caphc-shn paediatric medication reconciliation collaborative listen, reflect and move forward early...
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CAPHC-SHN Paediatric MedicationReconciliation Collaborative
Listen, Reflect and Move ForwardEarly Implementation Data Update and Key Learnings
Elaine OrrbinePresident & CEO
Canadian Association of Paediatric Health Centres
JoAnne WhittinghamCAPHC National Patient Safety Coordinator
Sixth Interactive Teleconference
Listen, Reflect and Move Forward
September 6th, 2006
Myth: Children are “Little Adults”
Child and youth health issues must be recognized and integrated within the overall health reform agenda
Key Challenges in Child and Youth Health Care
Sixth Interactive Teleconference
Listen, Reflect and Move Forward
September 6th, 2006
The CAPHC-SHN Paediatric Medication Reconciliation Collaborative (PMRC)
16 health centres from coast-to-coast representing six provinces have established 18 paediatric medication reconciliation teams
Patient populations vary across the teams from children admitted to paediatric wards in community hospitals to more complex populations including nephrology, mental health and respiratory medicine within acute care settings
Collectively the teams have made significant progress in changing the way we do business
As we move forward, more teams are coming on board and will benefit from the wisdom of the experienced teams
Sixth Interactive Teleconference
Listen, Reflect and Move Forward
September 6th, 2006
PMRC: Data Submissions
As of the end of June 2007: Baseline data from 18 teams
40 monthly submissions of baseline data Data collected on a median of 20 patients (range 10 to 94
patients per team ) and a total of 485 patients were reviewed Early implementation data from 16 teams
111 monthly submissions of early implementation data Data collected on a median of 50 patients (range 10 to 243
patients per team) and a total of 1360 patients were reviewed Full implementation data from 3 teams
14 monthly submissions of full implementation data Data collected on a median of 49 patients (range 5 to 92 patients
per team) and a total of 146 patients have been reviewed to date
Sixth Interactive Teleconference
Listen, Reflect and Move Forward
September 6th, 2006
Baseline and early implementation data;Distribution of Type 3 Discrepancies
0
0.2
0.4
0.6
0.8
1
1.2
1.4
Mea
n N
um
ber
of Typ
e 3
Dis
crep
anci
es
Team/Patient Population
Baseline 0.67 1.17 0.5 0.6 0.43 0.57 0.2 0.6 0.24 0.25 1.25 0.27 0.14 0.43 1.2 0.07 0.41 0.63
Early Implementation 0.15 0.5 0.41 0.25 0.26 0.26 0.26 * 0.08 0.08 0.88 0.16 0.27 0.81 1 * 0.18 0.09
A B C D E F G H I J K L M N O P Q R
Sixth Interactive Teleconference
Listen, Reflect and Move Forward
September 6th, 2006
Baseline and Early Implementation Data;Type 3 Discrepancies (System-wide)
Across the paediatric teams, a total of 485 patients were reviewed during the baseline stage and 261 Type 3 discrepancies were identified
The mean number of baseline Type 3 discrepancies identified ranged from 0.07 to 1.25
During the early implementation stage, a total of 1360 patients were reviewed and 389 Type 3 discrepancies were identified
The mean number of Type 3 discrepancies identified ranged from 0.08 to 1.00
Overall, for teams that have submitted early implementation data the mean number of Type 3 discrepancies per patient has decreased from a baseline value of 0.55 to an early implementation value of
0.29!
