1 Western Node Collaborative Chinook Health Region Medication Reconciliation

2 Background CHR is embarking to improve the process of medication reconciliation in efforts to decrease the possibility of adverse drug events to our patients. This includes increasing awareness of physicians, nursing staff, pharmacists and patients’ role in medication reconciliation. The project charter started Sept 05 and expected to be done by Dec 06 The project charter will meet the organization’s goal to establish a culture of patient safety.

3 CHR two units participating are: –Pincher Creek Acute Care (Med-Surg) –LRH 5A (Geriatric Rehab & Acute Care of the Elderly) Patient population: –Pincher Creek: Pediatrics, mental health, adults, med/surg, maternity, palliative, ICU –LRH 5A: geriatrics, rehab, acute medicine

4 Aim Project Charter: To eliminate undocumented intentional discrepancies and unintentional discrepancies by reconciling all medications for all patients. To prevent adverse drug events (ADEs) by implementing medication reconciliation. Decrease the number of undocumented intentional discrepancies and unintentional discrepancies by 75% by December Charter will consist of medication reconciliation of adult patients on Lethbridge Regional Hospital 5A and Pincher Creek Acute care with 5 or more medications.

5 Team Members Nursing Staff Pharmacists Multidisciplinary members Managers Directors Vice Presidents CEO QI Manager

6 Changes Tested PDSA 1 Objective: Reminder memos posted on chart racks and next to telephones will help reduce the number of undocumented intentional discrepancies by 30%.

7 Memo ( PDSA # 1) “Attention all physicians, nursing staff and pharmacist: if there is a change in medication orders please indicate reason for change directly on the Dr’s Orders Form. You have just helped eliminate a medication discrepancy and possibly avoid an adverse drug event. Thank you”

8 PDSA 2 Objective: Place blue “Medication Reconciliation Communication Forms” on patient charts that require admitting medication order clarification. This will help reduce the number of undocumented intentional and unintentional discrepancies by 30%.

9 Medication Reconciliation Communication Form Patient/Room: _________________________ Date/Time (hr):________________ Attention Doctor: ____________________ Please clarify the following medication orders on the patient’s chart: Form to be removed from chart and returned to Pharmacy

10 PDSA 1 PDSA 2

11 PDSA 2 PDSA 1

12 PDSA 1 PDSA 2

13 PDSA 1 PDSA 2

14 PDSA 1 PDSA 2

15 PDSA 1 PDSA 2

16 PDSA 1 PDSA 2

17 PDSA 1 PDSA 2

18 PDSA 1 PDSA 2

19 Keys to Success and Lessons Learned Successes Buy in from all team members (frontline & executive) Small group of physicians presently engaged Previous PDSA cycles experience by some team members Group dynamics positive and energetic Timing Higher awareness of the importance of medication reconciliation amongst nursing staff Barriers Lack of resources

20 Next Steps Test revisions to current audit –Cues: Allergies, medications to include: OTC, herbal, suppositories, eye drops, etc Initiate physician engagement

21 Contact Information Mary Schnell Bonnie Johnson Florrie Macdougall Julie Cuthbertson Mary Pederson Doug Pankoski Penny Kwasny Claire McCrank Colin Zieber Lila Ho-Takeda Donna Stelmachovich Janet Lapins Dr. Roland Ikuta Dr. Joel Weaver