Thunder Bay Regional Health Sciences Centre (TBRHSC)

1. <?xml version="1.0"?><AllQuestions /> <?xml version="1.0"?><Settings><answerBulletFormat>Numeric</answerBulletFormat><answerNowAutoInsert>No</answerNowAutoInsert><answerNowStyle>Explosion</answerNowStyle><answerNowText>Answer Now</answerNowText><chartColors>Use PowerPoint Color Scheme</chartColors><chartType>Horizontal</chartType><correctAnswerIndicator>Checkmark</correctAnswerIndicator><countdownAutoInsert>No</countdownAutoInsert><countdownSeconds>10</countdownSeconds><countdownSound>TicToc.wav</countdownSound><countdownStyle>Box</countdownStyle><gridAutoInsert>No</gridAutoInsert><gridFillStyle>Answered</gridFillStyle><gridFillColor>0,0,0</gridFillColor><gridOpacity>100%</gridOpacity><gridTextStyle>Keypad #</gridTextStyle><inputSource>Response Devices</inputSource><multipleResponseDivisor># of Responses</multipleResponseDivisor><participantsLeaderBoard>5</participantsLeaderBoard><percentageDecimalPlaces>0</percentageDecimalPlaces><responseCounterAutoInsert>No</responseCounterAutoInsert><responseCounterStyle>Oval</responseCounterStyle><responseCounterDisplayValue># of Votes Received</responseCounterDisplayValue><insertObjectUsingColor>Blue</insertObjectUsingColor><showResults>Yes</showResults><teamColors>User Defined</teamColors><teamIdentificationType>None</teamIdentificationType><teamScoringType>Voting pads only</teamScoringType><teamScoringDecimalPlaces>1</teamScoringDecimalPlaces><teamIdentificationItem></teamIdentificationItem><teamsLeaderBoard>5</teamsLeaderBoard><teamName1></teamName1><teamName2></teamName2><teamName3></teamName3><teamName4></teamName4><teamName5></teamName5><teamName6></teamName6><teamName7></teamName7><teamName8></teamName8><teamName9></teamName9><teamName10></teamName10><showControlBar>Slides with Get Feedback Objects</showControlBar><defaultCorrectPointValue>100</defaultCorrectPointValue><defaultIncorrectPointValue>0</defaultIncorrectPointValue><chartColor1>187,224,227</chartColor1><chartColor2>51,51,153</chartColor2><chartColor3>0,153,153</chartColor3><chartColor4>153,204,0</chartColor4><chartColor5>128,128,128</chartColor5><chartColor6>0,0,0</chartColor6><chartColor7>0,102,204</chartColor7><chartColor8>204,204,255</chartColor8><chartColor9>255,0,0</chartColor9><chartColor10>255,255,0</chartColor10><teamColor1>187,224,227</teamColor1><teamColor2>51,51,153</teamColor2><teamColor3>0,153,153</teamColor3><teamColor4>153,204,0</teamColor4><teamColor5>128,128,128</teamColor5><teamColor6>0,0,0</teamColor6><teamColor7>0,102,204</teamColor7><teamColor8>204,204,255</teamColor8><teamColor9>255,0,0</teamColor9><teamColor10>255,255,0</teamColor10><displayAnswerImagesDuringVote>Yes</displayAnswerImagesDuringVote><displayAnswerImagesWithResponses>Yes</displayAnswerImagesWithResponses><displayAnswerTextDuringVote>Yes</displayAnswerTextDuringVote><displayAnswerTextWithResponses>Yes</displayAnswerTextWithResponses><questionSlideID></questionSlideID><controlBarState>Expanded</controlBarState><isGridColorKnownColor>True</isGridColorKnownColor><gridColorName>Yellow</gridColorName><AutoRec></AutoRec><AutoRecTimeIntrvl></AutoRecTimeIntrvl><chartVotesView>Percentage</chartVotesView><chartLabelsColor>0,0,0</chartLabelsColor><isChartLabelColorKnownColor>True</isChartLabelColorKnownColor><chartLabelColorName>Black</chartLabelColorName><chartXAxisLabelType>Full Text</chartXAxisLabelType></Settings> <?xml version="1.0"?><AllAnswers /> Thunder Bay Regional Health Sciences Centre (TBRHSC) Medication Reconciliation

2. 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

3. Aim • Educate critical care staff on the medication reconciliation process (in three to four months) • Ensure a best possible medication history (BPMH) is obtained and documented for all critical care patients (in 12-months) • To reconcile and document all medication discrepancies on admission and transfer from critical care (in 12-months)

4. Team Members • Adam Vinet, Manager – Emergency Department • Cece Girard, Critical Care Staff Nurse • Chad Johnson, Clinical Nurse Specialist – Critical Care • Katrina Niemi, Critical Care Staff Nurse • Larry Bertoldo, Pharmacist • Lisa Beck, Director – Trauma Program • Marios Roussos, Intensivist • Wendy Winslow, Manager – Critical Care

5. Results PDSA #1

6. Results PDSA #1 (continued)

7. Results PDSA #2

8. Changes Tested • PDSA #1 • Implementation of nurse driven BPMH, a change from the pharmacist lead model • Nursing staff completed an e-learning module to learn how to obtain a BPMH and clinical tools were developed to assist nursing staff to obtain the BPMH

9. Changes Tested • PDSA #2 • Tested the current weekend process of RNs completing the BPMH while pharmacist is off • Nurses are expected to complete BPMH on weekends when pharmacist is off to ensure a 24/7 process that is not fully reliant on one pharmacist • Want to ensure that current process is “process driven” and not individual dependant

10. Lessons Learned • PDSA #1 • Need to focus and follow-up individually with nursing staff to asses why BPMH were not completed (identify barriers in completing) • PDSA #2 • Following up individually provided more details: • Why the BPMH was not obtained • Exposed ongoing barriers and questioned the expected BPMH time to completion • Need to consider having BPMH completion time extended to 48-hours

11. Next Steps • Evaluate quality of BPMH • Currently we are focusing on quantity, getting nursing staff in the habit of completing/obtaining a BPMH • Medication reconciliation at transfer • Develop process • Get buy-in from intensivist group