1. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative hi Kelowna General Hospital Renal – Pharmacy Collaboration Pharmacist Managed MedRec and Care of End Stage Renal Disease in Patients

2. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Background Patients with end-stage renal disease (ESRD) are at high risk for drug-related problems (DRPs),as these individuals take numerous drugs, have multiple co- morbidities, and experience frequent medication changes The project will target patients with end stage renal disease (on dialysis) who are admitted to Kelowna General Hospital acute care during the 6 month pilot project duration. Hospitalization of patients with ESRD can contribute to the risk of DRPs. 1

3. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Medication reconciliation is part of a broad process of pharmaceutical care, which is the collection of relevant drug, disease, and patient information through a chart review and interview with the patient and/or family members and healthcare providers, followed by an interpretation of all available information to identify, characterize, and resolve the patient’s actual and potential DRPs. The project will enable a multidisciplinary team to develop appropriate tools and an efficient process for a medication reconciliation and pharmaceutical care service in the ESRD inpatient population. 2 Background

4. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative The project will also help to identify the system problems, characterize the incidence, type, and timing of discrepancies and DRPs (and their associated medications) throughout the entire hospital stay. Furthermore, having this preliminary pilot data may increase the political will to allocate adequate resources to expand clinical pharmacy services to the renal (or other) areas throughout IHA. Expected start date is dependant on securing funding for the project 3 Background

5. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Objectives The purpose of this pilot project is to develop a pharmacist-managed medication reconciliation and pharmaceutical care service in the ESRD inpatient population to identify, characterize, and resolve medication discrepancies and DRPs, and collect preliminary information on drug acquisition cost changes and pharmacist time requirements to perform this activity. 4

6. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative To collect pertinent baseline information on the incidence and type of medication discrepancies and DRPs; To develop useful tools and an efficient process for the provision of medication reconciliation and pharmaceutical care; To identify, characterize, and resolve unintentional and undocumented intentional medication discrepancies, and calculate the medication reconciliation success index; 5 Goals

7. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative To assess the potential impact and relationship to gaps in the medication information transfer process of unintentional and undocumented intentional medication discrepancies and DRPs; To determine the number, type, and medications associated with identified DRPs; To determine the acquisition medication cost impact of medication reconciliation and pharmaceutical care; To determine and characterize the time required for a pharmacist to perform medication reconciliation and pharmaceutical care. 6 Goals

8. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Team Members Dr. Gerry Karr, Richard Slavik, Sue Bannerman, Cathy Farrow, Paul Filiatrault, Susan Haskett, Sean Hickey, Wrae Hill, Holly Morgan, Christina Krause, Norma Malanowich, Gordon McGreevy, Kevin Peters 7

9. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Team in Developmental Stage We have submitted our project proposal for funding We have written our MedRec charter We have started process mapping of an acute care episode for chronic renal patients 8

10. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Next Steps Obtain funding for project Finish process mapping Initiate project 9

11. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Process Map

12. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Contact Information Sue Bannerman Lead, Renal Program Interior Health Authority #210 - 1815 Kirschner Road Kelowna, BC V1Y 4N7 Phone: (250) 870-4690 Fax: (250) 870-4795 10

13. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Med Rec Charter