medication reconciliation spread to msnu 4 west pre admit clinic
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Medication Reconciliation: Spread to MSNU & 4 West Pre-Admit Clinic. Origins of Medication Reconciliation.

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Presentation Transcript
origins of medication reconciliation
Origins of Medication Reconciliation
  • The Institute for Healthcare Improvement (IHI) introduced the 100K Lives Campaign in December 2004 to challenge health care providers to join a national effort to make health care safer and more effective & ensure hospitals achieve the best possible outcomes for all patients.
  • On April 12, 2005, the Canadian campaign, Safer Healthcare Now!was created. The IWK Health Centre is a registered member.
medication reconciliation what is it
Medication Reconciliation – what is it?
  • A formal process for:
    • Obtaining a complete and accurate list of each patient’s current home medications (name, dosage, frequency, route)
    • Comparing the physician’s admission, transfer, and/or discharge orders to that list
    • Bringing discrepancies to the attention of the prescriber and ensuring changes are made to the orders, when appropriate
slide4
Why?
  • Concern over patient safety is growing, both among the Canadian public and among health care providers
  • 2.9-16.6% of patients in acute care hospitals experienced one or more adverse events
  • Greater than 50% of all hospital medication errors occur at the interfaces of care
    • Admission to hospital, Transfer from one nursing unit to another, Transfer to step-down care, Discharge from hospital
why now
Why Now?
  • It’s the right thing to do……..
    • Culture of safety: reduce medication errors & potential for patient harm
    • Key component of seamless care strategies
    • Saves time for physicians, nurses, and pharmacists in the long-term
  • Medication Reconciliation is a new Canadian Council on Health Services Accreditation Standard
  • Executive Leadership has endorsed Medication Reconciliation as a project of high priority
accreditation
Accreditation
  • Patient Safety Area: Communication
    • Reconcile medications with the patient/client at referral or transfer and communicate the patient’s/client’s medications to the next provider of service….
  • Tests for compliance
    • Do these processes take place as a shared responsibility, involving the patient/client, nursing staff, medical staff, and pharmacists, as appropriate?
    • Does the organization have an implementation plan for spread….
  • Accreditation should not be seen as the driver for medication reconciliation.
  • Documenting the patient’s best possible medication history and decreasing discrepancies and adverse events around medications is a safety goal for health care organizations nationally.
medication reconciliation can
Medication Reconciliation can…
  • Prevent omission of an at-home medication
  • Match in-house dose, frequency and route with at-home dose
  • Assure medications follow the patient from one care area to another
potential impact
Potential Impact
  • Implementation of medication reconciliation along with other interventions decreased the rate of medication errors by 70% and adverse drug events by 15%, over a seven month period.[i]
  • Implementation in a surgical population reduced potential adverse drug events by 80% within three months of implementation.[ii]

[i] Whittington J, Cohen H. OSF healthcare’s journey in patient safety. Qual Manag Health Care 2004;13(1):53-59

[ii] Michels RD, Meisel S. Program using pharmacy technicians to obtain medication histories. Am J Health Syst Pharm 2003;60:1982-1986

definitions
Definitions

Type O = No discrepancy

Type 1 = Intentional discrepancy

The physician has made an intentional choice to add, change or discontinue a medication and their choice is clearly documented.

*considered to be “best practice” in medication reconciliation

Type 2 = Undocumented Intentional discrepancy

The physician has made an intentional choice to add, change or discontinue a medication but their choice is not clearly documented.

* 25-75% of all discrepancies

Type 3 = Unintentional discrepancy

The physician has unintentionally changed, added or omitted a medication that the patient was taking prior to admission.

*potential to lead to ADEs

slide11
Goal
  • SHN Medication Reconciliation ultimate goal:

To prevent Adverse Drug Events by implementing medication reconciliation in hospitals across Canada.

  • SHN Medication Reconciliation primary goal:

To decrease undocumented intentional and unintentional discrepancies by reconciling all medications at all interfaces of care for all patients.

http://www.saferhealthcarenow.ca/

aim scope
Aim & Scope

What is the aim?

  • To reduce the number of unintentional and undocumented intentional discrepancies (Types 2 & 3) for the inpatient population by 75 %.

What is the scope/ boundaries?

  • Medication reconciliation will be completed within 24 hours of admission for all patients admitted to MSNU who are currently taking medications.
responsibilities
Responsibilities

BPMH-History taker (can be Pharmacy/ Nursing/ Physicians)

  • History taker interviews the patient/family on admission in order to get the best possible medication history (BPMH)
  • Pharmacist or Nurse assumes the history taker role and completes the admission medication history order sheet, listing all home medications.

*Signs record as the history taker.

Nursing

  • Does not duplicate the medication history on the Admission/ Visit Assessment Record (#7070)… just documents, “See Admission Medication History Order sheet”

*Ensure that there is an admission medication history order sheet completed first.

  • Maintains practice of asking family about medication concerns etc. (Scope of practice /workload measure)

Ordering Physician

  • Reviews the BPMH list, reconciles with the history taker and signs the sheet.

*The BMPH list then becomes the admission medication orders.

i have the list now what
I Have the List, Now What…

Reconciliation

  • Review BPMH and confirm each medication listed in the history with the appropriate source (health record, community pharmacy, physician, family, etc.).
  • Contact the physician to resolve any discrepancies.

Data Submission

  • Pharmacy audits the admission orders monthly, identifying the discrepancy type.
  • QIC uses data to complete SHN worksheet/ measurement tool and submits data to SHN.
  • QIC reports data results back to the team.
key players for med rec success
Key Players for Med Rec Success

Receives medication reconciliation education andcollaborates with

team to provide the BPMH

Review medication history, participate in reconciliation and signs BPMH as orders

SHN

Medication

Reconciliation

Participates in collection and reconciliation of BPMH on admission, as part of practice scope

Participates in reconciliation of

BPMH, identifies discrepancy types,

sends data to QIC

&

Education

Facilitates and Supports Process

progress
Progress

TEAMS

  • Inpatient Nephrology Unit
  • Inpatient Mental Health
  • Women’s Gynecology

Goal #1:

  • To implement use of the admission medication history order sheet.

Goal #2:

  • Medication reconciliation will become the standard of practice at all admission, discharge and transfer points, for all patients at the IWK.
slide19
PDSA
  • Methodology – Conducting small tests of change for improvement
    • Plan the change
    • Trial the change
    • Observe the results
    • Spread the change

Plan

Act

Do

Celebrate successes!

Ensure consistent/ accurate data is obtained

Share knowledge with others!

Ask questions!

Study

msnu next steps
MSNU…Next Steps
  • Educate
    • Pharmacists
    • Nurses
    • Physicians
  • Collect Baseline Data
  • Identify which measures will indicate if the changes will lead to improvement.
  • Implement small tests of change (PDSA) to identify and refine processes, procedures and practices which will lead to improvement and achieving the aim.
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