Safer Medicine Admissions Review Team (SMART)
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Safer Medicine Admissions Review Team (SMART). Carl Eagleton and Hannah O’Malley on behalf of the SMART Working Group. The Need… Increasing General Medicine patient volumes. Volume. EC arrival year. The Need… Increasing patient wait times in Emergency Care (EC). LOS (Hours).

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Safer Medicine Admissions Review Team (SMART)

Carl Eagleton and Hannah O’Malley

on behalf of the SMART Working Group

The Need…

IncreasingGeneral Medicine patient volumes


EC arrival year

The Need…

Increasing patient wait times in Emergency Care (EC)

LOS (Hours)

EC arrival year

The Innovation

  • Streamline the admission process

  • Improve patient and medication safety

  • Meet national Medication Reconciliation (MR) targets

  • ThedaCare’s ‘Admission Trio’ mapping the way

‘MAP’ Model of Care

  • Team-based admitting pharmacists

  • Pharmacist at the front of the hospital

  • Collaborative patient review with admitting doctor

  • Medication history and reconciliation in EC

  • Continuity of care

Adapting the ‘Admissions Team’

  • IHI Model for Improvement

  • TRIO to PAIR = MAP model

  • 5 week pilot study


The SMART model (a doctor and pharmacist working together) will be applied to 90% of triage category 2-5 patients presenting to EC who are referred to GM between the hours of 8am and 10pm, Monday to Friday.

Objectives andMeasures


  • Reduce unintended medication errors to zero

  • Complete MR ≤ 6 hours of GM referral


  • 80% of patients referred to GM will be seen by SMART within 60 minutes of referral

  • With 95% seen within 90 minutes


  • Improve patient experience


  • Improve Medication History documentation to 100%

  • Reduce length of stay by 0.25 days per patient

Process improvement data
Process Improvement - Data

Electronic Reports

With help from statistician a daily report was developed capturing the # of patients SMARTed versus total # in target group, time to be seen, time to MR, and LOS

Manual Data Collection

Manual data collection is needed to record interventions and contributions by pharmacists – an electronic data collection form is being developed to streamline this process


A dashboard has been developed to track progress on measures which are updated weekly or monthly

Percent of patients seen increasing as SMART tests new combinations and rolls out new teams

Safety data
Safety combinations and rolls out new teamsData

  • Clinical input by pharmacist occurs sooner and is proactive rather than reactive

  • More convenient communication and collaboration allowing errors to be prevented or rectified faster

  • 747 patients seen by SMART since August 2013

  • 302 contributions recorded and 65 interventions

  • Examples:

    “Patient had run out of epoetin injections and didn't know to continue them. Hb = 80g/L (anaemic), recommended to prescriber to restart”

    “HbA1c 79mmol/mol advised increase glipizide dose”

    “Citalopram 10mg charted but patient normally on escitalopram 10mg. Medication corrected.”

Key successes
Key Successes combinations and rolls out new teams

  • Improved working relationship between pharmacists, doctors and nursing staff

  • Rolling out eight general medical teams with the shared model of care covering 8am-10pm

  • Significant reduction in time to MR from >2 days to <6 hours and increased # of patients receiving MR

  • Earlier contribution by pharmacist has led to fewer medication errors

  • Winning medication safety and innovation award and best paper award at NZHPA

Buy in
Buy In combinations and rolls out new teams

  • Various stakeholders including pharmacy, nursing, medical staff and allied health union

  • Meetings held with Key EC nursing staff and presentations at EC nursing handovers

  • Presentations at medical RMO/SMO handovers to educate doctors about SMART

  • Email and poster communications

  • Weekly SMART updates at Medical Pharmacist meetings

  • SMART themed week involving all clinical pharmacists aimed to educate, engage and identify potential issues

Challenges combinations and rolls out new teams

  • Several measures require multiple methods of data collection

  • Quality of historical data such as number and type of interventions and contributions has not been reliable – needed to investigate more reliable ways of collecting

  • Risk of medicines charted by pharmacist being administered before being signed

  • Changing work hours of pharmacists – ensuring issues identified and addressed is important

SMART Staff Feedback combinations and rolls out new teams

SMART Staff Feedback combinations and rolls out new teams

THE SMART PHARMACISTS combinations and rolls out new teams