1. Medication Reconciliation : MSNU

2. Origins of Medication Reconciliation as a Patient Safety strategy The Institute for Healthcare Improvement (IHI) introduced the 100K Lives Campaign in December 2004 to challenge health care providers to join a national effort to make health care safer and more effective & ensure hospitals achieve the best possible outcomes for all patients. On April 12, 2005, the Canadian campaign, Safer Healthcare Now! was created. The IWK Health Centre is a registered member.

3. Medication Reconciliation A formal process for: Obtaining a complete and accurate list of each patient’s current home medications (name, dosage, frequency, route) i.e. the Best Possible Medication History -BMPH Comparing the physician’s admission, transfer, and/or discharge orders to that list (The IWK are currently piloting this process at admission) Bringing discrepancies to the attention of the prescriber and ensuring changes are made to the orders, when appropriate

4. Why? Concern over patient safety is growing, both among the Canadian public and among health care providers. 53.6% of enrolled patients had 1 unintended discrepancy (61.4% assessed as having no potential to cause serious harm but 38.6% had potential to cause mod.to severe discomfort or clinical deterioration)..the most common error was omission of a regularly used medication (46.4%) Cornish PL. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med 2005;165:424-429.] Cornish PL. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med 2005;165:424-429.] Greater than 50% of all hospital medication errors occur at the interfaces of care ( Admission,Transfer and Discharge) Rozich JD. Medication safety: One organization’s approach to the challenge. JCOM. 2001;8(10):27-34.. Rozich JD. Medication safety: One organization’s approach to the challenge. JCOM. 2001;8(10):27-34.

5. Why now?   Reduces medication error & potential for patient harm   Is a key component of seamless care strategies   Saves time for physicians, nurses, and pharmacists in the long-term   Medication Reconciliation is a new Canadian Council on Health Services Accreditation Patient Safety Standard for 2008 / ROP(required organizational practice)   Executive Leadership has endorsed Medication Reconciliation as a project of high priority

6. Accreditation : Patient Safety Communication ROP:ROP: Reconcile medications with the patient/client at referral or transfer, and communicate the patient’s/client’s medications to the next provider of service at referral or transfer to another setting, service, service provider or level of care within or outside the organization. Reconcile medications with the patient/client at referral or transfer, and communicate the patient’s/client’s medications to the next provider of service at referral or transfer to another setting, service, service provider or level of care within or outside the organization.

7. Accreditation Tests for compliance:Tests for compliance: -Is there a demonstrated, formal process to reconcile patient medications… -Does the process involve generating a single documented,comprehensive list…. -Does the process include documentation of the differences between the history and orders list… -Do processes take place as a shared responsibility, involving the patient/client, nursing staff, medical staff, and pharmacists, as appropriate -Does the organization have a plan for spread

8. How do we define discrepancies? What tools will be using ?

9. Types of Discrepancies Type O = No discrepancy. The medication name/dose/frequency taken at home by patient is the same as what was ordered for the patient in the admission orders. Type 1 = Intentional discrepancy The physician has made an intentional choice to add, change or discontinue a medication and their choice is clearly documented. *Types 1s are considered to be “best practice” in medication reconciliation

10. Type 2 = Undocumented Intentional discrepancy The physician has made an intentional choice to add, change or discontinue a medication but their choice is not clearly documented. Do not usually represent a serious threat to patient safety but causes confusion, rework and may lead to medication error. Can be reduced by standardizing the method for documenting admission medication orders * Type 2s account for 25-75% of all discrepancies Type 3 = Unintentional discrepancy The physician has unintentionally changed, added or omitted a medication that the patient was taking prior to admission. Can be reduced by multidisciplinary training at obtaining in-depth medication history and involving clinical pharmacists to identify and reconcile discrepancies Type 3s can lead to a med.error with the potential for an ADE.

11. Aim & Scope Aim To reduce the number of undocumented intentional and unintentional discrepancies (Types 2 & 3) for the inpatient population by 75 %. ~ SHN to raise bar for participating teams to 90% in fall 2007 and move toward transfer and discharge interfaces of care Scope Medication reconciliation to be completed within 24 hours of admission for all patients admitted to MSNU who are currently taking medications.

13. Steps for shared responsibility

14. Step 1 Collecting the BPMH- Pharmacy, Nursing and Physicians Interview the patient/family on admission to get the best possible medication history (BPMH) Complete the Medication History and Order Sheet listing all home medications. Sign the record as the interviewer Nursing :On the Admission/ Visit Assessment Record (#7070) Document, “See Medication History and Order sheet” Ensure that form #6360 is on the chart and completed. ____________________________________________________ Step 2 BMPH becomes admission orders Physician reviews the BPMH,reconciles the list and signs the medication history and order sheet. The BMPH list becomes the Admission Medication orders, upon signing.

16. Potential Impact Implementation of medication reconciliation along with other interventions decreased the rate of medication errors by 70% and adverse drug events by 15%, over a seven month period. Whittington J, Cohen H. OSF healthcare’s journey in patient safety. Q Manage Health Care 2004;13(1):53-59 Implementation in a surgical population reduced potential adverse drug events by 80% within four months of implementation. Michels RD, Meisel S. Program using pharmacy technicians to obtain medication histories. Am J Health System Pharmacy 2003;60:1982-1986

17. Supporters of this Project

18. Questions?