1. Medication Reconciliation in Home Care: Measures for Pilot Medication Reconciliation in Home Care: Measures for Pilot Olavo Fernandes PharmD, ISMP Canada SHN ! Medication Reconciliation Home Care Pilot Nov 12, 2008

2. Creating the most “up to date” medication record (best possible medication history) Patient and Family Interview Medication Information from all other sources document “up to date” medication record (BPMH) “medication discrepancies that require clarification” Compare: Review and follow up where indicated Examples: Medication vial inspection Referral record Community pharmacy Hospital Discharge Summary

3. Process For Identifying “Medication Discrepancies That Require Clarification” In Home Care Creating the most “up to date” medication record (best possible medication history) Compare : Patient / Family Interview ( a systematic and comprehensive, medication history interview- representation/ snapshot in time of what medication the client is actually taking) Patient / Family Interview ( a systematic and comprehensive, medication history interview- representation/ snapshot in time of what medication the client is actually taking)Vs. all other available sources of medication information (home care referral records, inspection of medication vials/ samples, community pharmacy information, hospital medication discharge summaries, unfilled prescriptions etc) all other available sources of medication information (home care referral records, inspection of medication vials/ samples, community pharmacy information, hospital medication discharge summaries, unfilled prescriptions etc) IDENTIFY: Medication Discrepancies That Genuinely Require Clarification” IDENTIFY: Medication Discrepancies That Genuinely Require Clarification”

4. Process For Identifying “Medication Discrepancies That Require Clarification” In Home Care Note process must include patient/ family medication history interview Note process must include patient/ family medication history interview Reconciliation process allows for clinician professional judgment to discern which “discrepancies genuinely require clarification “Reconciliation process allows for clinician professional judgment to discern which “discrepancies genuinely require clarification “ Herbals/ Non-prescriptionHerbals/ Non-prescription (over-the counter drugs)- will not classify as a discrepancy requiring clarification – unless prescribed by physician (or other prescriber )

5. SHN! Home Care Pilot Measures 1.Percentage of Eligible Clients with a Best Possible Medication History (BPMH) conducted by a Home Care clinician 2.Time to complete Best Possible Medication History (BPMH) in Home Care 3.Percentage of Eligible clients with at least one discrepancy that requires clarification 4.Classification or characterization of actual discrepancies that require clarification Also serves as a communication and documentation tool to other clinicians Also serves as a communication and documentation tool to other clinicians

6. 1. Percentage of Eligible Clients with a Best Possible Medication History (BPMH) conducted by a Home Care clinician The percentage of “eligible” clients receiving a formal BPMH The percentage of “eligible” clients receiving a formal BPMH “Eligible” “Eligible” = discharged from acute care + Kelly’s patients risk assessment tool positive This is a measure of the percentage of clients eligible for medication reconciliation in this month's sample who actually had a BPMH completed within one week following transfer to home care. This is a measure of the percentage of clients eligible for medication reconciliation in this month's sample who actually had a BPMH completed within one week following transfer to home care.

7. 1. Percentage of Eligible Clients with a Best Possible Medication History (BPMH) conducted by a Home Care clinician Numerator: Total number of clients with a completed BPMH. Numerator: Total number of clients with a completed BPMH. Denominator : Total number of clients in this month's sample eligible for medication reconciliation. Denominator : Total number of clients in this month's sample eligible for medication reconciliation. Goal/ Target: Goal/ Target: – 80% Practical Team Target (95% Ideal Goal)

8. 2. Time to complete Best Possible Medication History (BPMH) in Home Care The elapsed time in minutes from the initial review of medications from client referral (including preparation time), interview with the client and/or the family to the time when all sources of information have been gathered and the Best Possible Medication History (BPMH) has been completed, recorded and ready to be sent to the Most Responsible Physician (MRP) or Nurse Practitioner (NP). The elapsed time in minutes from the initial review of medications from client referral (including preparation time), interview with the client and/or the family to the time when all sources of information have been gathered and the Best Possible Medication History (BPMH) has been completed, recorded and ready to be sent to the Most Responsible Physician (MRP) or Nurse Practitioner (NP).

9. 2. Time to complete Best Possible Medication History (BPMH) in Home Care – This is a measure of the mean or average time for this process to be completed for the clients in each month's sample. – Note: this does not include time for actual reconciliation and clarifying discrepancies – does include time to document the BPMH and investigate and identify all “readily available” sources of information (readily available includes patient sources, vials in home prior to making external contacts such as community pharmacy, discharging hospital or primary care physician)

10. 2. Time to complete Best Possible Medication History (BPMH) in Home Care Enter Time: Enter Time: – Total amount of time (sum) in minutes to complete the BPMH for all clients in this month's sample Enter Patients in Sample: Enter Patients in Sample: – Total number of clients in this month's sample with a completed Best Possible Medication History Final result is a mean time per patient Final result is a mean time per patient Goal/ Target: Goal/ Target: – Variable according to patient

11. 3. Percentage of Eligible clients with at least one discrepancy that requires clarification The percentage of the “eligible” clients with at least one medication discrepancy which required clarification with a healthcare practitioner. The percentage of the “eligible” clients with at least one medication discrepancy which required clarification with a healthcare practitioner.