Sixth Interactive Teleconference
Listen, Reflect and Move Forward
September 6th, 2006
Baseline and Early Implementation Data;Distribution of Type 2 Discrepancies by Team
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8M
ean
Num
ber
of T
ype
2 D
iscr
epan
cies
Team/Patient Population
Baseline 0.33 0 0 1.3 0.18 0.29 0.3 0.93 1.030.25 1 0.270.050.13 1.6 0.2 0.59 1.05
Early Implementation 0.040.13 0.231.060.35 0.1 0.26 * 0.160.360.52 0.36 0 0.5 0.1 * 0.24 0.17
A B C D E F G H I J K L M N O P Q R
Sixth Interactive Teleconference
Listen, Reflect and Move Forward
September 6th, 2006
Baseline and Early Implementation Data;Type 2 Discrepancies (System-wide)
Across the paediatric teams, a total of 485 patients were reviewed during the baseline phase and 236 Type 2 discrepancies were identified
The mean number of Type 2 discrepancies identified ranged from 0 to 1.6 per patient
During the early implementation stage, a total of 1360 patients have been reviewed, to date, and 400 Type 2 discrepancies have been identified
The mean number of Type 2 discrepancies identified ranged from 0 to one per patient
Overall, for teams that have submitted early implementation data, the mean number of Type 2 discrepancies per patient has decreased
from a baseline value of 0.45 to an early implementation value of 0.29
Sixth Interactive Teleconference
Listen, Reflect and Move Forward
September 6th, 2006
Key Learnings
From a system-wide lens there has been an overall decrease in discrepancies
13/18 teams have made more than a 50% reduction in Type 3 discrepancies
10/16 teams have made more that a 50% reduction in Type 2 discrepancies
HOWEVER, we need to look at both sides of the coin While some teams are close to their goal (a 75%
reduction in the baseline rate) not all teams consider these changes to be sustainable
Sixth Interactive Teleconference
Listen, Reflect and Move Forward
September 6th, 2006
Team Example 1
2.0 Mean Number of Unintentional Discrepancies
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
Nov 2
005
Dec 2
005
Jan
2006
Feb 2
006
Mar
200
6
Apr 2
006
May
200
6
Jun
2006
Jul 2
006
Aug 2
006
Sep 2
006
Oct 2
006
Nov 2
006
Dec 2
006
Jan
2007
Feb 2
007
Mar
200
7
Apr 2
007
May
200
7
Jun
2007
Jul 2
007
Aug 2
007
Sep 2
007
Oct 2
007
Nov 2
007
Dec 2
007
Jan
2008
Feb 2
008
Mar
200
8
Apr 2
008
May
200
8
Jun
2008
Month
Mea
n
Actual Goal
One month of baselineOverall rate 0.63 (12/19)
5 months of early implementationOverall rate 0.09 (9/100)
Sixth Interactive Teleconference
Listen, Reflect and Move Forward
September 6th, 2006
Team Example 2
2.0 Mean Number of Unintentional Discrepancies
0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40
1.60
1.80
Nov 2
005
Dec 2
005
Jan
2006
Feb 2
006
Mar
200
6
Apr 2
006
May
200
6
Jun
2006
Jul 2
006
Aug 2
006
Sep 2
006
Oct 20
06
Nov 2
006
Dec 2
006
Jan
2007
Feb 2
007
Mar
200
7
Apr 2
007
May
200
7
Jun
2007
Jul 2
007
Aug 2
007
Sep 2
007
Oct 20
07
Nov 2
007
Dec 2
007
Jan
2008
Feb 2
008
Mar
200
8
Apr 2
008
May
200
8
Jun
2008
Month
Me
an
Actual Goal
Four months of baselineOverall rate 0.43 (12/28)
16 months of early implementationOverall rate 0.26 (50/189)
Sixth Interactive Teleconference
Listen, Reflect and Move Forward
September 6th, 2006
Team Example 3
2.0 Mean Number of Unintentional Discrepancies
0.00
0.05
0.10
0.15
0.20
0.25
0.30
0.35
Nov 2
005
Dec 2
005
Jan
2006
Feb 2
006
Mar
200
6
Apr 2
006
May
200
6
Jun
2006
Jul 2
006
Aug 2
006
Sep 2
006
Oct 20
06
Nov 2
006
Dec 2
006
Jan
2007
Feb 2
007
Mar
200
7
Apr 2
007
May
200
7
Jun
2007
Jul 2
007
Aug 2
007
Sep 2
007
Oct 20
07
Nov 2
007
Dec 2
007
Jan
2008
Feb 2
008
Mar
200
8
Apr 2
008
May
200
8
Jun
2008
Month
Me
an
Actual Goal
One month of baselineOverall rate 0.25 (3/12)
14 months of early implementationOverall rate 0.08 (13/158)
