Western Node Collaborative RIVERVIEW HOSPITAL Medication Reconciliation Project Phase One: Admitting June 19, 2006 Zaheen Rhemtulla B.Sc. (pharm)

Riverview Hospital (RVH) As part of British Columbia Mental Health and Addiction Services and governed under the Provincial Health Services Authority, Riverview Hospital provides specialized tertiary mental health services under 3 core programs: - Adult Tertiary Psychiatric Program (225 inpatient beds + 20 ICU beds) specialized tertiary acute care and rehabilitation services to adults living with a serious mental illness - Geriatric Psychiatric Program (145 inpatient beds) assessment and treatment services for inpatients as well as outpatient consultation services to patients who often have needs relating to end-stage dementing illness with severe chronic psychiatric and medical conditions - Neuropsychiatry Program (49 inpatient beds) care to a specialized group of individuals who have cognitive, affective, and psychotic symptoms associated with brain injuries or disease that are beyond the capacity of acute care hospitals and community-based settings

Background Information Recognizing that Medication Reconciliation is an evidence-based intervention that can prevent a high percentage of medication- related adverse events, Riverview Hospital first convened a MedRec team June 2005 in response to the Safer Healthcare Now Campaign and accreditation requirements. Having supportive executive sponsorship and leadership buy-in, the project now has a committed team of over 15 members from various disciplines including physicians, nurse clinicians, unit managers, pharmacists, and administrative staff as well as a new funded project leader. The team meet on a monthly basis to discuss the progress of the project which is being piloted on 5 wards throughout the hospital. Goal for completion for the admission part of the medication reconciliation process is October 2006.

Project Charter Based on studies documenting the high percentage of adverse events occurring in hospitals due to medication errors, particularly at points of transition, Riverview Hospital is focused on providing the best possible care to the patients it serves by developing and implementing procedures and systems that result in better documentation and eliminate unintentional medication discrepancies at these interfaces of care.

Importance Efficient transitions in care Better documentation Better communication Better safety Fewer hospitalizations Decreased costs Better patient care

Reason to adopt To provide the best possible care to a very vulnerable patient population (e.g. pt’s with psychosis/Dementia) Create standardization with all other health-care providers in order to provide “seamless care”.

Aims Reduce the mean number of undocumented intentional discrepancies at admission by 90% from baseline by October 2006 on the 5 pilot wards (2 geriatric wards, 2 adult tertiary care wards, 1 ICU) Reduce the mean number of undocumented unintentional discrepancies at admission by 90% from baseline by October 2006 on the 5 pilot wards Increase the medication reconciliation rate (success index) by 90% from baseline by October 2006 on the 5 pilot wards Provide a process to identify high risk patients (> 5 medications, co-existing medical conditions, potentially toxic medications) that may need additional collateral to achieve the Best Possible Medication History (BPMH)

Where are we in the process? Collecting baseline data on 5 pilot wards (2 geriatric assessment wards, 2 adult tertiary care wards, ICU). This has already resulted in better documentation and decreased the number of undocumented intentional discrepancies Starting with the Sunnybrook Hospital Admission Form and testing on a one-patient-one-physician basis, we are trialing the third draft of our own form

No new data collection for December/ January No new data collection for April 2006 Decrease due to better documentation Includes data for May-June Better documentation (charting) still needed to reach goal of 90% decrease from baseline

No new data collection for December/January No new data collection for April 2006 Includes data for May-June Target Goal (90% less than baseline) has been met

No new data collection for December/ January No new data collection for April 2006 Includes data for May-June Target Goal achieved

Keys to Success and Lessons Learned Successes: Leadership buy-in, team commitment, funding for project leader, funding for event attendance Barriers: Time constraints, individual preferences of methods for documentation, established ward admission procedures, varying needs on individual wards Lessons Learned: Do as many; Plan, Do, Study, Act (PDSA) cycles as possible to work out “wrinkles”

Next Steps Design a flowchart to capture “high need” patients requiring more collateral for BPMH Do more PDSA cycles to fine tune Admissions Form Trial form, to determine if it is universal for all patients admitted to RVH. Educate staff how to use to utilize form Implement form on all wards Collect data to see results

Medication Reconciliation Team Contact Information Riverview Hospital 2601 Lougeed Highway Coquitlam, BC (604) Project Leader: Zaheen Rhemtulla Administrative Leadership: Marilyn Francis Hu Risk Management: Peter Owen Clinical Support: Jane Dumontet Dr. Heather Dr. Meagan O’Keefe Riola Crawford Gail Lesley Bushell Richard Program Support:Ruby Virani Tin Au Valerie Linda Forensic RepresentativesEllen Dave