Transcript Thunder Bay Storyboard and Rapid Fire_ Template November 14

Thunder Bay Regional
Health Sciences Centre (TBRHSC)
Medication Reconciliation
Background
• Is a 375 bed academic health
science centre with a mission to
advance world-class Patient and
Family Centred Care in an academic,
researched-based acute care
environment.
• We provide service to Northwestern
Ontario with a population of
250,000 residents scattered over a
geographical area the size of France.
• Rationale – Improve patient safety
by developing a consistent approach
to obtain BPMH and reconcile
medications upon admission and
transfer
Aim
• Improve patient safety and risk for adverse
medication events
• Educate and engage critical care staff on the
medication reconciliation process
• Ensure Best Possible Medication History (BPMH) is
obtained and documented on all critical care patients
upon admission (process vs individual driven)
• To reconcile and document all medication
discrepancies on admission and transfer from critical
care
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Team Members
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Chad Johnson, Clinical Nurse Specialist – Critical Care
Wendy Winslow, Manager – Critical Care
Larry Bertoldo, Pharmacist
Lisa Beck, Director – Trauma Program, ED & ICU
Marios Roussos, Intensivist
Adam Vinet, Manager – Emergency Department
Cece Girard, Critical Care Staff Nurse
Katrina Niemi, Critical Care Staff Nurse
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Results
• Development of e-based Med Rec course on hospital
learning system
– Course content had input from staff and outlined key med
rec components and expected process
• Development of 24/7 BPMH process upon admission
using Pharmacist-Nurse collaborative model
– Nurses do BPMH on weekends and when pharmacist is off
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Results
• Development of tools and resources to facilitate
BPMH completion and involvement of family
– Paper form for family
– Triggers and reminders for staff to complete
• Development of process, forms and tools to facilitate
med rec upon transfer
– Pre-printed transfer orders with med rec section
– Availability of medication lists (BPMH vs current meds) for
patient rounds
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Results
• Re-education of staff after 8 months of
implementation to reinforce med rec key concepts
and utilize actual case based scenarios
– Using actual cases helped staff see relevance to change
and importance of med rec
• Ongoing engagement and recruitment of frontline
staff, including ward clerks to champion project
– Important to have several staff involved to sustain
processes after project completed
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Changes Tested
• Audited staff for completion and
comprehension of e-based Med Rec course
– Results reveal 100% completion, course easily understood
• Audited opportunities for RN to do BPMH
within 24 hrs of admission to ICU
– Results revealed more opportunity required
• Audits & interviews with staff to identify and
address barriers
– Approaches modified based on feedback
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Changes Tested
• Monthly audits done to assess completion
rates for nurse generated BPMHs on weekends
and when pharmacist is off
– Results reveal 75-80% completion rates
• Audit quality of nurse generated BPMHs
compared to pharmacist generated
– Areas for improvement identified and areas to refocus
education
• Audit compliance with med rec upon transfer
process planned for November
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Lessons Learned
• Need to follow-up individually (vs e-mail) with
nursing staff to assess barriers to BPMH completion
• Review and re-evaluate process frequently
– Changed BPMH completion timeframe extended to 48
hours
• Need a collaborative team approach model for
success
• Need to further engage physicians in process
• Takes time to integrate process changes into practice
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Lessons Learned
• Audit data helpful to demonstrate results of specific
strategies
– Impact when manager notifies staff that audit will follow
– Provides visual representation of successes
• Current computer charting system does not facilitate
streamline efficient med rec process
– Need to further work with IT/IS to develop solutions
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Next Steps
• Focus on refining a consistent medication
reconciliation process for all ICU transfers
– Get buy-in from Intensivist group
– Audit practice
• Integrate med rec throughout other areas of the
hospital
– Utilize lessons learned, tools and resources to
organizational strategy
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