1. Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative Brandon Regional Health Authority Home Care Medication Reconciliation

2. Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative Background Brandon Regional Health Authority – covers city of Brandon, MB and surrounding rural municipalities – services to ~ 180,000 people 1 regional hospital – 315 beds- serving Brandon RHA and many outside regions 5 Long Term Care facilities (PCH) and 1 Primary Access Center Public Health, Home Care, and Mental Health programs/services Approximately 100 physicians and 14 pharmacies

3. Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative Background Home Care working group developed in May 2007 Purpose - implementation of medication reconciliation in the Home Care program Decision to focus on clients admitted to the service of medication assistance for the Medication Reconciliation process –new or existing clients Plan to provide education for all home care clients regarding the importance of preparing & maintaining a current medication list

4. Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative Aim Purpose: To prevent adverse medication occurrences, through the process of medication reconciliation, for Home Care clients receiving medication assistance To promote various tools for all clients to maintain their own current medication list Aim Statements: Conduct a BPMH and reconcile discrepancies on 100% of clients receiving medication assistance by April 2008 Develop a system where 6 month medication reviews occur on 100% of clients receiving medication assistance by October 2008

5. Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative Team Members Mary Lou Lester – Pharmacist and Team Leader Dolores McGregor – Manager Home Care Dianne Strock/Donna McIntyre Hunt – Nursing Resource Managers Kylie Robinson – Case Coordinator Leslie Hayward – Intake Coordinator Kristi Chorney – Quality/Risk Management Liliana Rodriguez – Planning/Evaluation

6. Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative Changes Tested #1: Compare medication list obtained at admission to Home Care for next 5 patients to DPIN and/or inpatient profile (if recently discharged) #3 Trial use of Universal Medication Form with 5 regular users of PCH Respite. Evaluate potential benefit of this form as a tool for all clients to maintain their own current medication list #4 Contact Community Pharmacies to inform them of our work and why they may receive calls from home care staff to clarify client’s medication lists P P P P P S D A D D D D S S S S A A A A #2: Trial using Home Care BPMH and Reconciliation form when collecting new client medication list or updating existing client medication list #5 Develop a BPMH prompt tool to aid staff in obtaining the most accurate medication history from the client

7. Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative Changes Tested #6 Provide a “You and your Medication” booklet to all clients encouraging them to be more knowledgeable about their medications #8 Work with Procura to make a user-friendly med list printout that can be given to the patient and their physician #9 Use BPMH to complete medication list updates with existing med assist clients and formulate a way to flag each client for ongoing 6 month reviews P P P P P S D A D D D D S S S S A A A A #7 Work with Procura to attempt to use electronic program for gathering data, incorporate Med Rec process into Procura profiles #10 Look at options for BRHC to have access to med list in Procura system (mainly ER and POAC for admissions)

8. Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative Results

9. Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative Results

10. Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative Keys To Success Good communication with all stakeholders prior to and during implementation of medication reconciliation project is critical –suggest sending letter to local pharmacies and physicians prior to implementation explaining the project Gather baseline data and report to your team on the current situation prior to implementation to help motivate Develop easy to follow procedures for the use of new forms Create an updated process map so staff can see “the whole picture” of Med Rec once a process is developed Ongoing feedback from staff regarding what is working and what is not to assist with revisions as needed

11. Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative Lessons Learned Our provincial DPIN database cannot be the sole source to reconcile medications; in our region it should be used in conjunction with the pharmacy and then physician The entire process of medication reconciliation takes time, but is worthwhile, as discrepancies are present even in blister pack medications Our greatest source of discrepancies is often on hospital discharge The universal medication form (or other medication list tools) may not work for all clients (needs a motivated client or caregiver), but is a worthwhile tool to share with all new referrals to program

12. Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative Next Steps Continue to work on ways to gather data for our indicators by electronic process (Procura) Work with Procura to create a user-friendly medication list that can be printed and shared with the client and their physician Promote use of various medication list tools to all clients along with “You and Your Medications” book –UMF (Universal Medication Form) –blue Medication Record booklet –provincial “It’s Safe to Ask Med List” ( available June 2 nd )

13. Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative Contact Information Mary Lou Lester – pharmacist –lesterm@brandonrha.mb.calesterm@brandonrha.mb.ca –Phone: 204-578-4249 Dolores McGregor – Home Care Manager –mcgregord@brandonrha.mb.camcgregord@brandonrha.mb.ca –Phone: 204-571-8420