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Western Node Collaborative. Saskatoon Health Region Medication Reconciliation. Background. Saskatoon Health Region: largest health region in Saskatchewan

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western node collaborative
Western Node Collaborative

Saskatoon Health Region

Medication Reconciliation

background
Background
  • Saskatoon Health Region:
    • largest health region in Saskatchewan
    • provides services to almost 300,000 local residents and thousands of others from across the province who come to Saskatoon for specialized health services.
    • On any given day, approximately 35% of hospital care in Saskatoon is provided to people living outside the Health Region.
    • As an academic health sciences centre, the Health Region provides learning opportunities to future health care providers and participates in research that will build knowledge and improve care.
shr medication reconciliation project structure
SHR Medication Reconciliation Project Structure

Jean Morrison (Executive Sponsor),

Sandra Blevins, Brenda Thiessen, Janet Harding, Candice Bryden

Advisory Committee

Project Co-Chairs

Jackie Mann

Barb Evans

Team

Leads

Quality Services

Candice Bryden

Gerry Belton

Janice Seeley

Marlene Strenger

Physician

Champion

(vacant at present)

Steering Team

P r o j e c t T e a m s

RUH Pediatrics

Bernie McDonald (Lead)

Garth Bruce

Val Gerlach

Shelley Peacock

Margo Elmgren

SPH 6th Medicine

Barb Kirkland (Lead)

Cheryl Fransoo

Carmen Hampton

Trina Mucha

Susie Hoeppner

Donna Strilaef

Caroline Westman

Joy MacLaughlin

Norma Engele

Karen Wormsbecker

Maureen Preston

Holly Mansell

Judy Klassen

Joanne Kappel

RUH 5000

Lilah Weinberger (Lead)

Leah Gilmore

Doris Smith

Eva Lehnert Thiel

Noelle Rohatinsky

Kathy Bue

Renee Kennedy

Crystal Richter

St. Elizabeth’s

Monique Bollefer (Lead)

Russom Ockbaghzi

Ellen Kachur

Yvonne Berscheid

Brenda Hantke

Bev Weyland

SCH 4300

Jane Richardson (Lead)

Mark Sheridan

Audrey Sereda

Tess Gieg

Nadine Clarke

Marie Gifford

Shannon Stone

background1
Background
  • Pilot sites for medication reconciliation project include:
    • Surgery 5000, Royal University Hospital
    • Pediatrics, Royal University Hospital
    • Gynecology / PAC, Saskatoon City Hospital
    • 6th Medicine, St. Paul’s Hospital
    • St. Elizabeth’s Hospital, Humboldt (rural site)
background2
Background
  • Rationale for improving
    • Enhanced patient safety
  • What are you trying to improve?
    • Clarity and completeness of medication histories and orders from admission to discharge
    • Reduce medication history and ordering workload
background3
Background
  • Important dates:
    • Start date: October / November 2005
    • Region wide target implementation dates:
      • Admission: December 2006
      • Transfer and discharge: Spring 2007
      • Link with SK Health Pharmaceutical Information Program (PIP): June 2007
background4
Background
  • Why?
    • Evidence for improving patient safety is compelling
    • Requirement for CCHSA accreditation
    • CEO and Senior Leadership completely endorses
    • Enhances efficiencies; eliminates duplication of workload
    • Key component of seamless care strategies
  • Resources:
    • No dedicated resources
    • Group of interested, enthusiastic health care professionals agreed to participate
slide8
Aim
  • Purpose: Improve patient care by reducing adverse drug events through medication reconciliation
  • Scope and Boundaries:
    • Pilot areas selected. Focus on admission process initially.
  • Improvement Objectives (Admission):
    • Overall: To reduce adverse drug events and patient harm through the implementation of medication reconciliation on admission throughout SHR.
    • Pilot Aims:
      • Reduce # unintentional discrepancies by 75% in 12 months
      • Reduce # undocumented intentional discrepancies by 75% in 12 months
      • Increase overall success at reconciling medications by increasing the Medication Reconciliation Success index by 75% in 12 months
goals
Goals
  • Admission to Discharge:
    • Develop 1 form for admission medication reconciliation for use in SHR.
      • Form to serve dual purpose of physician’s order form and medication history documentation tool.
    • Develop 1 process for admission medication reconciliation in SHR.
    • Utilize PIP to generate on-line admission medication reconciliation form
    • Modify the current business process to integrate the preadmission data with patient’s acute care medication profile
    • Develop a new process where automation will generate a patient medication profile on transfer and discharge
changes tested
Changes Tested
  • Preadmission Medication List Physician Order Form
    • Focus groups (Pharmacy, Nursing, Physicians)
    • Satisfaction survey with each PDSA cycle
    • Changes made to content and design based on feedback
  • Medication reconciliation process
    • Focus groups
    • Satisfaction survey with PDSA cycle #1
  • Test effectiveness of and reaction to medication reconciliation form
    • Survey
    • Missing information check-list
    • BPMH
results run charts of key measures
Results: Run Charts of Key Measures

Pediatrics – Includes OTCs and Herbal Products (n=6)

results run charts of key measures1
Results: Run Charts of Key Measures

Pediatrics – OTCs and Herbal Products Removed (n=4)

results run charts of key measures2
Results: Run Charts of Key Measures

6th Medicine – Includes OTCs and Herbal Products (n=2)

results run charts of key measures3
Results: Run Charts of Key Measures

Gynecology / PAC – includes OTCs and Herbal Products (n=4)

results run charts of key measures4
Results: Run Charts of Key Measures

St. Elizabeth’s Hospital – includes OTCs and Herbal Products (n=1)

results run charts of key measures5
Results: Run Charts of Key Measures

Surgery 5000 – includes OTCs and Herbal Products (n=11)

keys to success lessons learned
Keys to Success & Lessons Learned
  • Major Keys to Success
    • Enthusiastic and committed Advisory, Steering, and Ward team members
    • 1:1 and small group educational sessions with staff
    • Increasing number of staff engaged in the process
  • Barriers
    • Dedicated resources
    • Staff buy-in on certain pilot areas
    • Process – obtaining a complete and accurate medication history
    • Timelines – balance between Safer Healthcare Now / Quality Improvement Methodology and Accreditation deadline
    • PDSA cycle turn around time
keys to success lessons learned1
Keys to Success & Lessons Learned
  • Lessons learned to date about these changes
    • Large scale change in process required. Not as easy as anticipated.
    • Preadmission Medication List Physician Order Form appears to be working well.
    • Medication reconciliation process requires further development.
      • Further education on “How to Perform a Medication History” required
        • Education sub-committee formed
next steps
Next Steps
  • Changes we are planning on testing to help us achieve our goals:
    • Effect of a standardized method for providing education
    • Ability of staff to take a complete and accurate medication history
    • Use of PIP to generate on-line Preadmission Medication List Physician Order Form
    • Use of automation to generate a patient medication reconciliation and order form on transfer and discharge
contact information
Contact Information
  • Barb Evans
    • barb.evans@saskatoonhealthregion.ca
    • Phone: 306-655-2268
  • Jackie Mann
    • jackie.mann@saskatoonhealthregion.ca
    • Phone: 306-655-7946
  • Janice Seeley
    • janice.seeley@saskatoonhealthregion.ca
    • Phone: 306-655-6832