Medication Reconciliation in Home & Community Care

1. Medication Reconciliation in Home & Community Care Jo Dunderdale, RN, MA Program Development & Planning Leader Home & Community Care Vancouver Island Health Authority (VIHA)

2. Value of the Med Rec Process • Provides a standardized process and tools • Utilizes the experience and expertise of front line clinicians • Creates a formalized process for communicating with the Physician and Pharmacist • Provides clear documentation for all care providers

3. Value of the Med Rec Process • Clinicians feel they are a part of a larger (National) patient safety initiative • Clinicians feel they are making a difference (described as practice changing) • Meets Accreditation requirements • Improves patient safety

4. Challenges • Takes more time initially to complete BPMH • A change in practice for many clinicians – new forms, processes • Difficult to obtain Physician buy in • Lack of understanding of Model for Improvement

5. Challenges • Time – for clinical staff and other team members • Staff changes – clinical staff and planning group • Competing priorities • Spread beyond initial pilot site

6. Strategies(to overcome challenges) • Identify and work with early adopters • Be open to suggested changes • Be prepared for continuous change • Provide some education/support for QI • Avoid adding forms without deleting others (incorporate BPMH into existing forms or replace others)

7. Strategies(to overcome challenges) • Support clinicians to be part of planning group (may need backfill) • Identify Physician Champions • Recognize and reward success (chocolate works!) • Communicate, communicate, communicate • Share stories, data, experiences • Address concerns

8. Types of Medication Discrepancies

9. Sustainability • Current status - Continue to be in pilot phase but are increasing testing sites. • Clinicians continue to require support to sustain practice change. • Require management and senior executive support • Will need ongoing monitoring/audit process

10. Sustainability Planned activities for the future: • Include process in general orientation for all Nurses and Case Managers • Create a DVD and video conferencing or e-learning presentation for spread throughout VIHA HCC • Participate in research to measure prevention of harm

11. Lessons Learned • Data is powerful • Stories are even more powerful • Start small • Difficult to change practice • Need consistent, supportive leadership • Be patient, but keep on moving forward