1. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Central Okanagan PALLIATIVE MED REC Home and Community Care

2. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Background Palliative Clients who are admitted to Hospice for Pain and Symptom Management (PSM). Patient risk = loss of pain control; anxiety around uncertainties in medication also causes increased pain levels Hospice temporarily located within a Residential setting until stand- alone site is ready

3. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Background Multidiscliplinary team – Community, Acute, Residential, and Cancer Centre Goals are to: –Expedite transitions –Prevent Adverse Drug Events in transitions Project started just prior to Learning Session 1 in Saskatoon Project charter draft written prior to LS1

4. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Aim #1 4 Aim Statements: 1.Create Best Possible Medication History (BPMH) for 95% of the identified Palliative group within 24 hrs of admission to Hospice, and identify the discrepancies. The target date is Apr. 30, 2008.

5. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Aim #2 & #3 Reconcile 100% of the identified discrepancies within 48 hrs of admission, by Apr. 30, 2008. Create a Best Possible Medication Discharge Plan (BPMDP) for 95% of patients transitioning back to the Community, by Apr. 30, 2008.

6. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Aim #4 4.Reduce Edmonton Symptom Assessment System (ESAS) score for symptom management by 50% by Apr. 30, 2008. (ESAS scores nine symptoms – pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, wellbeing and shortness of breath - on a scale from 0 to 10, with 10 being the worst possible symptom score. A reduced score would show improvements in symptom management.)

7. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Team Members Community Care Manager Director, Residential Services Clinical Practice Consultant, Home Care Nursing (HCN) Clinical Resource RN’s (Acute, Hospice & HCN Palliative Care) Cancer Centre RN Pharmacists (Clinical & Community) Family Practitioner Quality Improvement (SHN) Rep

8. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Changes Tested Who is completing BPMH? Clinical resource nurse. Tested may different forms, only to fine tune an already existing form created in our acute care setting.

9. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Changes Tested 2.Tested best timing to complete BPMH to have an accurate completed Med Rec done. a)BPMH within 48hrs of admission with a goal of 1 week to Med Rec by Physician. b) BPMH within 24hrs of admission with a goal of 1 week to Med Rec by Physician c) BPMH on admission with Med Rec within 24 hrs of admission.

10. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Results 1.Forms tested….. Ours fine tuned. Tested 6 forms. 2.Timing….. We found doing a BPMH on admission to unit resulted in physicians completing the reconciliation soon after admit, with physician cooperation completing the Med Rec with appropriate, accurate orders.

11. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Results 3.Clients are often admitted to unit when CRN is not available. The target group is not always having a Med Rec completed with in the target timeframe. 4.Process Map prior to Med Rec created. Process map and limited data follows…

12. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Process Map Prior to Med Rec

13. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Results June: incomplete data ; CRN away. BPMH complete = 1 July (after July 23) P&SM admits = ? BPMH complete = 0 August P&SM admits = ? BPMH complete = 4 September (to date) P&SM admits = ? BPMH complete = 2

14. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Results Run Charts of your Key Measures Insert your run charts here (More than one slide may be necessary) Annotate your run charts with specific changes you’ve tested

15. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Example of Annotated Graph: Improved Access (delete this slide before saving)

16. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Keys to Success and Lessons Learned We need to expand our team educate and include bedside nurses in the process with 1 or 2 to take on the role of champions when the CRN is not available to complete the BPMH.

17. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Keys to Success and Lessons Learned One person completing the BPMH is too heavy a load! Persistence! We need to persevere with follow up to get the physicians understand the importance of completing the med rec. Process takes longer than anticipated; but well-designed form shortens and smoothes out the process.

18. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Next Steps We are aiming for hospice staff buy in and participation in creating a BPMH for each pain and symptom management client admitted to the hospice unit. Adopt a BPMH/Med Rec form that includes our measurement components. Include ESAS (Edmonton Symptom Assessment Scale) measurements on admit and discharge for all the Med Rec clients.

19. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Contact Information Dianne Stockwell (Clinical Resource Nurse) dianne.stockwell@interiorhealth.ca (250) 862-4109 Faye Burch (Director, Residential Services) faye.burch@interiorhealth.ca (250) 870-5784 Holly Morgan (Clinical QI Coordinator) holly.morgan@interiorhealth.ca (250) 862-4300 Ext 7210