1. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Medication Reconciliation “The Good Sam Way” Southgate Care Centre Edmonton Alberta

2. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Where did we start? Southgate Care Centre – third floor Why? Largest facility with 225 beds greatest potential for admissions An enthusiastic team first to respond to the invitation

3. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Purpose To establish a multidisciplinary medication reconciliation process on the third floor of the GSS Southgate Care Centre with the intention of improving our process through testing cycles of change, measuring our results and when successful spreading to the other units in the facility.

4. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative We are aiming to … ↓ Unintentional Discrepancies (errors) by 75% by Oct 2007 ↓ Undocumented Intentional Discrepancies by 75% by Oct 2007 ↑ Success Index by 75% by Oct 2007 Reconcile the BPMH on all admissions within 7 days by Oct 2007

5. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Our Southgate Team Val Porter Clinical Pharmacist Miki Skendzic Registered Nurse

6. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Changes Tested P P P P P S D A D D D D S S S S A A A A Usual admitting orders by RN, pharmacist obtains additional information and team completes BPMH within 3 days.

7. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Changes Tested P P P P P S D A D D D D S S S S A A A A Physician to reconcile AMO with BPMH on weekly rounds after brief face-to-face explanation by Mec Rec team.

8. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Changes Tested P P P P P S D A D D D D S S S S A A A A Streamlined the process so both team members are able to the complete the BPMH.

9. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Changes Tested P P P P P S D A D D D D S S S S A A A A Included all types of admissions, not just from active treatment, as those numbers were small. Results: Community admissions problematic!

10. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Changes Tested P P P P P S D A D D D D S S S S A A A A Comments added to the right side of BPMH form caused confusion with reconciliation. Results: A “comment section” was added to left side of the form.

11. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Results August 07 Vacation plans = smaller numbers of reconciliations completed (3) Small sample size gives artificial positive results August 07 Vacation plans = smaller numbers of reconciliations completed (3) Small sample size gives artificial positive results

12. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Results

13. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Results

14. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Keys to Success … A committed team - RN and Pharmacist Openness to PDSA model of change Support from facility administration A realistic LTC approach to Med Rec Funding $$$ for team meeting time +++ informal PR to staff and physicians

15. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Lessons learned … Timelines established are achievable 3 days - collection of BPMH 7 days - physician to reconcile Capturing the process on paper helps to build GSS policy guide the team explain Med Rec to others Pharmacy medication profiles can be misleading Is the info current or historical?

16. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Next Steps Trial the Home Medication Form Residents to complete prior to admission Staff to use as a worksheet Plan the “spread” to other units Problem solving the variable physician’s patterns of practice. Remember to use balancing measures for these next steps!

17. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Contact Information Kathy James Fairbairn Consultant Pharmacist Team Lead kjames@gss.org Kim Wanner Nurse Facilitator/Educator kim@viscom.ca