Providence health care medication reconciliation
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Providence Health Care Medication Reconciliation. Western Node Collaborative. Residential Team Learning Session 3 Storyboard. Providence Health Care - Residential. Five Residential care sites Holy Family Hospital ECU Langara Mount Saint Joseph Hospital ECU Brock Fahrni Pavillion

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Providence Health Care Medication Reconciliation

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Providence health care medication reconciliation

Providence Health Care Medication Reconciliation

Western Node Collaborative

Residential Team

Learning Session 3 Storyboard


Providence health care residential

Providence Health Care - Residential

Five Residential care sites

  • Holy Family Hospital ECU

  • Langara

  • Mount Saint Joseph Hospital ECU

  • Brock Fahrni Pavillion

  • Youville Residence

    Home to 697 residents

    Admissions to Residential Care via Priority Access

  • 40% of PHC residential admissions came from PHC acute sites

  • Other 60% from:

    • Other acute care facilities

    • Other residential care facilities

    • Direct from the community

    • Readmissions


Residential team members

Residential Team Members

  • Lynette Best (Sponsor)

  • Pam Kelly, Residential Section Head, Pharmacy Services (Team Lead)

  • Fruzsina Pataky, Regional Medication Safety Coordinator

  • Sue Higginbotham, Clinical Nurse Leader, Holy Family

  • Julia Duda, QI Specialist

  • Jody Burrell, Pharmacist Youville

  • Lisa James, Pharmacist Brock Fahrni

  • Barb Laurillard, Pharmacist Langara

  • Ron Wall, Coordinator, Pharmacy IS

  • Nick Groves, Project Leader - Primary Health Care Transition Fund


Aim statements

Aim Statements

  • Reduce the mean number of undocumented intentionaldiscrepancies on residents moving into Residential Neighbourhoods by 75% by October 2006

  • Reduce the mean number of unintentional discrepancies on residents moving into Residential Neighbourhoods by 75% by October 2006

  • Increase our Medication Reconciliation Success Index(MRSI) by 75% by October 2006


Baseline data

Baseline Data


Objectives

Objectives

  • To streamline the medication reconciliation process

  • To examine all moving in processes related to medications

  • To minimize transcription

  • To ensure that medications are not overlooked


Streamlined processes

Streamlined Processes:


Moving in medication orders mimo

Moving In Medication Orders - MIMO


Changes tested

Changes Tested

P

P

P

P

P

D

D

D

D

D

A

A

A

A

A

S

S

S

S

S

PDSA 9

Aug 06

Implemented MIMO at Brock Fahrni

PDSA 7

May 06

Implemented MIMO at MSJ ECU

PDSA 8

Implemented review of stopped orders

PDSA 5

Apr 06

Developed Rx spreadsheet to track MIMOs

PDSA 6

Implemented MIMO at Langara Residence

PDSA 2

Mar 06 Evaluation of HFH MIMO Implementation

PDSA 3 Nurse Satisfaction

PDSA 4 Posted RN Instructions

PDSA 1

Jan-Feb 06

Implemented MIMO at

Holy Family ECU


Medication reconciliation indicators phc residential care admissions

Medication Reconciliation IndicatorsPHC Residential Care Admissions


Undocumented intentional discrepancies upon admission

Undocumented Intentional Discrepancies Upon Admission


Unintentional discrepancies upon admission

Unintentional Discrepancies Upon Admission


Medication reconciliation success index upon admission

Medication Reconciliation Success Index Upon Admission


One resident s story

One Resident’s Story

Home

VGH

May 8

UBCH

May 19

Langara

June 13

  • 5 drugs omitted on initial admission from home

  • At least 3 opportunities for medication reconciliation

  • Undetected until admitted to Langara

  • TW, 75 year old female


Leadership support

Leadership Support

  • Organizational commitment to best practice and evidence based care

  • Early engagement with the Institute for Healthcare Improvement Collaboratives

    • 2001 Quantum Leaps in Patient Safety

  • Patient Safety Leader Position created 2004

    • Patient Safety Officer Training – IHI

  • Joined Safer Healthcare Now! Campaign in 2005 implementing all 6 initiatives

  • Participation in SHN Med Rec Collaborative


Keys to success

Keys to Success

  • Team Accelerators

    • Team Leader - Early Adopter

    • Physician advocate

    • Resources allocated to do the work

    • Quality Support

    • Small Tests of Change

    • Nurse and Physician Buy In – What’s in it for me?

  • Rolling out – implementing across program

    • Involving key stakeholders – CNL, UC, Rx

    • Education

    • Timely follow-up - communication


Lessons learned

Lessons Learned

  • RNs need to be reminded of their role in reconciling the medication list with the residents current/previous medications prior to faxing MIMO to physician’s office

  • Generating MIMO’s more than 24hr prior to the arrival of the resident results in confusion and duplication of work.

  • Nurses need to be reminded to NOT have the physician fax the completed form back to them. The reconciliation needs to take place over the phone in order for Pharmacy to receive a clean, legible copy of the orders

  • Standing orders tend to be omitted by the nursing staff (bowel protocol) on the MIMO. Pharmacy automatically enters these orders now.


Next steps

Next Steps

  • Complete MIMO implementation at final PHC Residential Care site

  • Develop implementation plan for PharmaNet-based Admission Medication Orders to be used at PHC Residential Care sites for admissions from the community

  • Adapt printed discharge orders from other VCH Acute Care facilities as admissionorders to PHC Residential Care


Contact information

Contact Information

For more information contact:

Pam Kelly, Team Leader

Phone: (604) 322-2601

Email:[email protected]


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