nursing education medication reconciliation patient safety initiative last updated: may 2015
TRANSCRIPT
Nursing Education
Medication Reconciliation Patient Safety InitiativeLast updated: May 2015
Outline• MedRec Basics
• MedRec Champions
• Important Dates
• Admission, Transfer, Discharge• Overview and responsibilities
• Measurement
• Resources
What is Medication Reconciliation?
• Patient Safety Initiative
• Goal: • Develop a structured process to ensure that
comprehensive and accurate medication information is collected and follows the patient’s journey during key transitions of care (admission, transfer and discharge).
• Accreditation Canada ROP Requirement
Key Transitions of Care
Step1
•Complete a Best Possible Medication History (BPMH)
Step 2
•Reconciliation on Admission
Step 3
•Reconciliation during key Transitions of Care (i.e Transfers (service to service within the same facility) and Discharges (end of service)
Step 4
•Measurement for sustainability and continuous improvement
Admission MedRec
• Best Possible Medication History (BPMH) is the cornerstone of the MedRec admission process.
• BPMH is:• a medication history• a reference point for decisions to continue,
discontinue or modify the medication regimen during key transitions of care
• acts as the one “source of truth”• serves as medication orders on admission
(once reconciled and signed by prescriber)
Admission
Sources used to obtainhistory
Date/Time the historycompleted
All prescribed homeMedications [including Over-the-counter (OTC) medicationsif they were PRESCRIBED to pt.]
Self-prescribed Medications – (for information purposes only)
Additional Comments (information purposes only)
Reconciliation section(Prescriber Use Only)
Prescriber signs & includes date and time of reconciliation
Page #s
BPMH
Divisions of Authority to Complete
LEFT SIDE:
Medication History(may be completedby a licensed Health Care Professional; this includes, but is not limited to, prescribers)
RIGHT SIDE:
Prescriber Use OnlySection of BPMH
• A BPMH may be completed prior to, or alongside, all other admission orders being written (Proactive/Prospective Model)
or
• After initial admission orders have been written (Retroactive/Retrospective Model).
• In either case, a BPMH should ideally be completed within 24h of admission.
25
8.6
Admission
• The Prescriber Reconciliation Section can be completed either:• Pre-op
or• Post-op
• This will be decided by the Admitting Prescriber on a patient by patient basis
Prescriber Reconciliation
Ensure you are checking the chart for BPMH orders Pre-op and Post-op, but note that the BPMH can only be used as an order and scanned to pharmacy once
Direct admit from another facility• Patients who already have a completed admission BPMH
from another site (copy faxed to your site).
In this case:
• The BPMH will not serve as inpatient orders, but as a history/reference only.
• A new BPMH is not to be completed.
Where will the BPMH be kept?• The BPMH will be kept in the Patient Care Orders Section (pink
sheets) of the chart
• It will be the top page of the section and be placed opposite the pink sheets
•This is so the BPMH is easily accessible for review when the prescriber writes their orders
• New information may be learned about the patient’s HOME medications after the initial BPMH is processed.
• Any licensed health care professional may document the new information so the home medication history is as accurate as possible
• If there is no room, start a new admission BPMH page and renumber all associated pages
BPMH Tool: Late Entries
•Write “Late Entry” and the name, dose, route and frequency of the medication
• Date, time and sign your entry
•Notify the prescriber to address the discrepancy
•Do NOT process/scan to pharmacy again
• Any orders needed are to be written on the Patient Care Order (Pink) sheets
Late Entries/Addendums
SCANNEDC
What are my responsibilities?
• PRESCRIBERS will be completing the BPMHs (not nursing)• Nursing will however be responsible for the documentation
and notification of prescriber re: any late entries• Alternatively, you can flag to your Charge
• Also, flag to your charge nurse if your patient has been admitted more than 24h and they do not have a completed BPMH in their chart.
• Check to see if BPMH is used as orders Pre-op and Post-op• BPMH can only be processed as orders once (either Pre-op
or Post-op)
Transfer MedRec
Transfer
A change in service, and/or level of care within the facility
• ex. Grey Nuns Surgery to Grey Nuns Internal Medicine
• If the attending physician changes/rotates but the patient remains cared for by the same service, this is not considered a transfer
• Within-service bed changes are not considered transfers
Is there a tool for transfer?
• There is no paper “tool”, but a neon green sticker will be used.
• It is signed/dated/timed by the Sending and Receiving prescriber and included with any transfer orders written.
