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 3 surrounding rural municipalities – population of 49,750. 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 two trial areas: –use of a BPMH form for all clients admitted to the service of medication assistance (new or existing clients) –use of Universal Medication Form for clients Initial trial done with a small controlled group of clients being transferred into Respite Care (temporary bed in Long Term Care facility) where the LTC staff can give us feedback on the accuracy of the form at admission

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 the use of a Universal Medication Form as a tool for all clients to maintain their own current medication list Aim Statements: At admission, to reduce medication discrepancies (types TBD) for the target group by 75% by April 2008 Conduct a BPMH and reconcile discrepancies on 100% of clients receiving medication assistance by April 2008

5. Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative Team Members Mary Lou Lester – Pharmacist and Team Leader Jayne Troop – Program 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

7. Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative Forms Sample

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

10. Results – BPMH form Total BPMH completed: 9 Average medications per patient: 11 Mean number of discrepancies per patient: 2.3 Most common discrepancy: Medication omitted from home care list Main source used for reconciliation: Community Pharmacy

11. Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative Results Minimum: 10 minutes Maximum: 120 minutes

12. Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative Results Minimum: Same Day Maximum: 22 days

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

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

15. Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative Results Respite Trial Total Reconciliations completed: 12 Percent of clients with UMF at admission present and current: 67% (33% of forms were faxed by home care to PCH) Main source used for reconciliation: Physician, followed by Pharmacy and Family Average medications per patient: 5 Mean number of discrepancies per patient: 0.9 Percent of patients with 1 or more discrepancies: 33% Most common discrepancy: Incorrect frequency

16. 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 Ongoing feedback from staff regarding what is working and what is not –be prepared to make revisions as needed (benefit of your planning cycles)

17. Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative Lessons Learned Our provincial DPIN database is not the best source to reconcile medications; in our region a better source for Home Care is 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 may not work for all clients (needs a motivated client or caregiver), but is a worthwhile form to share with all new referrals to program. Selecting indicators that are easily measured will be a challenge

18. Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative Next Steps Determine and finalize our indicators for success Make any final revisions in our forms and procedures based on feedback from users Begin planning how we will keep the BPMH current Promote use of Universal Medication Form for all clients – Include our seniors groups in getting this form and message out to the public.

19. 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 Jayne Troop – Home Care Program Manager –troopj@brandonrha.mb.catroopj@brandonrha.mb.ca –Phone: 204-571-8420