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Admission Medication Reconciliation at Lions Gate Hospital Lean Transformation Services Laarnie St-Laurent, Lean Coordinator Lorelei Grosser, Lean Coordinator.

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Presentation on theme: "Admission Medication Reconciliation at Lions Gate Hospital Lean Transformation Services Laarnie St-Laurent, Lean Coordinator Lorelei Grosser, Lean Coordinator."— Presentation transcript:

1 Admission Medication Reconciliation at Lions Gate Hospital Lean Transformation Services Laarnie St-Laurent, Lean Coordinator Lorelei Grosser, Lean Coordinator Carissa Looman, Lean Educator

2 Admission MedRec at Lions Gate Hospital Objectives: What is MedRec? Why do MedRec? How was MedRec implemented? Brief overview of Lean Methodology How Lean was used for implementation How are we doing now? Audit Results What are key lessons learned? Impacts of MedRec

3 Ever wondered… Right medication? Right dose? Right time? Admission MedRec at Lions Gate Hospital

4 What is MedRec? Admission MedRec at Lions Gate Hospital

5 What is MedRec? Best Possible Medication History Reconciliation (Orders) Pharmanet (Prescribed Drugs) Admission MedRec at Lions Gate Hospital

6 Why do MedRec? Did you know… 40-50% of patients on admission are at risk of unintentional medication discrepancies? Medication errors may harm patients Of these, 6% are at risk of harm serious enough to increase length of stay from 2-8 days 2. Admission MedRec at Lions Gate Hospital

7 Why do MedRec? Some Local Data At Lions Gate: About 38.8 daily admissions 12.5 patients at risk of unintentional discrepancies 0.75 patients daily at risk of staying 2 to 8 days longer About $246K additional costs per year (based on average cost of $450/patient/night) Admission MedRec at Lions Gate Hospital

8 How was MedRec implemented? Lean is about… Maximizing Value Minimizing Waste Improving Quality Continuous improvement Admission MedRec at Lions Gate Hospital

9 Steps to Achieving Continuous Improvement– sequence to approach the tools Observe and Collect Data Standard Work Unit Layout/ Cell Design (Flow) Mistake Proofing Visual Controls Other tools to improve flow and implement pull See for yourself & collect objective data that becomes the starting point for discussions -Without Standards, there can be no improvement Taiichi Ohno Adapted from Virginia Mason Lean Leader Certification Materials First: Understand the Current State Then: Improve the Process Rather than thinking specific tools do not apply, consider if their concept can provide benefit. And Then: Repeat!

10 VCH Improvement System Lean Tollgate LTS_VCH Improvement System_V1 Project Definition Current State Analysis Future State Development Implementation/ Go-Live Audit/Refine Sustainment

11 Observations: Data Collection How was MedRec implemented? Admission MedRec at Lions Gate Hospital

12 Future State Value Stream Map Triage Emerg NurseEmerg Doctor Admission MRO printed for certain areas in Emerg BPMH documented by RN or Pharmacist on MRP reconciles home medications MedRec Order (MRO) form processed How was MedRec implemented? Admission MedRec at Lions Gate Hospital

13 Standard Operating Procedures: How was MedRec implemented? Who Why When How Admission MedRec at Lions Gate Hospital What

14 How was MedRec implemented? Admission MedRec at Lions Gate Hospital

15 How was MedRec implemented? Auditing and Breakthrough Lanes: Met MedRec criteria Did not meet MedRec criteria Admission MedRec at Lions Gate Hospital

16 How was MedRec implemented? Auditing and Breakthrough Lanes: Why did not meet MedRec criteria? Admission MedRec at Lions Gate Hospital

17 How was MedRec implemented? Auditing and Breakthrough Lanes: Did not meet MedRec? Now what???? Admission MedRec at Lions Gate Hospital

18 How are we doing now? Organizational Targets Completion Rate75% BPMH Completion75% Reduction in unintentional discrepancies75% Reduction in undocumented intentional discrepancies75% Admission MedRec at Lions Gate Hospital

19 How are we doing now? AreaQuantitative Results Elective Surgery: Implemented on November % have complete, accurate medication histories 100% receive post-op medication orders 75% reduction in unintentional discrepancies 85% reduction in undocumented intentional discrepancies Admission MedRec at Lions Gate Hospital

20 How are we doing now? Area Quantitative Results Emergent/Direct Admissions Implemented on May 23, % to 80% reconciliation rate (exceeded target of 75%) 47.5% best possible medication history completion rate 50% reduction in unintentional medication discrepancies 55% reduction in undocumented intentional medication discrepancies Admission MedRec at Lions Gate Hospital

21 Comparison: Vancouver Coastal SiteAverage Completion Rate Since Implementation Richmond Hospital60% Vancouver General78% Coastal Squamish General60% St. Marys Hospital65% Powell River GeneralTBA Lions Gate Hospital78%

22 How are we doing now? Examples of good saves and Qualitative Results… Admission MedRec at Lions Gate Hospital

23 MedRec Success Stories UnitGood saves… EmergencyMD ordered only one of patients home meds at half the dose the patient was taking. When med history was taken by RN, MD ordered the rest of home meds (5 pages were missed). PediatricsPatients Pharmanet only showed one medication. When BPMH was taken, patient was taking medication at a different dose than on Pharmanet and was also taking a number of other medications NOT on the Pharmanet. DaycareSurgical patient was seen in PSSU 2 weeks prior to surgery, but had filled other prescriptions since then. Daycare RN picked up on new meds when BPMH was done prior to surgery.

24 Admission MedRec at Lions Gate Hospital

25 Reference List: 1 Canada. Accreditation Canada. Required Organization Practice. Ottawa: Accrediation Canada, Print. 2 Canada. Optimizing Medication Safety at Care Transitions – Creating a National Challenge. Toronto: Print. Admission MedRec at Lions Gate Hospital

26 Questions??? Thank you for listening! Admission MedRec at Lions Gate Hospital

27 February 27, 2013 What is MedRec? Systematic Partnership Conversation Admission MedRec at Lions Gate Hospital

28 February 27, 2013 How was MedRec implemented? Source: James P. Womack. Lean Thinking. 5 Steps to Lean Thinking Admission MedRec at Lions Gate Hospital

29 February 27, 2013 Audit & Refine Paper flow Implement Medication Management Admission MedRec at Lions Gate Hospital


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