© institute for safe medication practices canada 2009® preventing adverse drug events (ades)...

© Institute for Safe Medication Practices Canada 2009®

Preventing Adverse Drug Events (ADEs) through Medication

Reconciliation

State of the Nation – National Teleconference

April 2009

© Institute for Safe Medication Practices Canada 2009® Slide 2

Objectives

• To provide updates, developments, issues and learning from the intervention leadership team:

• Marg Colquhoun, Olavo Fernandes, Brenda Carthy & Alice Watt

• To encourage measurement appropriate to your MedRec model

• To celebrate what we have accomplished


Agenda• Medication Reconciliation Updates:

• State of the Nation• Acute Care• Long Term Care (LTC)• Tools

• Measurement Update• Clarity, Frequency and Duration

• Moving on with Medication Reconciliation……• Transfer, Discharge, Homecare Pilot,

Ambulatory/ Community, High 5’s

• Open Forum : Q & A’s


What impact has SHN had in Canada?

“Thousands of practitioners are collaborating, sharing, learning, implementing safe practices and

improving safety”

Phil Hassen, CEO CPSI Accomplishment Report


SHN Medication Reconciliation Teams

As of March 2009

Acute Care: 320

Long Term Care: 84

Home Care: 15

Total = 419 Canadian Teams


Med Rec Accomplishments

• Dr. Chaim Bell - CIHR research project

• University Health Network – National Commitment to Care Award

• Vancouver Coastal Health Providence Healthcare – 3M Healthcare Quality distinction award

• Send us ones we do not know about!


Acute Care

• Lilly Hospital Pharmacy National Survey Results (n=158)

• Seventy-one percent (71%), of respondents are registered as participating in the Safer Healthcare Now! medication reconciliation intervention


Long Term Care

• Atlantic Node just completed a successful LTC Collaborative with > 20 teams

• Ontario Node leading a project in fall 2009 with ~ 14 teams

• Kaizen project in Toronto


What We’ve Learned

• MedRec decreases the potential for ADEs

• MedRec requires training

• Why MedRec?

• Get your own cases, use your own data

• How it is done in your organization

• BPMH training is vital

• People are beginning to expect MedRec


Accreditation Canada Evidence of Compliance Changes

• Triage and Clinics

• Currently preparing ROP information for consultation with content experts and organizations

• Accreditation Canada views this work as a priority and that updated information will be released over the next few weeks


International Med Rec- High Fives

• CPSI/ ISMP Canada is also collaborating with the World Health Organization on medication reconciliation

• ‘Assuring Medication Accuracy at Transition in Care’ for the WHO/Joint Commission International High 5s

• Being launched in June 2009

• Will be recruitment of Canadian teams


Med Rec Communities of Practice (CoP)


The medication reconciliation CoP has garnered over 1,000 members since its launch just three years ago.

CoP Membership


Med Rec COP Usage by Month

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Nu

mb

er

of

Hit

s

MedRec CoP Usage Statistics

The site receives upwards of 18,000 visits per month with numerous members engaging in helpful discussion threads.


New Community of Practice

• FAQ’s based on 3 years of experience

• Greater capacity

• Growing pains

• Tutorials


New CoP Issues

• Login to the new CoP

• If you need help contact Brenda Carthy at [email protected]

• Reaching our members

• Set an alert for the Announcements. Instructions are available in the HELP section.

• Send feedback to [email protected]

mailto:[email protected]

mailto:[email protected]


CoP Help


SHN Mentorship Program

• Mentorship program links successful teams to teams that require assistance with their programs

• Facilitates a one-on-one institution partnerships with teams/ institutions that have learnings/ successes they can share to mentor other teams

• Call for mentors and mentees

• Mentorship program links successful teams to teams that require assistance with their programs

• CoP has information

• Contact us if you are interested in participating


Tools and Resources

New Wallet Card Coming Soon

Medications: More Than Just Pills!!!

Prescription Medicines

These include anything you can only obtain with a doctor’s

order such as heart pills, inhalers, sleeping pills.*

Eye/Ear Drops Inhalers Nasal Spray Patches Liquids Injections Ointments/Cream

Prompt the patient to include medicines they take every day and also ones taken sometimes such as for a cold, stomachache or headache.

DON’T FORGET THESE TYPES OF MEDICATIONS

Over-The-Counter Medicines

*These include things that can be purchased at a pharmacy without an order from the doctor such as aspirin, Tylenol, laxatives, other bowel care products, herbs like garlic and Echinacea or vitamins and minerals like calcium, B12 or iron.

AND

Adapted from


Additional Tools

• BPMH training• Frequently Asked

Questions: FAQ’s• E learning packages

under consideration• Medication

reconciliation introduction packages

See the Community of Practice


Measurement


MedRec Teams Reporting to Central Measurement Team

National Statistics:

• Average of 100 teams reporting every month to Central Measurement Team


Measurement Activity

15%

34% 33%

18%

0%

20%

40%

60%

80%

100%

At Goal Active Inactive No Data

Activity Level by InterventionMedication Reconciliation - Sept 2008


•

The average rate of unintentional discrepancies decreased from 1.02 between November 2005 and June 2006, to an average rate of 0.61 discrepancies between May 2007 and December 2008.


Over a 16-month period, the average rate of undocumented intentional discrepancies dropped from 0.77 to 0.48 and has been sustained for an additional 20 months.