12. 3. Percentage of Eligible clients with at least one discrepancy that requires clarification Numerator: Numerator: – Total number of the clients with at least ONE medication discrepancy that requires clarification with a clinician. Denominator : Denominator : – Total number of clients with a completed Best Possible Medication History (BPMH). Goal/ Target: Goal/ Target: – Variable (more linked to medication information transfer process of your referring service)

13. Classification or characterization coding: “actual discrepancies that require clarification” The classification of each medication as a discrepancy and the assignment of the discrepancies to a classification category or code The classification of each medication as a discrepancy and the assignment of the discrepancies to a classification category or code Allows teams to learn most common patterns of discrepancies or potential causes in your local practice Allows teams to learn most common patterns of discrepancies or potential causes in your local practice

15. Classification or characterization coding: “actual discrepancies that require clarification” When selecting categorization code each medication order will have only one discrepancy categorization. Clinicians can select whichever one they think is the most important. When selecting categorization code each medication order will have only one discrepancy categorization. Clinicians can select whichever one they think is the most important. It is often helpful to defer to the alphabetical classification order It is often helpful to defer to the alphabetical classification order – for example is for a medication order there may be an incorrect medication, an incorrect dose and an incorrect route…the clinician can select code : A drug

16. DATA ENTRY & SUBMISSION Please open the Power Point Titled “ Measurement for Med Rec Home Care 081112

17. Medication Reconciliation in Home Care Pilot Project Communities of Practice Ann MacLaurin July 20, 2008

18. Overview on the use of the Communities of Practice INTRODUCTION A Community of Practice (CoP) is an intuitive web-based online application that enables group collaboration and knowledge management. * * CoP Info Guide 27 Jan 2006

19. Overview on the use of the Communities of Practice A CoP provides teams with the means to instantly establish online areas for: 1. 1.group collaboration - temporary or ongoing 2. 2.facilitate group interaction 3. 3.share text content, images and files 4. 4.enable real-time communication via chat and instant messaging CoP Info Guide 27 Jan 2006

20. To access the Community of Practice (CoP) Go to the SHN home pageGo to the SHN home page http://www.saferhealthcareno w.ca/Default.aspxhttp://www.saferhealthcareno w.ca/Default.aspxhttp://www.saferhealthcareno w.ca/Default.aspxhttp://www.saferhealthcareno w.ca/Default.aspx On the left hand menu there is a link to the Community of Practice.On the left hand menu there is a link to the Community of Practice.

22. CoP: Information Guide On the bottom of this page you will find a link to the CoP information guide

23. http://www.saferhealth carenow.ca/Default.as px?folderId=124 CoP: Information Guide

24. To Join the Medication Reconciliation CoP http://www.saferhealthcarenow.ca/Defaul t.aspx?folderId=124 http://www.saferhealthcarenow.ca/Defaul t.aspx?folderId=124 http://www.saferhealthcarenow.ca/Defaul t.aspx?folderId=124 COMMUNITIES OF PRACTICE

28. It is free and easy to join.

29. To become a member fill in all the required information and hit the Join button

30. Login

31. Login

32. There are files for Acute Care and Long Term Care

33. Upon entering the CoP, you see the “What’s New” page. This page provides a summary of all new and recently added content and access to on-going opinion polls and the most recent note board posting.

34. Home Care Folder

35. Medication Reconciliation In Home Care Pilot Project Getting Started Tool Kit! Debbie Conrad RN November 2008

36. CONTENTS Highlights: Team commitment to the ProjectHighlights: Team commitment to the Project High lights: Criteria for Population SelectionHigh lights: Criteria for Population Selection Important datesImportant dates SHN Frame work for Medication Reconciliation in Home CareSHN Frame work for Medication Reconciliation in Home Care MeasurementsMeasurements ToolsTools Quick Reference GuidesQuick Reference Guides Past Power Point PresentationsPast Power Point Presentations

37. TOOLS Team CharterTeam Charter Medication Risk Assessment (MedRAT)Medication Risk Assessment (MedRAT) Best Possible Medication History (BPMH)Best Possible Medication History (BPMH) Interview Guide/TipsInterview Guide/Tips Data Collection ToolsData Collection Tools Data SubmissionData Submission PDSA ToolPDSA Tool

38. TOOLS Narrative for each toolNarrative for each tool Basic tool for team development ( Narratives & samples included in some)Basic tool for team development ( Narratives & samples included in some) Sample Tools from Western CollaborativeSample Tools from Western Collaborative Tool TemplatesTool Templates

40. QUICK REFERENCES Quick Reference Guide for Data Collection Quick Reference Guide for Getting Started

42. Power point Presentations SHN Pilot-Getting Started in Home Care Sept 11’08SHN Pilot-Getting Started in Home Care Sept 11’08 Medication Reconciliation in Home Care Oct’14 MeetingMedication Reconciliation in Home Care Oct’14 Meeting Presentation for Team Meeting Nov 12APresentation for Team Meeting Nov 12A Measurement for Med Rec Home Care -081112 Nov 12 BMeasurement for Med Rec Home Care -081112 Nov 12 B

43. POINTS TO REMEMBER Lessons Learned from Western CollaborativeLessons Learned from Western Collaborative Testing Measures, Tools, ProcessesTesting Measures, Tools, Processes Small tests of changeSmall tests of change You are the experts!You are the experts! Keep it Simple!Keep it Simple!