Sixth Interactive Teleconference
Listen, Reflect and Move Forward
September 6th, 2006
Team Example 4
2.0 Mean Number of Unintentional Discrepancies
0.00
0.50
1.00
1.50
2.00
2.50
3.00
Nov 2
005
Dec 2
005
Jan
2006
Feb 2
006
Mar
200
6
Apr 2
006
May
200
6
Jun
2006
Jul 2
006
Aug 2
006
Sep 2
006
Oct 20
06
Nov 2
006
Dec 2
006
Jan
2007
Feb 2
007
Mar
200
7
Apr 2
007
May
200
7
Jun
2007
Jul 2
007
Aug 2
007
Sep 2
007
Oct 20
07
Nov 2
007
Dec 2
007
Jan
2008
Feb 2
008
Mar
200
8
Apr 2
008
May
200
8
Jun
2008
Month
Me
an
Actual Goal
Four months of baselineOverall rate 1.25 (50/40)
11 months of early implementationOverall rate 0.88 (90/102)
Sixth Interactive Teleconference
Listen, Reflect and Move Forward
September 6th, 2006
Team Example 5
2.0 Mean Number of Unintentional Discrepancies
0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40
Nov 2
005
Dec 2
005
Jan
2006
Feb 2
006
Mar
200
6
Apr 2
006
May
200
6
Jun
2006
Jul 2
006
Aug 2
006
Sep 2
006
Oct 20
06
Nov 2
006
Dec 2
006
Jan
2007
Feb 2
007
Mar
200
7
Apr 2
007
May
200
7
Jun
2007
Jul 2
007
Aug 2
007
Sep 2
007
Oct 20
07
Nov 2
007
Dec 2
007
Jan
2008
Feb 2
008
Mar
200
8
Apr 2
008
May
200
8
Jun
2008
Month
Me
an
Actual Goal
Five months of baselineOverall rate 0.43 (40/94)
6 months of early implementationOverall rate 0.81 (47/58)
Sixth Interactive Teleconference
Listen, Reflect and Move Forward
September 6th, 2006
Key Lessons Learned
The implementation of MedRec has been complex and resource intensive while teams have dealt with multiple competing priorities;
While the data shows significant progress in reducing discrepancies on a system level, there is still variability from month to month, as well as between teams in the discrepancy rates;
The majority of teams are not yet at the point where they feel they have reached “sustainability”
The concerns expressed by the paediatric teams are being echoed across the country
The next 12 months are dedicated to supporting all of our teams to reaching their goal rate, sustaining and spreading MedRec
Sixth Interactive Teleconference
Listen, Reflect and Move Forward
September 6th, 2006
Key Lessons Learned: Challenges
Engagement of medical and corporate leadership Resistance to practice change Limited resources to continue to educate staff and
conduct audits Competing priorities with other initiatives Team fatigue and maintaining motivation
The main themes in barriers to sustainability include;
Sixth Interactive Teleconference
Listen, Reflect and Move Forward
September 6th, 2006
Key Lessons Learned: Enablers
Where teams feel they are sustaining improvements, there is clear management support, staff with dedicated time to manage the project and engagement of front-line colleagues
Internal support from senior leadership, particularly those who have operational responsibility for patient safety, is key to implementation teams achieving sustainability;
Within the implementation and care teams, communication and education are key strategies to ensure staff buy-in and continued success of the initiative
Sixth Interactive Teleconference
Listen, Reflect and Move Forward
September 6th, 2006
As we continue our journey
We would like to acknowledge and thank the following paediatric teams for their commitment and continued dedication!
Children's & Women's Health Centre of BC
Alberta Children's Hospital
Stollery Children's Hospital
Saskatoon Health Region
Winnipeg Children's Hospital
Children's Hospital of Eastern Ontario
Children's Hospital of Western Ontario
Credit Valley Hospital
Grand River Hospital
Hospital for Sick Children
Kingston General Hospital
McMaster Children's Hospital
North York General Hospital
Quinte Healthcare Corporation
IWK Health Centre
Janeway Child Health Centre