to the MATCH Collaborative
PreWork Session
July 31, 2013
Medication Reconciliation
Using the MATCH Toolkit
“Presented to”
Georgia Hospitals
July 31, 2013
Kristine Gleason, MPH, RPh - Clinical Quality Leader, Northwestern Memorial Hospital
Vicky Agramonte, RN, MSN - Project Manager, Healthcare Quality Improvement Program , IPRO
Today’s Objectives
1. Provide an introduction of the MATCH
Toolkit
2. Discuss pre-work requirements to participate
in the MATCH-lite Collaborative
3. Discuss strategies to link medication
reconciliation with current initiatives
3
MATCH “lite” Collaborative Timeline
•
July 17, 2013 HAC Call to introduce collaborative
•
July 31, 2013 Introduction to the MATCH toolkit and
Collaborative Pre-work
• August 20, 2012 Regional Meeting – Savannah
•
August 27, 2013 Regional Meeting – Atlanta
•
September/October Coaching Calls – Date/Time TBD
https://members.gha.org/source/Calendar/
A Focus On
Medication Reconciliation
A process to decrease medication errors and patient harm
by:
1. Obtaining, verifying, and documenting patient’s current prescription and
over-the-counter medications; including vitamins, supplements, eye
drops, creams, ointments, and herbals
2. Comparing patient’s pre-admission/home medication list to ordered
medicines and treatment plans to identify unintended discrepancies
3. Discussing unintended discrepancies (e.g., those not explained by the
patient’s clinical condition or formulary status) with the physician for
resolution
4. Providing and communicating an updated medication list to patients
and to the next provider of service at discharge
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Adapted from The Joint Commission National Patient Safety Goal 03.06.01
Current Evidence to Reduce Readmissions:
Implementing Bundled Interventions
Pre-Discharge
Intervention
Bridging
Interventions
• Patient education
• Transition coaches
• Medication Reconciliation • Physician continuity
• Discharge planning
across settings
•Scheduling follow-up
• Patient-centered
appointment
discharge instruction
Post-Discharge
Intervention
• Follow-up telephone calls
• Patient-activated hotlines
• Timely communication with
next provider of service
• Timely follow-up with
ambulatory provider
Note: Individual components of these change packages have not been tested
by themselves and might not reduce the risk for 30-day rehospitalization.
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Source: Hansen et al. Interventions to Reduce 30-Day Rehospitalization: A Systematic Review.
Ann Intern Med. 18 October 2011;155(8):520-528.
Does Medication Reconciliation Impact
the Patient Experience?
Hospital Consumer Assessment of Healthcare Providers and
Systems (HCAHPS) Domains:
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•
•
•
Communication with Nurses
Communication with Doctors
Responsiveness of Hospital Staff
•
•
•
Pain management*
Communication about medicines*
Discharge information*
•
•
•
•
Cleanliness of hospital environment
Quietness of hospital environment
Overall rating of hospital
Willingness to recommend hospital
*Impacted by
Medication
Reconciliation
Source: HCAHPS Fact Sheet. Available at: http://www.hcahpsonline.org/facts.aspx (accessed 2012 June 20)
Opportunities to Educate and Communicate
• Use Medication Reconciliation as an opportunity to educate
patients on their medications throughout their hospital stay
– Home medications that are continued during the hospitalization
– Home medications that were discontinued and why
– Ordered medications, include indication and possible side effects
– Ordered as-needed (PRN) medications that are available to them by
asking
• Empower patients to ask questions and become active
•
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partners
Trace patients through hospital stays to identify opportunities
for interaction
ED
Admission
Intrahospital
Transfer
Discharge
PostDischarge
“Bundling” Medication Reconciliation
with Current Initiatives
Care Transitions
ED
Admission
Intrahospital
Transfer
Discharge
PostDischarge
Phases of Medication Management
Med History,
Reconcile
Order,
Transcribe,
Clarify
Procure,
Dispense
Deliver
Administer
Monitor
Educate,
Discharge
Measurement / Analysis
Harm Estimate/Evidence from Literature
Harm Estimate/Evidence from Organization
Prioritize / Implement Evidence-Based Interventions
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Measure Improvements / Monitor for Sustainability
A Step-by-Step Guide to Improving the
Medication Reconciliation Process
MATCH Toolkit, with
customizable, actionable
information, is available
at:
http://www.ahrq.gov/qua
l/match/match.pdf
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YOUR Mission (to implement a successful med rec
process) if YOU Choose to ACCEPT It
Webinar 1
July 11
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Webinar 2
July 31
Regional Meetings
August 20 OR August 27
2 Office Hours
Calls
Date/Time TBD
DEFINE
MEASURE
ANALYZE
IMPROVE
CONTROL
Build the
Project
Foundation
Establish a
Measurement
Strategy
Design/
Redesign the
Process
Implement the
Process
Assess and
Evaluate
Identify Team
Members
Data
Collection Plan
Flow Chart
Implementation
Plan
Monitor
Performance
Process Map
Collect Data
Pilot Test
Develop a
Charter
Identify Key
Drivers
Address low
compliance
