“ presented to ” georgia hospitals july 31, 2013
DESCRIPTION
Medication Reconciliation Using the MATCH Toolkit. “ Presented to ” Georgia Hospitals July 31, 2013 Kristine Gleason, MPH, RPh - C linical Quality Leader, Northwestern Memorial Hospital Vicky Agramonte, RN, MSN - Project Manager, Healthcare Quality Improvement Program , IPRO. - PowerPoint PPT PresentationTRANSCRIPT
“Presented to”
Georgia Hospitals
July 31, 2013
Kristine Gleason, MPH, RPh - Clinical Quality Leader, Northwestern Memorial Hospital
Vicky Agramonte, RN, MSN - Project Manager, Healthcare Quality Improvement Program , IPRO
Medication ReconciliationMedication ReconciliationUsing the MATCH ToolkitUsing the MATCH Toolkit
Today’sToday’s Objectives Objectives
1. Provide an introduction of the MATCH Toolkit
2. Discuss pre-work requirements to participate in the MATCH-lite Collaborative
3. Discuss strategies to link medication reconciliation with current initiatives
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MATCH “lite” Collaborative Timeline
• July 17, 2013 HAC Call to introduce collaborative
• July 31, 2013 Introduction to the MATCH toolkit and Collaborative Pre-work
• August 20, 2012 Regional Meeting – Savannah
• August 27, 2013 Regional Meeting – Atlanta
• September/October Coaching Calls – Date/Time TBD
https://members.gha.org/source/Calendar/
A Focus OnMedication Reconciliation
A process to decrease medication errors and patient harm by:
1. Obtaining, verifying, and documenting patient’s current prescription and over-the-counter medications; including vitamins, supplements, eye drops, creams, ointments, and herbals
2. Comparing patient’s pre-admission/home medication list to ordered medicines and treatment plans to identify unintended discrepancies
3. Discussing unintended discrepancies (e.g., those not explained by the patient’s clinical condition or formulary status) with the physician for resolution
4. Providing and communicating an updated medication list to patients and to the next provider of service at discharge
Adapted from The Joint Commission National Patient Safety Goal 03.06.014
Current Evidence to Reduce Readmissions: Current Evidence to Reduce Readmissions: Implementing Bundled InterventionsImplementing Bundled Interventions
Source: Hansen et al. Interventions to Reduce 30-Day Rehospitalization: A Systematic Review. Ann Intern Med. 18 October 2011;155(8):520-528.
Pre-Discharge Intervention
Bridging Interventions
Post-Discharge Intervention
• Patient education• Medication Reconciliation• Discharge planning•Scheduling follow-up appointment
• Transition coaches•Physician continuity across settings•Patient-centered discharge instruction
• Follow-up telephone calls• Patient-activated hotlines•Timely communication with next provider of service•Timely follow-up with ambulatory provider
Note: Individual components of these change packages have not been tested by themselves and might not reduce the risk for 30-day rehospitalization.
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Does Medication Reconciliation Impactthe Patient Experience?
