Safer Healthcare Now! Teleconference Tuesday, November 21, 2006 A Kick Start to Medication Reconciliation Dr. Hilary Adams Quality Improvement Physician, Family Medicine Calgary Health Region Judy Schoen Pharmacy Patient Care Manager, Calgary Health Region

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 The team Multidisciplinary Champions/opinion leaders QI support if possible Don’t forget frontline staff! Distinct group with common focus (e.g. nursing unit, specific service etc)

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 Getting Started GSK from SHN PDSA quality improvement model FOCUS –Find an opportunity –Organize a team –Clarify current process –Understand variability –Sustain results

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 Why baseline data We don’t know what we don’t know Recognize size of problem Get buy in early Helps show improvement Makes it a priority

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 Success Index: 56.9% Mean # of Undocumented Discrepancies: 0.6/patient Mean # of Unintentional Discrepancies: 1.7/patient 5 Baseline Measures

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 Current process and Variability Analyze current process for gaps and drops Understand variability ? multiple locations for data

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 Past Process: Hospitalist History and Physical Form Source(s) of Information Incomplete med list 7

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 Past Process: Hospitalist History and Physical Form Source(s) of Information No med list 88

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 Past Process: Nursing Medication History No med list 9

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 Variety of processes Unclear roles Concerns about duplication Rework in locating information in chart Key Learnings 10

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 Variety of processes Unclear roles Concerns about duplication Rework in locating information in chart Team Vision: Standard approach Clear roles Single location for home medication information in chart Collect Best Possible Medication History (BPMH) in 24 – 48 hours 11

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 Team Charter Identify all team members Purpose of project Guiding principles Scope and boundary Goals and objectives Ideas for change Principles for working together Roles and responsibilities

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 Challenges at the Onset No clear owner.No clear owner. Variety of processes.Variety of processes. Obtaining accurate medication information.Obtaining accurate medication information. Limited clinical pharmacy resources.Limited clinical pharmacy resources. Physician / nursing buy-in.Physician / nursing buy-in. Difficulty in adopting new practices.Difficulty in adopting new practices. Lack of communication between interfaces.Lack of communication between interfaces. 13

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 Critical Aspects No duplication/melds with current workflow Prompts/cues on forms (e.g. dose) Involvement of all disciplines Education Strong leadership Monitoring our progress Auditing the process, not individuals 14

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 An Improved Process: What things may look like Standardized approach Multidisciplinary Clear roles. Defined location for home medication information in patient chart. Increased awareness of key questions to ask to illicit the BPMH. 15

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 An Improved Process: What things may look like Ease of use Flexible Does not result in duplication Clear communication Close the loop Prompts health care providers to provide BPMH

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 Step 2: Pre-Admission Medication List 17

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 Step 3 & 4: Additions/Clarifications of Pre-Admission Medication List 18

Safer Healthcare Now! TeleconferenceTuesday, November 21,

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 Step 5: Physician Review 20

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 Challenges Wellnet – not a complete record “As directed” on Rx Patient altering own medications Limited sources of information outside of office hours Transposing to PCIS (EMR) Adapting learnings to the community 21

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 Lessons learned Understand variation in current practice is critical Multidisciplinary approach is essential Vision of final outcome critical BPMH auditor must be separate to the process Clear definitions Deal with one issue at a time Small successes build momentum Just do it! (when is it right enough?)

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 Gains A nurse on Unit 62 received a phone call from a patient’s wife. She asked why her husband was on lasix. The nurse pulled the patients chart and referred to the BPMH form in which the MD had documented that lasix was to be ‘held’ due to dehydration. The nurse was able to efficiently respond to the patient’s wife. 23

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 Baseline Measures Success Index: 56.9% at baseline to as high as 92.8% Mean # of Undocumented Discrepancies: 0.6/patient to as few as 0.0 Mean # of Unintentional Discrepancies: 1.7/patient to as few as

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 Step 1: Patient Risk Assessment Tool Step 1: Patient Risk Assessment Tool 25

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 Referrals to Pharmacy 26

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 Success Index

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 Undocumented Intentional Discrepancies

Safer Healthcare Now! TeleconferenceTuesday, November 21, 2006 Unintentional Discrepancies