Gap Analysis
Process
Design
Education /
Training
Sustainability
A Systematic Approach to Improvement
DMAIC is a step by step process improvement methodology used to
solve problems by identifying and addressing root causes
Define
Measure
Identify the problem
and goal
Measure current
performance
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Analyze
Validate key
drivers of error
Improve
Control
Use mechanisms
to sustain
improvement
Fix the drivers of
poor performance
For more DMAIC information, including free access to a toolkit and project templates,
visit the Society for Healthcare Improvement Professionals website at www.shipus.org
Define
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Build the Project
Foundation
Assemble Your Team
Executive Sponsor
Project responsibilities: provide overall guidance and accountability, remove barriers, provide
strategic oversight and appropriate resources, review progress
Sponsors
Project responsibilities: accountable for success, responsible for implementation of
recommendations, provide tactical oversight, reach clinical consensus
Improvement Leader
Project responsibilities: Accountable for using DMAIC to manage project and
complete deliverables in a timely manner, partner with Process Owner
Process Owner
Project responsibilities: Accountable for implementing, controlling and
measuring the project outputs and improvements
Team Members: Make significant and focused contributions to
timely and successful implementation
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EVERYONE Is Involved and Accountable!
Map the Current Process
A High Level Process Map is a simple picture of a complex process represented by 4-8 key
steps. It is essential to better understand the process being improved and to gain
agreement on project scope.
Physician places discharge order
Physician writes new prescription
Physician prepares d/c instructions
Nurse collects the d/c instructions and
prescription and counsels the patient
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Patient discharged
How to construct a high level process map:
1. Get Team together - include all stakeholders
2. Define and agree to a process
3. List all participants of the process – depts., mgrs, and
job performers
4. Define beginning and end points
5. Brainstorm key process steps
6. Determine order of process steps
7. Validate by physically walking through process
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Develop a Charter
Strategic Linkage
• Clearly ties the project to organizational goals
Problem Statement
• Concise description of the issues
Goal
Scope
• Area to be covered – avoid scope creep
Deliverables
• Tangible end-products, must align with goal
Resources
• Necessary requirements for project success
Metrics
Milestones
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• Describes planned accomplishments
• Objective measurement of progress
• Used to monitor progress and maintain focus
Medication Reconciliation Phase III
Linkage to NMH Goal: Best Patient Experience – Deliver care that is safe and without error.
Advancing
Excellence in
Problem
Health
Care Statement: NMH has made significant strides in developing and implementing a Medication Reconciliation process
organization-wide. Through close measurement and monitoring, we have identified the need for additional efforts including:
process reassessment and refinement (SDS, Prentice, Discharge). With the proposed 2009 revision to The Joint Commission
standard we are presented with new process design opportunities (ED, Outpatient Areas); and, a renewed focus on transfers
(internal and external).
Goal/Benefit: 1) To measurably decrease the number of discrepant medication orders (both inpatient and outpatient) and the
associated potential and actual patient harm. 2) Fully meet the Joint Commission’s National Patient Safety Goal #8,
documentation and reconciliation of all medications at admission, transfer and discharge for all inpatients, ED visits and
outpatient encounters and external transfers.
Scope: Focus on outpatient Same Day Surgery, Prentice, ED, and procedural areas, transfer and discharge processes
Deliverables:
• Improved compliance of medication reconciliation through refined processes in areas stated above.
• A sustainable measurement and monitoring approach to be embedded in current reporting infrastructure.
Resources Required:
• We will need leadership to prioritize med rec work and facilitate manager involvement in design and implementation efforts
Key Metric(s):
• % inpatient Med Rec compliance at admission,
transfer and discharge by discipline (MD, RN, RPh)
• % inpatient Med Rec compliance by service
• % outpatient Med Rec compliance at admission and
discharge
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#1
#2
#3
#4
Exec Sponsor: C Watts Sponsors: DDerman-MD, CPayson-RN, DLiebovitz–IS, NSoper-Surgery
JFoody, KOLeary–Medicine, KNordstrom–Pharmacy
Milestones:
Description
Date (month, 2008-9)
Define Phase
July
Measure/Analyze
August
Improve
December
Control
January
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Subject Matter Expert: K Gleason
Process Owner: H Brake
Improvement Leader: ML Green
A Word About Scope
Begin by
identifying all
areas within
your facility
where patients
receive
medication.
