Medication Reconciliation in the Community Laying the Foundation!

1. Marie Owen Medication Reconciliation in the CommunityLaying the Foundation!

2. What is Medication Reconciliation? • Medication Reconciliation is a formal process in which healthcare professionals partner with patients to ensure accurate and complete medication information transfer at interfaces of care • In Home Care this involves getting information from clients and comparing it to orders, medication calendars, labels, vials and other sources of information, resolving discrepancies, communicating and documenting

3. Safer Healthcare Now! • History of Medication reconciliation • What we’ve learned • Why we are proud • Why we don’t give up!

4. Cross Canada Check-Up http://www.ismp-canada.org/medrec/map/

6. Medication Reconciliation:What it Does… Resolves Potential Errors such as: • Failure to continue clinically important home medications while in the hospital • Missed or duplicated doses resulting from inaccurate medication records • Failure to clearly specify which home medications should be resumed and / or discontinued at home after hospital discharge • Duplicate therapy at discharge

7. What was the problem? 7 Clients returning home from hospital at risk for falls, ER visits and hospital readmits due to medication adverse events No standardized approach to medication management Clients being asked for the same information by multiple care providers Information not shared between various care and service providers, e.g., Meds Check

8. The Need 8 Required a standardized process for medication management in the community Sustainable process that generates quality data to track changes / improvements in clients’ outcomes Responsible for reporting to Central Local Health Integration Network (funders of the project) Develop a system easy to use Internally – align with organization’s strategy to provide quality care = safety, science, service

10. What can the client/caregiver expect? Example procedure of a Community Service in Ontario 10 First visit: • The nurse or pharmacist completes a medication inventory • Best Possible Medication History (BPMH) • Makes recommendations • Preventive medicine is used and prescribed appropriately (e.g., Vitamin D, EC ASA) • Blister pack or dosette system, visual reminders • Increased PSW hours for reminders, OT assessment, referral to a community support agency • Summary completed identifying discrepancies and recommendations; nurse/pharmacist send letter(s) to client’s physicians • Indications are appropriately treated after feedback from physician(s)

11. What can the client/caregiver expect? Example procedure of a Community Service in Ontario 11 Second visit: • Education to the client/caregiver • Administration techniques appropriate • Provides client/caregiver with medication schedule • A copy of the medication schedule is forwarded to the family physician and service providers

12. Examples of Limitations Identified Example procedure of a Community Service in Ontario 12 Physical Cognitive (forget to take medications) Accessibility (cannot get to pharmacy or family physician) Adherence (clients may refuse to take medications due to side effects) Safety Knowledge gap (many clients do not understand what their medication is, how to take it, why they require it, and what the side effects are) Storage and Organization

13. How have the clients/caregivers benefited? Example procedure of a Community Service in Ontario 13 • Enables nurse and pharmacist to: • Create a complete and accurate inventory of all medications • Prescribed/over-the-counter/herbal • Assess for Safety, Simplicity and Correctness • Compare the current medications with medications prescribed • Identify any discrepancies or medication related problems • Bring it to the attention of the prescribing physician

14. Have we made a difference? Example procedure of a Community Service in Ontario 14 • Population Health • 1420 clients received medication reconciliation between April 2010 – March 2011 • After MMSS 43% rated ability to self-manage medications as excellent, before MMSS it was 15% • 49% improvement in self-management • 96% rated ability to self-manage as good or excellent • Only 4% of clients rated fair/poor

15. Have we made a difference? Example procedure of a Community Service in Ontario 15 • Population Health (cont’d) • On average, 3-5 discrepancies/medication related problems identified/client • 85% of discrepancies resolved • 86% of medication related problems resolved • Reduction in .5-1 medication/client

16. Interfaces in the Medication Information Transfer Process

17. What We’ve Learned • It IS worth the effort - successful teams would not go back to the old way • There can still be a surprising amount of resistance • It requires new processes • It is more complicated than it sounds • BPMH training is required • Patient must be at the centre • The answers are local

18. This Action Series • Canada is a leading country!! • Create more experience, successful new approaches and reliable processes in home care • Measure success • Learn from others and spread the learning

19. Question: The Problem Do you have a sense of what the problem is? Do you believe that there is a problem in the home care environment? Yes? No?

20. A Medication Reconciliation Allegory/Metaphor! By Mark Kearney, Pharmacist, Queensway Carleton Hospital

21. You come into the hospital wearing size 32 black pants, a blue shirt, a black belt and cowboy boots… Imagine

22. You leave the hospital …wearing a green dress A blue shirt … Red shoes No belt … and a cowboy hat!

23. Discrepancies: Ordered a cowboy hat instead of cowboy boots Forgot to reorder your belt Got the blue shirt right Replaced the black pants with a red dress What Happened? Before After

24. Medication Reconciliation in Home Care • How do we do it? • When do we do it? • Who does it?

25. How?

26. Identify and target Step One

27. Interview Compare Identify Document Step Two

28. Resolve Identify Communicate Document Step Three

29. Confirm Communicate Verify Step Four

30. Question How are you Feeling?

31. QuestionWhat step do you feel will be the biggest change to your current process? Use your pointer

33. Does the process work? “As a nurse who is always aghast when the client hands me a shoebox full of pill bottles, with no recourse but to just put them on the medication list, I am so thrilled to have a formal method to deal with these medications. Very often this shoebox contains every medication the client has taken for the past 10 years, many of them mixed together or missing labels. Recently, a client was discharged on parenteral anticoagulant therapy. Without medication reconciliation, he would have continued to take the oral anticoagulant he had been on before his hospital stay. The nurse discovered this issue through the application of medication reconciliation and a potentially dangerous situation was avoided.” Cheryl Prest RN Can Care Health Services Pilot Team Leader

34. When?

35. Who?