Coming Full Circle: AMI and Med Rec Across the Continuum Medication Reconciliation in Home Care Date: April 23 rd, 2007 Time: 10 – 11 am MDT Dial-in: Participant Code: Western Node Breakthrough Series Collaborative May 2007 – May 2008

Medication Reconciliation Mission and Collaborative Goals Mission: –Over the course of the next year, a breakthrough improvement in medication reconciliation. Goals: –Aligned with that stated in the Medication Reconciliation Getting Started Kit available on the Safer Healthcare Now! website ( –The primary goal of medication reconciliation is to eliminate undocumented intentional discrepancies and unintentional discrepancies by reconciling all medications, at all interfaces of care, for all patients. –Develop a process which provides an accurate list across the continuum of care, from admission to an acute care setting, transfer within the setting or to another facility, discharge to the community, and ongoing in the home. The primary emphasis is to create systems of care that dramatically reduce the number of ADEs through the reconciliation of medications.

Home Care – Learning Goals Explore the process of obtaining, updating and communicating a complete Best Possible Medication History (BPMH) Identify core processes to aid in the BPMH and identification of medication errors Develop a BPMH tool for the home care environment for SHN! Develop and test 2 measures which have relevance to monitoring the process and outcomes to prevent harm in the Home Care environment

What’s a BPMH? (Best Possible Medication History) Documentation of all medications that a patient has been taking at home including drug name, dose, frequency and route.

Your Story Please share: What you have done to date around medication reconciliation in home care. What sources of information you currently use to find out what medications a patient is taking (e.g., BC Pharmanet, community pharmacy, patient).

Getting Started – Forming a Team System Leadership (Organizational Leaders) Technical Expertise (Clinical Leaders) Day-to-Day Coordination (Day-to-Day Leaders)

Start Small – Focus Your Area of Work Consider the population you would like to work on. For example referrals into home care: –from a specific acute care site –on a specific population (e.g. elderly admissions) –from one GP in the community –others?

Pre-Work for Learning Session #1 1.Form Your Team 2.Create a Process Map –The current steps that are taken from the time of referral to home care until a complete list of medications are obtained for the client.

Because: provides an overview of the complete process visibly communicates how complicated the system can be. assists in determining the areas for improvement which have the most impact on the aims brilliant ideas – especially from staff who don't normally have the opportunity to participate, but who really know how things work an event that is interactive, that gets people involved and talking an end product – the map – which is easy to understand and highly visual Process mapping is also easy, creative and fun. Why Process Map?

What Is a Process Map? Step-by-Step schematic pictures of a process Boxes show the steps in the procedure arrows indicate the logical flow Symbols have specific meanings to help understand the process Flowcharts can document: –Flow of information – Movement of a patient – Delivery of a service – Any combination of the above

When To Use This Tool? Provide a Common Understanding Identifying Root Causes Defining Projects Designing Remedy Implementing Holding the Gains

Types of Process Maps (aka Flow Charts) Macro Flow Chart Sometimes called a top down chart Documents major steps - usually no more that 6 steps Below each major step, list the major sub-steps Promotes focus on essential steps Represents only useful work Helps Identify what should happen Faster/more efficient that detailed flowcharting Used as quick overview of a new process/project Micro Flow Chart Describes most/all of the steps Level of detail dependant on ability to see problems on a higher level Use sparingly A ‘Drill’ tool into problem area of a process

Source: SHN Medication Reconciliation Getting Started Kit (2007)

Flow Chart Symbols

Where to Start? Tips for Flow Charting 1. Decide on level of detail up front 2. Get basic process down first 3. Chart the process the way it is now 4. Define boundaries 5. Use standard symbols - keep it simple 6. Should be only one output arrow - if more may need decision box

How’s Your Brain So Far?!

Upcoming Calls Med Rec in Long-Term Care April 24, am MDT ; Participant Code: Office Hours *open time for teams to call and ask questions about measurement, Enrollment Activities, etc) Med Rec May 2, pm MDT , Participant Code #

Questions?