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Domains:•Communication with Nurses
•Communication with Doctors
•Responsiveness of Hospital Staff•Pain management*
•Communication about medicines*
•Discharge information*
•Cleanliness of hospital environment
•Quietness of hospital environment
•Overall rating of hospital
•Willingness to recommend hospital
*Impacted by Medication
Reconciliation
Source: HCAHPS Fact Sheet. Available at: http://www.hcahpsonline.org/facts.aspx (accessed 2012 June 20)6
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Opportunities to Educate and Communicate
• Use Medication Reconciliation as an opportunity to educate patients on their medications throughout their hospital stay – Home medications that are continued during the hospitalization
– Home medications that were discontinued and why
– Ordered medications, include indication and possible side effects
– Ordered as-needed (PRN) medications that are available to them by asking
• Empower patients to ask questions and become active partners
• Trace patients through hospital stays to identify opportunities for interaction
“Bundling” Medication Reconciliationwith Current Initiatives
Harm Estimate/Evidence from Literature Harm Estimate/Evidence from Organization
Med History, Reconcile
Order, Transcribe,
Clarify
Procure, DispenseDeliver
Administer Monitor Educate, Discharge
Phases of Medication Management
Measurement / Analysis
Prioritize / Implement Evidence-Based Interventions
Care Transitions
8 Measure Improvements / Monitor for Sustainability
A Step-by-Step Guide to Improving the A Step-by-Step Guide to Improving the Medication Reconciliation ProcessMedication Reconciliation Process
MATCH Toolkit, with customizable, actionable information, is available
at: http://www.ahrq.gov/qua
l/match/match.pdf
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YOUR Mission (to implement a successful med rec YOUR Mission (to implement a successful med rec process) if YOU Choose to ACCEPT Itprocess) if YOU Choose to ACCEPT It
Webinar 1July 11
2 Office Hours Calls
Date/Time TBD
Webinar 2July 31
Regional Meetings August 20 OR August 27
Establish a Measurement
Strategy
Design/ Redesign the
Process
Identify Team Members
Process Map
Develop a Charter
Data Collection Plan
Collect Data
Identify Key Drivers
Flow Chart
Gap Analysis
Process Design
Implementation Plan
Pilot Test
Education / Training
Monitor Performance
Address low compliance
Sustainability10
Identify the problem and goal
Measure current performance
Validate key drivers of error
Fix the drivers of poor performance
Use mechanisms to sustain
improvement
Analyze
A Systematic Approach to Improvement
Define Measure Improve Control
DMAIC is a step by step process improvement methodology used to solve problems by identifying and addressing root causes
For more DMAIC information, including free access to a toolkit and project templates, visit the Society for Healthcare Improvement Professionals website at www.shipus.org 11
Build the Project Foundation
Define
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Assemble Your Team
Team Members: Make significant and focused contributions to timely and successful implementation
Executive SponsorProject responsibilities: provide overall guidance and accountability, remove barriers, provide
strategic oversight and appropriate resources, review progress
Improvement LeaderProject responsibilities: Accountable for using DMAIC to manage project and
complete deliverables in a timely manner, partner with Process Owner
EVERYONE Is Involved and Accountable!
Process OwnerProject responsibilities: Accountable for implementing, controlling and
measuring the project outputs and improvements
SponsorsProject responsibilities: accountable for success, responsible for implementation of
recommendations, provide tactical oversight, reach clinical consensus
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Map the Current Process
A High Level Process Map is a simple picture of a complex process represented by 4-8 key
steps. It is essential to better understand the process being improved and to gain
agreement on project scope.
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How to construct a high level process map:
1. Get Team together - include all stakeholders
2. Define and agree to a process
3. List all participants of the process – depts., mgrs, and job performers
4. Define beginning and end points
5. Brainstorm key process steps
6. Determine order of process steps
7. Validate by physically walking through process
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Develop a Charter
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Advancing Advancing Excellence in Excellence in Health CareHealth Care
Medication Reconciliation Phase IIIMedication Reconciliation Phase III
Linkage to NMH Goal: Best Patient Experience – Deliver care that is safe and without error.
Problem Statement: NMH has made significant strides in developing and implementing a Medication Reconciliation process organization-wide. Through close measurement and monitoring, we have identified the need for additional efforts including: process reassessment and refinement (SDS, Prentice, Discharge). With the proposed 2009 revision to The Joint Commission standard we are presented with new process design opportunities (ED, Outpatient Areas); and, a renewed focus on transfers
(internal and external).
Goal/Benefit: 1) To measurably decrease the number of discrepant medication orders (both inpatient and outpatient) and the associated potential and actual patient harm. 2) Fully meet the Joint Commission’s National Patient Safety Goal #8,
documentation and reconciliation of all medications at admission, transfer and discharge for all inpatients, ED visits and outpatient encounters and external transfers.
Scope: Focus on outpatient Same Day Surgery, Prentice, ED, and procedural areas, transfer and discharge processes
Deliverables: • Improved compliance of medication reconciliation through refined processes in areas stated above.
• A sustainable measurement and monitoring approach to be embedded in current reporting infrastructure.
