Accreditation Canada & ISMP Canada ISMP Community of Practice Medication Reconciliation October 15, 2008

Outline Background Answers to common questions Additional questions

Background

Required Organization Practices (ROPs) ROPs are Evidence-based expectations to enhance patient/client safety and minimize risk Requirements for organizations in accreditation Relevant to organizations across the continuum of care Incorporated into the accreditation program in 2006, and now integrated within Qmentum standards

Required Organization Practices (ROPs) cont’d ROPs were developed in collaboration with Key stakeholders Institute for Safe Medication Practices Canada Canadian Patient Safety Institute Canadian Medical Protective Agency Canadian Institute for Health Information Healthcare Insurance Reciprocal of Canada Content experts on Accreditation Canada Patient Safety Advisory Committee (PSAC)

Patient Safety Required Organization Practices (ROPS) ROPs organized in several important patient safety areas: Culture Communication Medication Use Worklife Infection control Falls prevention Risk assessment More information about all ROPs is available at http://www.accreditation-canada.ca/default.aspx?page=355&cat=30

Patient Safety Required Organization Practices (ROPS) Medication reconciliation represents 2 Communication ROPs Communication : Improve the effectiveness and coordination of communication among care/service providers and with the recipients of care/service across the continuum. Required Organizational Practices: Inform and educate patients/clients about their role in patient safety (written and verbal communication) Employ effective mechanisms for transfer of information at interface points Implement verification processes and other checking systems for high risk care/service activities Reconcile the patient’s/client’s medications upon admission to the organization, and with the involvement of the patient/client. Reconcile medications with the patient/client at referral or transfer, and communicate the patient’s/client’s medications to the next provider of service More information available at http://www.accreditation-canada.ca/default.aspx?page=355&cat=30

What is Medication Reconciliation? Medication reconciliation is the collection and communication of accurate client/patient medication information Medication reconciliation is important for continuity of patient/client medications to Reduces likelihood of medication errors Potentially uncover medication errors that may harm patients/clients

Medication Reconciliation for 2008 and 2009 To promote consistent practice and evaluation, Accreditation Canada has established the following expectations for medication reconciliation for organizations being surveyed in 2008 and 2009 Medication reconciliation is considered implemented, when the organization has: a formal process for medication reconciliation at admission in at least one unit/ service area/ site, and a formal process for medication reconciliation at transfer or referral in at least one unit/ service area/ site, and a documented plan that includes timelines for implementation of medication reconciliation across all units/ services areas/ sites.

Medication Reconciliation beyond 2009 Accreditation Canada is reviewing information from the field and results from accreditation surveys to determine medication reconciliation expectations for organizations being surveyed in 2010 Accreditation Canada anticipates organizations will remain committed to patient safety by continuing to implement medication reconciliation

Common Questions

Medication Reconciliation Indicator Do we only have to collect information on the number of patients that receive medication reconciliation on admission? Answer: Yes, that is the only indicator for medication reconciliation at this time

Medication Reconciliation Indicator cont’d How often do we collect the indicator? Answer: The data is to be collected on a continuous basis The requirement for reporting is annually but the data are entered in fields that reflect quarters

Medication Reconciliation Indicator cont’d What is the numerator and denominator? Answer: Denominator: Total number of patients admitted to the unit of service at the organization for the measurement period

Medication Reconciliation Indicator cont’d Numerator: number of patients who receive formal medication reconciliation If criteria are used to identify who receives medication reconciliation, the criteria need to be identified e.g. patients on 4 or more pre-admit medications, patients > 75 years old, etc.

Medication Reconciliation Indicator cont’d An explanation should be provided for why criteria are being used to select individuals for medication reconciliation Organizations enter the information in the comment box in portal under the medication reconciliation indicator

Medication Reconciliation at Transfer Does Transfer include discharge? Answer: Yes, discharge is meant to be included in “transfer to another setting, service, service provider or level of care within or outside the organization”

Medication Reconciliation in Emergency Do all triaged patients in ED need to receive medication reconciliation? Answer: Yes, currently this is how the standard is written Based on feedback from the field this requirement is being reviewed Results from the review will be communicated to all organizations

Medication Reconciliation in Ambulatory Care Ambulatory care and clinics do not always include admission or care related to medications; is it necessary to do medication reconciliation? Answer: Based on feedback from the field the details and requirements of the ROP for outpatient settings is currently being reviewed Results from the review will be communicated to organizations

Medication Reconciliation in Ambulatory Care cont’d Still important for safety of outpatient services to reconcile medications (such as outpatient surgery, dialysis facilities, outpatient oncology clinics, and family practice areas) The process for reconciling medications in outpatient settings is different than the process for inpatient transitions A medication list is collected to know what medications a patient is taking or receiving prior to the outpatient visit in order to provide quality care

Medication Reconciliation in Ambulatory Care cont’d At the end of the outpatient visit, two things should be verified: Based on what occurred in the visit, is any medication that the patient was taking or receiving prior to the visit being discontinued, altered, or held pending consultation with the prescriber? Have any new prescriptions been added? Based on the answers to the these questions reconciliation and follow up can occur More information is available from ISMP

Medication Reconciliation in Home care Homecare services do not always involve medications; is it necessary to do medication reconciliation? Answer: It is important for homecare services to do medication reconciliation when they are involved in a medication management with clients

Pharmacist Role in Medication Reconciliation What is the role of a pharmacist in medication reconciliation? Answer: Pharmacists play a key role in assisting with medication reconciliation Accreditation Canada specifies in the test for compliance that medication reconciliation is a shared responsibility involving the pharmacist

Medication Reconciliation for Respiratory Therapy As a RT company we only deliver oxygen to clients; do we need to do medication reconciliation? Answer: Yes, medication reconciliation remains an important part of safe services Accreditation Canada requires RT organizations review medications for possible interactions or contraindications with oxygen More details are available on the Accreditation Canada website

Service area / site / unit What is the difference between these terms? Answer: All three terms were used to reflect how different organizations are structured and where medication reconciliation may take place Common meanings are: Site is facility you work for, e.g. hospital, long term care home , home care agency Service could be the specialty where you work, e.g. medicine , surgery Unit is the specific unit where you work, e.g. Medicine 4D

Best Possible Medication History For the comprehensive list of medications can it be the BPMH – for Safer Healthcare Now? Answer: Yes, it is one kind of process that can be used 

Part 3 Additional Questions

Accreditation Canada Resources Accreditation Canada Accreditation Specialist Accreditation Canada Technical Support Accreditation Canada’s Website: www.accreditation-canada.ca Organization Portal

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