Implementing Iatrics PDI for Medication Reconciliation July Veronica Breadner RN Marie Descent BSc.Phm., RPh.
Halton Healthcare Services (HHS) is comprised of 3 acute care community hospitals - Oakville- Trafalgar Memorial, Milton District and Georgetown Hospital – 420 beds (314 acute/67 CCC/39 Rehab) – 34,401 surgical procedures – 20,519 admissions – 157,793 Ambulatory visits – 3,519 Deliveries – 128,873 ED visits – 3000 staff – 325 physicians 6/3/2010
Standardized process across organization – Patient D/C Instructions – Electronic documentation Promote enhanced utilization of electronic record system Enhancement of Med history in EMR across continuum of care Increased efficiency of data collection methods and auditing ability Med history easily updated Improved legibility Utilize existing pharmacy dictionary 6/3/2010
Screen Appearance Ease of use and access Implementation time Ongoing support & consultation Training materials Cost Extent of experience Standardized drug names D/C Prescription Standardized discharge instructions 6/3/2010
Met more of evaluation criteria than other two vendors Physicians could use the tool in place of CPOE Generates order sets and DC Rx Partnered with Micromedex – we were already familiar with. Utilizes Meditech programming – HCIS platform – simplify report writing and dictionary build Design screens familiar to staff Lower cost alternative Opportunity for Discharge Instructions 6/3/2010
Project Team Project Lead Director of Pharmacy Manager Clinical Informatics 1 FTE Pharmacy Analyst 1 FTE Nurse Analyst Project Management Consultants Working Group Sponsored by CNO Multidisciplinary team balanced with Pharmacy and Nursing representation, Physician representation, Patient Safety Coordinator and Professional Practice 6/3/2010
Iatrics training Installs Dictionary builds Deciding on Pilot Units Communication to stakeholders Physicians Leadership Professional Practice Safety Champions Nursing Public Process Flow mapping Form development End-User Training 6/3/2010
Challenges: Dual position Other responsibilities Underestimating need for additional staff Physician engagement Creative use of resources Pharmacy Student placement within Emergency Secondment of Nursing staff as resources for staff 6/3/2010
eLearning Hands on training MedRec Champion training Go-Live support for 2 weeks/unit ◦ Ongoing pager support Huddles MedRec Resource Binder Biweekly Newsletter/Updates 6/3/2010
Pilot Areas: ◦ Pre-Admission Clinic ◦ Surgical unit ◦ Renal Medicine Unit Software Installs handled by Tech team Testing Go-Live with Admission, then month later Transfer and 2 weeks after that Discharge ◦ Form issues – completed by vendor Team available days/evenings for end-user support ◦ PDSA Improvement Cycles 6/3/2010
Audit trails in Iatrics Compliance with entering home med list Compliance with printing order forms Evaluating correct process utilized Pharmacy Audit form utilization by Physicians Audit Medication Reconciliation for submission to Accreditation Canada and SHN 6/3/2010
Admission Admission Pre-Admission Pre-Admission Transfer Transfer Discharge Rx Discharge Rx Patient Discharge Instructions Patient Discharge Instructions Patient Discharge Instructions for LTC Patient Discharge Instructions for LTC Patient Recorded Home Medications Patient Recorded Home Medications 6/3/2010
Corporate support and communication Use of Champions is key Early engagement of pilot units Increased communication with Physician groups Differentiate between personal preferences and global needs Impact on other departments Contracts with Unit Managers Never under-estimate impact of change process on affected units/departments 6/3/2010
Project plan to roll out to remaining OTMH inpatient units by December 2010 Big Bang rollouts at Georgetown and Milton sites Consider concurrent rollout in identified Outpatient units 6/3/2010
Maintain momentum Raise profile corporately 6/3/2010
6/3/2010