Medication Reconciliation in Home Care Alberta Health Services Home Living Programs Edmonton Area Presentation to National Medication Reconciliation Pilot Project Team by: Wendy Harrison April 27 and 28, 2009

Who are we? Alberta Health Services (AHS) was created in May 2008. To provide a patient-focused health system that is accessible and sustainable for all Albertans. This organization brings together 12 formerly separate health entities in the province. (9 of these entities were geographic health regions).

Alberta Health Services Edmonton Area serves the cities of Edmonton, St. Albert and Sherwood Park and several communities and rural areas around Edmonton.

Home care services are provided to over 10,000 clients: living in their own homes (includes apartments and lodges) attending Adult Day Programs or the Comprehensive Home Option for Independent Care of the Elderly (CHOICE) Program Community Aids to Independent Living (CAIL) Clients are admitted for: short term services (e.g. immediately post-op following surgery or for home parenteral therapy) long term care (e.g. for chronic conditions) palliative or end of life care assistance to obtain basic medical aids and equipment

Supportive Living services are provided to over 2000 clients living in congregate settings. Services are intended for medically stable clients who require basic support services on site, as well as meals, laundry, housekeeping and life enrichment activities. There are common areas for socializing and the environment is safe and accessible.

Project Aim The aim of this project is to develop and trial a framework for medication reconciliation in home care. This pilot project will: Explore and test processes to obtain, update, and communicate a complete Best Possible Medication History (BPMH) with home care clients Identify core processes to aid in the BPMH and identification of medication discrepancies e.g. use of risk assessment Test measures for monitoring the process and outcomes for medication reconciliation in the home care environment Demonstrate evidence of involvement of client and/or family in the process

Change Ideas To conduct a pilot study with Case Managers from all 6 Home Care Networks Test educational material for Best Possible Medication History (BPMH), communication to prescriber, documentation and reconciliation: For those coming in as new participants in Phase II Update for those who participated in Phase I Track number of discrepancies Track type of discrepancies

Change Ideas, continued Test Risk Assessment Tool (RAT) and gather information from participants about how and when to use RAT Create question journal to track questions asked, responses given, and changes made. Observe any impacts on triage function (assignment of clients to case managers) as a result of pilot

Queenie Choo, Executive Sponsor, Director, Home Living Programs Wendy Harrison, Team Lead, Manager, Education & Practice Development, Kari Elliott, Manager, Quality and Research Noreen Vanderburgh, Danielle Kuzyk, Sherilyn Houle, Pharmacists Lisa Dubbeldam, Clinical Nurse Educators Eileen Keogh, Occupational Therapy Professional Practice Leader Liz Ross, Nursing Professional Practice Leader Jane Newman, Home Care Supervisor Yvonne Houle, Administrative Assistant Leader Betty Fradgley, Education Manager, Supportive Living Joanne Gordash, Nurse Practitioner, Supportive Living Dr. Mary Hurlburt, Physician

MEASURES # of BPMH’s completed for eligible clients Good News  27 clinicians volunteered to participate They rated education sessions as: Thorough Processes were easy to comprehend Good preparation for medication reconciliation.

MEASURES, continued First data submission January 2009: 5 clients. February 2009: 2 clients March 2009: 8 clients April 2009: 21 clients  Rising time for completing BPMH 

Small Tests of Change Plan, Do, Study, Act (PDSA) : Developed newsletter and posters Key messages for supervisors Brought supervisor onto committee Strong Executive support e.g. Director stressed medication reconciliation on walkabouts Committee role as champions

CHALLENGES TO WORK THROUGH Communication Raising awareness and understanding of medication reconciliation Responding to staff suggestions for improvement Changing processes takes time Staff workload Need to minimize perception of “one more thing to do or add” for busy people

MOVING FORWARD Committee members encouraged participants and were on site to answer questions Outstanding executive sponsor support Dedicated working group team members with positive outlook Celebration of small steps Weekly update on progress e-mails to supervisors acknowledgement of staff involvement varied approaches to communication and sharing data with participants

LESSONS LEARNED Communicate clearly and often Provide time for clinicians to attend education and learn about the documentation required Listen and work with perceptions e.g. “We do this already. Do we need extra paperwork?”

KEY INSIGHTS Clinicians value medication reconciliation Processes need to support clinical practice and respect impact on workload. e.g. reduce paperwork by eliminating duplication of chart forms Clinicians report practice change: no longer “just recording lists of meds from pill bottles” Risk assessment may indicate next steps in assisting with medications rather than serve as initial screening.

NEXT STEPS Continue to refine documentation and tools Share documentation forms and education materials on Communities of Practice website Learn more about risk assessment for home care clients related to medication safety Continue with “spread”

CONTACT INFORMATION Name: Wendy Harrison Email: wendy.j.harrison@albertahealthservices.ca Phone Number: 780-735-3351 (office) 780-902-8249 (cell)