Medication Reconciliation in Home & Community Care Jo Dunderdale, RN, MA Program Development & Planning Leader Home & Community Care Vancouver Island Health Authority (VIHA )

Value of the Med Rec Process Provides a standardized process and tools Utilizes the experience and expertise of front line clinicians Creates a formalized process for communicating with the Physician and Pharmacist Provides clear documentation for all care providers

Value of the Med Rec Process Clinicians feel they are a part of a larger (National) patient safety initiative Clinicians feel they are making a difference (described as practice changing) Meets Accreditation requirements Improves patient safety

Challenges Takes more time initially to complete BPMH A change in practice for many clinicians – new forms, processes Difficult to obtain Physician buy in Lack of understanding of Model for Improvement

Challenges Time – for clinical staff and other team members Staff changes – clinical staff and planning group Competing priorities Spread beyond initial pilot site

Strategies (to overcome challenges) Identify and work with early adopters Be open to suggested changes Be prepared for continuous change Provide some education/support for QI Avoid adding forms without deleting others (incorporate BPMH into existing forms or replace others)

Strategies (to overcome challenges) Support clinicians to be part of planning group (may need backfill) Identify Physician Champions Recognize and reward success (chocolate works!) Communicate, communicate, communicate Share stories, data, experiences Address concerns

Types of Medication Discrepancies

Sustainability Current status - Continue to be in pilot phase but are increasing testing sites. Clinicians continue to require support to sustain practice change. Require management and senior executive support Will need ongoing monitoring/audit process

Sustainability Planned activities for the future: Include process in general orientation for all Nurses and Case Managers Create a DVD and video conferencing or e-learning presentation for spread throughout VIHA HCC Participate in research to measure prevention of harm

Lessons Learned Data is powerful Stories are even more powerful Start small Difficult to change practice Need consistent, supportive leadership Be patient, but keep on moving forward