• A sticker will be placed on the Patient Care Order by the UNIT CLERK at the time of transfer
Receiving a Patient within the Facility
If the Surgery Program is receiving a patient from another service, the Receiving Prescriber will sign the MedRec Transfer sticker acknowledging the BPMH medications and current medications have been reviewed
Sending a Patient within the Facility
If the Surgery Program is sending a patient to another service, the Sending Prescriber will sign the MedRec Transfer sticker acknowledging the BPMH medications and current medications have been reviewed
• Exception: “Vascular IMCU Transfer Orders” PPCO will have a check box on the last page to indicate when this task is completed.
The PPCO reads: The above orders were created upon review of the patient’s current medications and Best Possible Medication History (BPMH)
IMCU to Ward – GNCH Only
Prescriber will check off this box
(No sticker will be required)
What are my responsibilities?
• Nursing has no official responsibility at transfer
• Be aware of the process • help to remind prescribers this needs to be done
on transfer of service within-hospital
Discharge MedRecGNCH - Vascular Service Patients Only
Note: For all Non-Vascular Surgery Patients (i.e General Surgery, Ortho Surgery, Gyne Surgery etc), Discharge MedRec will not be completed. Please continue with your current Discharge Process.
Discharge
• Refers to the end of service provision by the care facility• i.e. the patient physically exits the current facility
and subsequently goes home or to a different care facility
Tip: “Elvis has left the building” and is not returning (Case number is closed)
Transfer Discharge
Patient remains within the facility
• From Service To Service
Patient physically leaves the facility
• Out of the Hospital Setting (ex. Home, group home, independent living)
• Out of a facility to another healthcare facility (ex. Grey Nuns Hospital to Youville Home)
Transfer vs. Discharge
Complete and accurate list of discharge medications Plus a list of discontinued home medications
Once signed by prescriber:
• Discharge medication orders and/or
• Prescription (if a quantity specified)
• This will replace current discharge prescription process
Why a Discharge MedRec Tool?
Discharge MedRec Tool
Date and Time
Prescribers Orders
Bubble Packaging Requested
Discharge MedicationList
DiscontinuedMedications (Prescribedand Self-prescribed)
Prescriber Name andSignatureUnit Contact Information
Prescription/Quantity
Page #s
Other Important Information
Community Pharmacy Information
Discharge Tool: Two-plyWhite ply:
• Chart copy. If patient would prefer to take this copy in person to his or her pharmacy, a copy of it must be made for the chart. Clearly mark the photocopy as, “CHART COPY.”
Yellow ply:
• Copy for patient/resident or caregiver for information purposes
• Provide along with yellow copy of the Short Stay Discharge Summary Form.
• Patient/caregiver will always receive this copy.
If Discharge Tool is faxed to a Community Pharmacy
• In this case, the patient will ONLY receive the Yellow copy
What if the patient does not have a BPMH?
• Effective the start date of implementation, a discharge MedRec tool is to be completed for ALL VASCULAR SERVICE patients being discharged
• Even if there is no official BPMH in chart from admission.
What if the patient was admitted before MedRec implementation started?
• These patients will not have a formal BPMH in chart
• Effective the start date of implementation:• Discharge MedRec tool is to be completed for ALL
VASCULAR SERVICE patients being discharged.
Discharge directly to another facility
• BPMH should be faxed to the receiving facility in addition to the discharge MedRec tool.
• This provides the receiving facility with an understanding of the patient’s home medications, as a point of reference.
• Help ensure the patient/caregiver always leaves the facility with yellow copy of the discharge MedRec tool
• If the patient is additionally going to be given the white prescription copy (top copy) to take to their pharmacy, a photocopy will need to be made for the chart. Clearly mark the photocopy as “CHART COPY”
• Liaise with the team pharmacist (if available) to ensure the patient has been provided explanation/education re: any medication changes.
What are my responsibilities?
Measurement and Evaluation
Auditing:• Auditing of admission and discharge MedRec will
occur on a monthly basis by your unit’s designated auditor.
Measure QuestionSuccess Measure Was MedRec completed?Quality Measure Was it done well?Outcome Measure Were there any discrepancies?
Measurement and Evaluation:
MedRec ResourcesCompassionNet
• Internal and External Resources
• MedRec Policy
• On Deck with MedRec Newsletters
MedRec Info Binders• Binders will be at Unit Clerk’s desk
MedRec Flow Sheet/Responsibilities Poster
• In report room
MedRec Project Team• [email protected]
MedRec Page: CompassionNet1. Go to www.compassionnet.ca
2. Click “Care & Safety”
3. Then click on
4. Then click on
If I have questions, who do I ask?
• MedRec Champions
• MedRec Team • During implementation dates: in-person and via pagers;
• Pager #1: (780) 445-5398
• Pager #2: (780) 969-9879
• After implementation dates: via email
• Do you have proposed changes to the MedRec work?
• Complete a “Change Request Form” (available on CompassionNet)
• Submit to: [email protected]
• Questions? Feedback?
• Email [email protected]
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