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Tips for Successful Chartering
•
•
•
•
•
•
•
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Keep it simple … anyone should be able to review your
charter and know what you are looking to do and why it is
important
Include data … If you do not have initial data, use
placeholders
Identify where the project “Starts – Stops”
Ensure your scope reflects your time horizon
Try to avoid projects over 12 months long
Estimate where necessary, refine over time …
‘something’ provides a guide, ‘nothing’ causes delays
Focus on outcomes
Measure
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Establish a
Measurement
Strategy
Data Collection Plan
Caution: Jumping into data collection without a clear plan wastes time,
energy, resources, etc.
What to
Operational
Collection
Measure
Definition
Method
What
Question the
Specific
System, existing Elements to be
data will answer Definition
forms, new
collected
handwritten
forms, etc.
“Medication
Copy of Atinstructions
Home Meds
Was an updated were reviewed
List form,
medication list
with the
reasons for
provided to the
patient”
nonpatient and checked on AtManual
compliance.
reviewed at
Home Meds collection from Use Med Rec
discharge?
List form
existing forms
audit form
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Sampling Plan
Where
When
How Many
Physical
Timing and Number of
location frequency of data points
collection
to be
collected
GI Lab
2-weeks all
shifts. August
15 - 31
All visits
Collect Data
•
•
Work with the team and
staff to identify potential
drivers and build a data
collection form
Seek assistance from the
team and staff in collecting
the data to increase buy-in
•
Observe the data collection
process periodically to
identify issues, errors
•
Graph the data you intend
to collect to (1) confirm how
you plan to use the data
and (2) identify any missing
data elements
Identify Key Drivers
The backside of the baseline data collection form:
Identifying
(& addressing)
the problematic
issues that
drive outcomes
will lead to
lasting
improvement
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Involvement of Frontline Staff is KEY
Analyze
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Design/Redesign
the Process
Flow Chart
A flowchart outlines current
workflow and helps identify:
•Successful medication
reconciliation practices
•Current roles and
responsibilities for each
discipline at admission,
transfer, and discharge
•Potential failures
•Unnecessary redundancies
and gaps in the process
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Gap Analysis
•
•
•
•
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Assess the current state of your facility’s medication
reconciliation process
Identify gaps between your current process and one
that comprises best practices
Collect policies, procedures, programs, metrics, and
personnel that support the current process
Describe barriers and rate implementation feasibility
Design a Successful Med Rec Process
Best Practice: Develop a single medication list, "One Source
of Truth”
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Guiding Principles
•
•
•
•
•
•
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Clearly define roles and responsibilities
Standardize, simplify, and eliminate unnecessary
redundancies
Make the right thing to do the easiest thing to do
Develop effective forcing functions, prompts, and
reminders
Educate workforce, and patients, families, and
caregivers
Ensure process design meets all pertinent local
laws or regulatory requirements
Strategies to Overcome
Lack of Resources and Time
1. Get Leadership Buy-In
• Let them know why they should care: Patient Safety,
Public Reporting, Financial Incentives
2. Bundle the Work
• Identify similarities among projects – get 2 things
accomplished for the price of 1
3. Identify Opportunities for “Quick Wins”
• Prioritize changes that may be easily developed and
implemented
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Homework
Complete prior to the regional meeting:
1. Put together a High Level Process Map for med
rec. Remember: Keep it high level – No more than
8 steps
2. With your team, create a project charter. Use the
template on the next slide
3. Adopt a plan to collect baseline data and audit 5
medical records for compliance with the current
process
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Questions and Discussion
Vicky Agramonte, RN, MSN
Project Manager
Healthcare Quality Improvement Program
Island Peer Review Organization, Inc. (IPRO)
Albany, NY 12211-2370
(518) 426-3300 X115
[email protected]
Kristine Gleason, MPH, RPh
Clinical Quality Leader
Northwestern Memorial Hospital
Chicago IL 60611
312.926.9172
[email protected]
THANK YOU!
If you want to learn more about IPRO, please visit our website at: http://www.ipro.org
If you want to learn more about Northwestern Memorial Hospital, please visit our website at http://www.nmh.org