Measurement Learning from Teams

Several similar interdisciplinary practice models or processes possible

Important to distinguish for measurement purposes

1. Proactive Reconciliation2. Retroactive Reconciliation3. Hybrid model of 1 and 2


Proactive Medication Reconciliation Process

1. Create the BPMH

2 Using the BPMH, Admission medication orders (AMOs) are written by the prescriber.

3. Verify that the prescriber has assessed every medication on the BPMH, identifying and resolving any outstanding discrepancies with the prescriber, if any.

BPMHBPMH Admission Orders

Admission Orders

STEP 1 STEP 2 STEP 3

Verify every medication in BPMH has been assessed by prescriber.

PROACTIVE MEDICATION RECONCILIATION MODEL

LEADS TOLEADS TO


Retroactive Medication Reconciliation Process

1. Primary medication history is taken

2. Admission medication orders are written by prescriber

3. Create the BPMH

4. Compare the BPMH against the patient’s admission medication orders, identifying and resolving any discrepancies with the prescriber.

STEP 4Compare BPMH with AMOs and resolve any discrepancies

Primary Medication

HIstory

Primary Medication

HIstory

Admission Orders

Admission Orders BPMHBPMH

STEP 1 STEP 2 STEP 3

RETROACTIVE MEDICATION RECONCILIATION MODEL

LEADS TOLEADS TO


Measurement Learning

• Everyday reconciliation process and measurement process are actually distinct and different activities

• After baseline, team needs to measure after reconciliation in order to measure the improvement


When should you measure ?


When to measure?(unintentional and undocumented intentional

discrepancies) • Done after the team has completed its normal or

standard reconciliation processes• Second person

• Independent of clinician who has done the main reconciliation• Resource requirements - meant to be low intensity • Performed on a very small sample (subset of patients) monthly

for a finite period of time only • Can be from same clinical area, different clinical area, quality /

patient safety staff member• Aim is to measure the quality of medication reconciliation

• To ensure medication discrepancies have all been identified (no need to count discrepancies team has identified and are in the process of being resolved)

• Look at all available patient information - no need to repeat BPMH, clarify with team as necessary


When to Stop/ Change Frequency of

Measuring Unintentionals?

• Reached its 1) measurement goal (original relative target definition) or 2) reached 0.3 unintentional discrepancies per patient (absolute target- average 75th percentile for MedRec 2 for calendar 2008)

• Held its gains for 3 consecutive data points (months) in a 3-6 month period is considered to be “At Goal”.

• Teams at goal can start/ continue to measure % of patients with formal reconciliation at admission (regularly)

• Should then ensure quality is maintained by reinstituting discrepancy measurement twice/year


New Measure for Admission Medication Reconciliation

• Added to align / synchronize with Accreditation Canada performance indicators (same definitions)

• % patients receiving formal medication reconciliation on admission

• Denominator is total admissions (can be by unit or institution)


Moving On

• Transfer medication reconciliation

• Discharge medication reconciliation

• E-learning

• Ambulatory care

• Homecare


MedRec at Transfer and Discharge

• Feedback from teams: many have started and moved toward sustaining admission med rec and are now earnestly focused on transfer and discharge

• National Calls Upcoming – revisit principles, processes and tips on these interfaces

• Teams sharing their successes, lessons learned and processes

• Studies completed and in progress

For Consideration: Ambulatory Medication Reconciliation ModelFor Consideration: Ambulatory Medication Reconciliation Model Creating the most “up to date” medication record (BPMH)

(From SHN Home Care Pilot)

Patient and Family Interview

Medication Information from all

other sources

document

“up to date” medication

record (BPMH)

“medication discrepancies that

require clarification”

Compare:Compare:

Review and follow

up where indicated

Examples:

•Medication vial inspection

•Referral record

•Community pharmacy

•Hospital Discharge Summary


Medication Reconciliation Homecare

• Evidence shows significant issues with medication errors in home care.

• SHN! is exploring the issue in the home and community care realm in a pilot project


Aim of Pilot Project • Develop/validate framework to aid

homecare providers in the implementation of medication reconciliation into care delivery processes.

• This framework is to take into consideration the unique challenges of the homecare delivery setting in Canada.

• This is being done by exploring developing and testing medication reconciliation strategies for implementation in the homecare setting.


What are the teams doing?

• Applying a structured medication reconciliation process to targeted client populations

• Testing tools, guides and measures to determine what works and what does not work in the home care setting.

• Collecting data in order to identify processes for improvement throughout the pilot

• Identifying the challenges that are unique to applying medication reconcilation processes in this sector


Early Successes

• Positive impact on clinicians

• Clinicians are beginning to spread the word outside the pilot that this is best practice

• Success with strategies for physician engagement

• With familiarity, process time is decreasing

• Preliminary data demonstrates that medication reconciliation is needed in the homecare sector


OVERALL VIEW: Measure Three

Percentage of Discrepancies that require clarificationDiscrepancy Rate

0%

20%

40%

60%

80%

100%

120%

Pilot Teams

Per

cen

tag

e o

f D

iscr

epan

cies

Atlantic

Ontario

Western


OVERALL VIEW: Measure Two

Time to Complete the BPMHTime to Complete the BPMH in Minutes

0

20

40

60

80

100

120

Pilot Teams

Tim

e in

Min

ute

s

Atlantic

Ontario

Western


• Please contact Brenda Carthy for CoP issues [email protected]

• Please send your email address to Brenda Carthy [email protected]

© institute for safe medication practices canada 2009® preventing adverse drug events (ades)...

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