Presentation on theme: "Medication Reconciliation: whose job is it anyway?"— Presentation transcript:
Medication Reconciliation: whose job is it anyway?
Why a Multidisciplinary approach? Limitations identified in ‘pharmacists only’ approach Baseline data from June 2010 showed pharmacists could reconcile medications for 35% of patients within 48 hours (gold standard is within 24 hours) Insufficient pharmacists to complete and sustain medRec If pharmacist’s sole focus could compromise other medication safety activities. Gaps in medRec process would occur after hours and weekends Address by targeted intervention of complex patients only?
Initial Training : January 2011 Pharmacy High 5 team developed a presentation – Presented to pharmacists and High 5 core group: “Train the trainer” Best Possible Medication history taking Med Rec process Compulsory attendance Resources provided to train/teach ward staff. – Training Road shows – ward based training Identified unit-specific processes – Grand/ ICU rounds
Ongoing Training JMO, Registrar and Resident training – Occasional ward based training – Secured additional training slots in orientation program Medical Intern Pre-registration workshop Pharmacist orientation New grad nursing awareness training
Patient Safety Culture in our hospital 2010 Patient safety culture survey: ED & Geriatrics 2011: Multidisciplinary approach of High 5 Initiative (60%) 2011: eMR commenced in ED (~25%) 2014: Patient safety culture changed for the better?
2014 Survey: Objectives: Primary: Do clinicians understand the importance of Medication Reconciliation: who, how and why? Secondary: – Were there any barriers to implementing this change – Can these barriers be overcome or resolved? Question Design What is your current staff position/specialty? Demographic Questions If there is no documented medication history or MMP in the patient notes, what would be your next course of action? Multiple choice & ‘Free text’ Questions What impact does the MMP have on your clinical decision making? Extremely/Very/Moderately/Slightly/ No significant impact Rating scale In your experience, have there been any barriers to completing or recording information on the MMP? Removed bias
Method 2 Study sites: POWH, Redlands Study group: Doctors, pharmacists and nurses Collected data for 7 days via – Paper forms – Email ‘Survey monkey’ link Supported by Directors of Clinical Services/Nursing/Pharmacy Survey respondents remained Anonymous
Results: Demographics Staff positionApprox. Staff Population Population that responded (%) n = 138 Doctors (JMOs & SMOs) 40049 (12%) Nursing120065 (5%) Pharmacists3224 (75%)
Results: Education/Training Sample Comments/suggestions: – “I thought this was the role of the pharmacist? Any training would be useful” (Intern) – “Wasn’t able to attend” (Registrar) – “Online training, inservice, verbal discussion?” (RN) AnswerYesNo Did you receive any education/training? N = 133 (%) 62 (46.6)71 (53.4) Was the education given at orientation sufficient? N= 106 (%) 58 (54.7)48 (45.3)
Who is responsible for completing the Medication Management Plan (MMP) form?
What do you understand to be the main reason/s for Medication Reconciliation?
Safety Culture *Medication Management Plan Form = a tool used at POWH to conduct Medication Reconciliation
Overall Comments ClinicianComments DoctorMMPs are very useful for JMOs! A good tool when available in patient notes It’s a great initiative, please keep it going Electronic would be great MMP has no significant impact on admission because it is not usually done on admission NurseI have found the MMP helpful if I have difficulty reading the doctor’s handwriting and also for checking that doses are correct when the charts change over to the next one Some education would be good so we can use it more effectively on ward rounds It’s not the nurse’s role to fill out the MMP form-should be medical or pharmacist PharmacistMMPs are very useful but time consuming Only Pharmacists are doing MMPs Increases workload for pharmacists
Discussion Identified barriers: – Education reaching all stakeholders (frontline up) – Time – Documentation (electronic vs paper) Identified improvements: – Patient safety culture awareness – Multidisciplinary approach identified Limitations
Factors identified required for future success Dedicated resources Strong multidisciplinary leadership Physician champion engagement Software that supports the High 5 SOP and Ongoing comprehensive staff education plan Change readiness of organisation
Doctors’ attitudes ‘We’re very busy’ ‘Can’t the pharmacists do it?’ ‘It means writing everything out multiple times’ ‘What’s the point of it?’ ‘Why don’t we just wait until electronic prescribing comes in?’
Issues Capturing the correct audience to educate them that its everyones responsibility We are missing the middle level (staff specialists, VMOs etc) IT systems don’t speak to each other (or a mixture of paper and electronic notes) It requires a change in attitude- but support for change Senior staff don’t realise the importance of the process
Problem: Professional boundaries and established hierarchies may result in disagreements about where the responsibility for medicines reconciliation lies Solution: Focus on reducing the risk for patients and increasing the availability of timely, accurate information Any potential professional or hierarchical differences should be put aside to enable appropriately trained and competent healthcare professionals to take the lead
Problem: Competing demands and the common response that the problem is too big ‘we dont know where to start’ can be overwhelming for staff This can lead to delays in getting medicines reconciliation off the ground Solution: People need to be supported by managers to enable them to prioritise their workload simple structures should be put in place so that medicines reconciliation becomes part of the organisation’s everyday work
There are no quick fixes, but this is a far from insurmountable problem A possible five-level hierarchy approach:
There are no shortcuts to breaking down silos. You can’t fix the environment if the organization doesn’t understand the problem. You can’t improve the development process if the right environment doesn’t exist to enable healthy guidelines. Climb the pyramid brick by brick to the ultimate goal: better clinical outcomes through true collaboration.
Practicalities How do we ensure senior physicians care? IIMS categorised into ‘med rec’ errors? Statistics on IIMS, Med rec compliance to individual departments/teams? League tables?? Grand rounds? Presentations of RCAs concerning medication errors? Using Accreditation- Standard 4 as a bargaining chip?
Involving Patients The value of involving patients and/or their carers in the medicines reconciliation process should not be underestimated Patients are a valuable source of information about the medicines they take and, with support, they can be encouraged and enabled to take a fuller and more active part in the process
Organisational approach The profile of medicines reconciliation needs to be raised in all healthcare organisations The Chief Executive, senior management lead and board members of an organisation can help by promoting the uptake of medicines reconciliation Collaborative approach with other Australian hospitals involved Get process right before instituting eMM- detrimental to put bad stuff into a good system