1. Pharmacy Services Providence Health Care Medication Reconciliation Western Node Collaborative Residential Team Learning Session 3 Storyboard

2. Pharmacy Services Providence Health Care - Residential Five Residential care sites Holy Family Hospital ECU Langara Mount Saint Joseph Hospital ECU Brock Fahrni Pavillion Youville Residence Home to 697 residents Admissions to Residential Care via Priority Access 40% of PHC residential admissions came from PHC acute sites Other 60% from: –Other acute care facilities –Other residential care facilities –Direct from the community –Readmissions

3. Pharmacy Services Residential Team Members Lynette Best (Sponsor) Pam Kelly, Residential Section Head, Pharmacy Services (Team Lead) Fruzsina Pataky, Regional Medication Safety Coordinator Sue Higginbotham, Clinical Nurse Leader, Holy Family Julia Duda, QI Specialist Jody Burrell, Pharmacist Youville Lisa James, Pharmacist Brock Fahrni Barb Laurillard, Pharmacist Langara Ron Wall, Coordinator, Pharmacy IS Nick Groves, Project Leader - Primary Health Care Transition Fund

4. Pharmacy Services Aim Statements 1.Reduce the mean number of undocumented intentional discrepancies on residents moving into Residential Neighbourhoods by 75% by October 2006 2.Reduce the mean number of unintentional discrepancies on residents moving into Residential Neighbourhoods by 75% by October 2006 3.Increase our Medication Reconciliation Success Index (MRSI) by 75% by October 2006

5. Pharmacy Services Baseline Data MeasureBaseline Undocumented Intentional Discrepancies 1.4 per resident Unintentional Discrepancies 0.9 per resident Success Index82%

6. Pharmacy Services Objectives To streamline the medication reconciliation process To examine all moving in processes related to medications To minimize transcription To ensure that medications are not overlooked

7. Pharmacy Services Streamlined Processes:

8. Pharmacy Services Moving In Medication Orders - MIMO

9. Pharmacy Services Changes Tested PDSA 1 Jan-Feb 06 Implemented MIMO at Holy Family ECU PDSA 2 Mar 06 Evaluation of HFH MIMO Implementation PDSA 3 Nurse Satisfaction PDSA 4 Posted RN Instructions PDSA 5 Apr 06 Developed Rx spreadsheet to track MIMOs PDSA 6 Implemented MIMO at Langara Residence PDSA 7 May 06 Implemented MIMO at MSJ ECU PDSA 8 Implemented review of stopped orders PDSA 9 Aug 06 Implemented MIMO at Brock Fahrni PD AS PD AS PD AS PD AS PD AS

10. Pharmacy Services Medication Reconciliation Indicators PHC Residential Care Admissions

11. Pharmacy Services Undocumented Intentional Discrepancies Upon Admission

12. Pharmacy Services Unintentional Discrepancies Upon Admission

13. Pharmacy Services Medication Reconciliation Success Index Upon Admission

14. Pharmacy Services One Resident’s Story 5 drugs omitted on initial admission from home At least 3 opportunities for medication reconciliation Undetected until admitted to Langara HomeUBCH May 19 Langara June 13 VGH May 8 TW, 75 year old female

15. Pharmacy Services Leadership Support Organizational commitment to best practice and evidence based care Early engagement with the Institute for Healthcare Improvement Collaboratives –2001 Quantum Leaps in Patient Safety Patient Safety Leader Position created 2004 –Patient Safety Officer Training – IHI Joined Safer Healthcare Now! Campaign in 2005 implementing all 6 initiatives Participation in SHN Med Rec Collaborative

16. Pharmacy Services Keys to Success Team Accelerators –Team Leader - Early Adopter –Physician advocate –Resources allocated to do the work –Quality Support –Small Tests of Change –Nurse and Physician Buy In – What’s in it for me? Rolling out – implementing across program –Involving key stakeholders – CNL, UC, Rx –Education –Timely follow-up - communication

17. Pharmacy Services Lessons Learned RNs need to be reminded of their role in reconciling the medication list with the residents current/previous medications prior to faxing MIMO to physician’s office Generating MIMO’s more than 24hr prior to the arrival of the resident results in confusion and duplication of work. Nurses need to be reminded to NOT have the physician fax the completed form back to them. The reconciliation needs to take place over the phone in order for Pharmacy to receive a clean, legible copy of the orders Standing orders tend to be omitted by the nursing staff (bowel protocol) on the MIMO. Pharmacy automatically enters these orders now.

18. Pharmacy Services Next Steps Complete MIMO implementation at final PHC Residential Care site Develop implementation plan for PharmaNet- based Admission Medication Orders to be used at PHC Residential Care sites for admissions from the community Adapt printed discharge orders from other VCH Acute Care facilities as admission orders to PHC Residential Care

19. Pharmacy Services Contact Information For more information contact: Pam Kelly, Team Leader Phone: (604) 322-2601 Email:pkelly@providencehealth.bc.ca