Medication Reconciliation: Spread to MSNU & 4 West Pre- Admit Clinic

Origins of Medication Reconciliation 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.

Medication Reconciliation – what is it? A formal process for: – –Obtaining a complete and accurate list of each patient’s current home medications (name, dosage, frequency, route) – –Comparing the physician’s admission, transfer, and/or discharge orders to that list – –Bringing discrepancies to the attention of the prescriber and ensuring changes are made to the orders, when appropriate

Why? Concern over patient safety is growing, both among the Canadian public and among health care providers % of patients in acute care hospitals experienced one or more adverse events Greater than 50% of all hospital medication errors occur at the interfaces of care – –Admission to hospital, Transfer from one nursing unit to another, Transfer to step-down care, Discharge from hospital

Why Now? It’s the right thing to do…….. – –Culture of safety: reduce medication errors & potential for patient harm – –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 Standard Executive Leadership has endorsed Medication Reconciliation as a project of high priority

Accreditation Patient Safety Area: Communication – –Reconcile medications with the patient/client at referral or transfer and communicate the patient’s/client’s medications to the next provider of service…. Tests for compliance – –Do these processes take place as a shared responsibility, involving the patient/client, nursing staff, medical staff, and pharmacists, as appropriate? – –Does the organization have an implementation plan for spread…. Accreditation should not be seen as the driver for medication reconciliation. Documenting the patient’s best possible medication history and decreasing discrepancies and adverse events around medications is a safety goal for health care organizations nationally.

Stakeholder Support Executive Leadership Team Quality/ Patient Safety Team Project Team CAPHC SHN Atlantic Node SHN National Campaign ISMP CCHSA

Medication Reconciliation can… Prevent omission of an at-home medication Match in-house dose, frequency and route with at- home dose Assure medications follow the patient from one care area to another

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.[i] Implementation in a surgical population reduced potential adverse drug events by 80% within three months of implementation.[ii] [i] Whittington J, Cohen H. OSF healthcare’s journey in patient safety. Qual Manag Health Care 2004;13(1):53-59 [ii] Michels RD, Meisel S. Program using pharmacy technicians to obtain medication histories. Am J Health Syst Pharm 2003;60:

Definitions Type O = No discrepancy Type 1 = Intentional discrepancy The physician has made an intentional choice to add, change or discontinue a medication and their choice is clearly documented. *considered to be “best practice” in medication reconciliation 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. * 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. *potential to lead to ADEs

Goal SHN Medication Reconciliation ultimate goal: To prevent Adverse Drug Events by implementing medication reconciliation in hospitals across Canada. SHN Medication Reconciliation primary goal: To decrease undocumented intentional and unintentional discrepancies by reconciling all medications at all interfaces of care for all patients.

Aim & Scope What is the aim? To reduce the number of unintentional and undocumented intentional discrepancies (Types 2 & 3) for the inpatient population by 75 %. What is the scope/ boundaries? Medication reconciliation will be completed within 24 hours of admission for all patients admitted to MSNU who are currently taking medications.

Responsibilities BPMH-History taker (can be Pharmacy/ Nursing/ Physicians) History taker interviews the patient/family on admission in order to get the best possible medication history (BPMH) Pharmacist or Nurse assumes the history taker role and completes the admission medication history order sheet, listing all home medications. *Signs record as the history taker. Nursing Does not duplicate the medication history on the Admission/ Visit Assessment Record (#7070)… just documents, “See Admission Medication History Order sheet” *Ensure that there is an admission medication history order sheet completed first. Maintains practice of asking family about medication concerns etc. (Scope of practice /workload measure) Ordering Physician Reviews the BPMH list, reconciles with the history taker and signs the sheet. *The BMPH list then becomes the admission medication orders.

Medication History & Order Sheet

I Have the List, Now What… Reconciliation Review BPMH and confirm each medication listed in the history with the appropriate source (health record, community pharmacy, physician, family, etc.).Review BPMH and confirm each medication listed in the history with the appropriate source (health record, community pharmacy, physician, family, etc.). Contact the physician to resolve any discrepancies.Contact the physician to resolve any discrepancies. Data Submission Pharmacy audits the admission orders monthly, identifying the discrepancy type.Pharmacy audits the admission orders monthly, identifying the discrepancy type. QIC uses data to complete SHN worksheet/ measurement tool and submits data to SHN.QIC uses data to complete SHN worksheet/ measurement tool and submits data to SHN. QIC reports data results back to the team.QIC reports data results back to the team.

Key Players for Med Rec Success Patient/ Family Patient/ Family Nursing Nursing Quality Pharmacy Physicians SHN SHN Medication Medication Reconciliation Reconciliation Review medication history, participate in reconciliation and signs BPMH as orders Receives medication reconciliation education and collaborates with team to provide the BPMH Facilitates and Supports Process Participates in reconciliation of BPMH, identifies discrepancy types, sends data to QIC Participates in collection and reconciliation of BPMH on admission, as part of practice scope &Education

Family Letter

Progress TEAMS Inpatient Nephrology Unit Inpatient Mental Health Women’s Gynecology Goal #1: To implement use of the admission medication history order sheet. Goal #2: Medication reconciliation will become the standard of practice at all admission, discharge and transfer points, for all patients at the IWK.

PDSA Methodology – Conducting small tests of change for improvementMethodology – Conducting small tests of change for improvement – –Plan the change – –Trial the change – –Observe the results – –Spread the change Plan Do Act Study Celebrate successes! Ensure consistent/ accurate data is obtained Share knowledge with others! Ask questions!

MSNU…Next Steps Educate – –Pharmacists – –Nurses – –Physicians Collect Baseline Data Identify which measures will indicate if the changes will lead to improvement. Implement small tests of change (PDSA) to identify and refine processes, procedures and practices which will lead to improvement and achieving the aim.

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