1. Western Node Collaborative David Thompson Health Region Medication Reconciliation Project

2. Background  Patient Population: Adult medical patients admitted through ER with 5 or more home medications  Improvement: Simplify the flow from Medication History to Admission orders and to provide a tool for more accurate Medication History  Start Date = April 2006 End Date = Jan 2008  Purpose: To decrease adverse drug events and improve communication about medications at transition points  Resources: Team Members, Pharmacy, ER Department, Health Records

3. Aim  To develop and implement a regional Medication Reconciliation and Physician Admission form that incorporates the best possible medication history (BPMH) and facilitates timely and accurate admission orders

4. Improvement Objectives  To decrease the number of undocumented intentional discrepancies for patients admitted to RDRHC medical units from ER by 75% by September 30, 2006  To have ER nurses complete BPMH on 25% of patients with home medications by September 30, 2006.  To increase the number of BPMH completed by nurses, pharmacists, and physicians admitted to medical unit 33, RDRHC by 30 per month by December 31, 2006.

5. Team Members  Steve Freriks - ER Pharmacist  Elaine Berard - ER/Project Nurse  Dr. Brian Lang-Hodge - ER Physician  Celina Colegrave - Medication Safety Officer  Annamarie Fuchs - Utilization Manager  Linda Poloway - Patient Safety Coordinator

6. Changes Tested  PDSA #1- Change made to the home medication record  tested by nurse and pharmacist on two patients  adopted form with changes  PDSA #2 - Extended function of form to include physicians’ admission orders to cover and reconcile home medications  adopted form with changes

7. Changes Tested Continued  PDSA #2a (change concept = culture of safety - continuing education for staff) Staff education package distributed:  Posters  individual learning packet for each staff member  medical staff newsletter  PDSA #2b (change concept = culture of safety - continuing education for staff) Staff education continued:  one-one-one training sessions  group in-services to ER department, Unit Managers and ER physicians

8. Changes Tested Continued  PDSA #3 (change concept = taking care of business - standardize a document)  Implementation of new Form  Testing the usefulness and reliability of the new Form  PDSA #4 (change concept = culture of safety - providing training and education)  Survey of Physicians and Nurses regarding education package and posters about the Medication Reconciliation Record and Order Form  continue with further educational sessions  continue with one-on-one training sessions

9. Changes Tested Continued  PDSA #5,6,7,8 (change concept = Administrative System: Optimize inspection and use affordances)  Calculate compliance rates for completing Forms (Nursing staff #5; Physicians #6)  Determine accuracy of completed Forms (Nursing staff #7; Physicians #8)  Feedback results to nursing staff and physicians  Repeat PDSA 5-8 in one month after feedback results

10. Results Compliance Data 10-Sep-0613-Sep-06 #%#% # patients38 44 # forms completed 1026%1841% # patients admitted 660%1161% # forms used by physician 583%11100%

11. Results Accuracy of Forms

12. Results

13. Results Continued

15. Keys to Success and Lessons Learned  Focus on developing functional form  Enlist multidisciplinary champions working within the ER department who have already established working relationships  Support by nursing administration to facilitate timely, expeditious form development  Remain sensitive to nursing & physician workload when introducing a new initiative

16. Keys to Success and Lessons Learned  Onsite daily support by the team to reinforce the information  Repeated reinforcement by multiple team members and multiple formats (email, mailbox, verbal) helps to get buy-in from staff  Bribery with ice cream helps increase response rate to surveys!!!!

17. Keys to Success and Lessons Learned  Staff/physicians return to “old habits” - need to continue with ongoing education  Give positive feedback to staff as well as review poorly written Forms

18. Next Steps and Plans for Spread  Sept  presentation to Regional P&T and Quality Council  In-service to Pharmacy Department RDRHC  In-service to Drumheller Site staff and physicians  Trial Meditech Discharge Prescription report on 1 unit  Oct  In-service to staff and physicians on compliance and accuracy data  Team members to Learning Session #3  Nov  spread to ER & pre-op admits at Drumheller (first rural site)  Presentation to Regional Nursing Leadership  Articles in Medical Staff Newsletter  Display posters on all nursing units

19. Next Steps and Plans for Spread  Life after LS3  Develop plan for spread throughout RDRHC site and then all rural sites  Develop plan for link to Community (i.e. link to Meditech Discharge Prescription Report; close the loop admission/discharge/readmission)

20. Contact Information Celina Colegrave Medication Safety Officer ccolegrave@dthr.ab.ca Tel: 403-357-5195