Resources Required:• We will need leadership to prioritize med rec work and facilitate manager involvement in design and implementation efforts
Key Metric(s):• % inpatient Med Rec compliance at admission, transfer and discharge by discipline (MD, RN, RPh)• % inpatient Med Rec compliance by service
• % outpatient Med Rec compliance at admission and discharge
Exec Sponsor: C Watts Sponsors: DDerman-MD, CPayson-RN, DLiebovitz–IS, NSoper-Surgery Subject Matter Expert: K Gleason Process Owner: H BrakeJFoody, KOLeary–Medicine, KNordstrom–Pharmacy Improvement Leader: ML Green
Milestones: Description Date (month, 2008-9)
#1 Define Phase July#2 Measure/Analyze August
#3 Improve December#4 Control January
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A Word About Scope
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Begin by identifying all areas within your facility
where patients receive
medication.
• Keep it simple … anyone should be able to review your charter and know what you are looking to do and why it is important
• Include data … If you do not have initial data, use placeholders
• Identify where the project “Starts – Stops”
• Ensure your scope reflects your time horizon
• Try to avoid projects over 12 months long
• Estimate where necessary, refine over time … ‘something’ provides a guide, ‘nothing’ causes delays
• Focus on outcomes
Tips for Successful Chartering
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Establish a Measurement
Strategy
Measure
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Caution: Jumping into data collection without a clear plan wastes time, energy, resources, etc.
What to Measure
Operational Definition
Collection Method
Sampling Plan
What Where When How ManyQuestion the
data will answerSpecific
DefinitionSystem, existing
forms, new handwritten forms, etc.
Elements to be collected
Physical location
Timing and frequency of
collection
Number of data points
to be collected
Was an updated medication list provided to the
patient and reviewed at discharge?
“Medication instructions
were reviewed with the patient”
checked on At-Home Meds
List form
Manual collection from existing forms
Copy of At-Home Meds
List form, reasons for
non-compliance.
Use Med Rec audit form GI Lab
2-weeks all shifts.
August 15 - 31 All visits
Data Collection Plan
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Collect Data
• Work with the team and staff to identify potential drivers and build a data
collection form
• Seek assistance from the team and staff in collecting the data to increase buy-in
• Observe the data collection process periodically to identify issues, errors
• Graph the data you intend to collect to (1) confirm how
you plan to use the data and (2) identify any missing
data elements
Identify Key Drivers
23 Involvement of Frontline Staff is KEY
The backside of the baseline data collection form:
Identifying (& addressing) the problematic
issues that drive outcomes
will lead to lasting
improvement
Design/Redesign the Process
Analyze
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Flow Chart
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A flowchart outlines current workflow and helps identify:
•Successful medication reconciliation practices
•Current roles and responsibilities for each discipline at admission, transfer, and discharge
•Potential failures •Unnecessary redundancies
and gaps in the process
Gap Analysis
• Assess the current state of your facility’s medication reconciliation process
• Identify gaps between your current process and one that comprises best practices
• Collect policies, procedures, programs, metrics, and personnel that support the current process
• Describe barriers and rate implementation feasibility
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Design a Successful Med Rec Process
Best Practice: Develop a single medication list, "One Source of Truth”
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Guiding Principles• Clearly define roles and responsibilities
• Standardize, simplify, and eliminate unnecessary redundancies
• Make the right thing to do the easiest thing to do
• Develop effective forcing functions, prompts, and reminders
• Educate workforce, and patients, families, and caregivers
• Ensure process design meets all pertinent local laws or regulatory requirements
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Strategies to OvercomeLack of Resources and Time
1. Get Leadership Buy-In• Let them know why they should care: Patient Safety,
Public Reporting, Financial Incentives
2. Bundle the Work• Identify similarities among projects – get 2 things
accomplished for the price of 1
3. Identify Opportunities for “Quick Wins”• Prioritize changes that may be easily developed and
implemented
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Homework Complete prior to the regional meeting:
1. Put together a High Level Process Map for med rec. Remember: Keep it high level – No more than 8 steps
2. With your team, create a project charter. Use the template on the next slide
3. Adopt a plan to collect baseline data and audit 5 medical records for compliance with the current process
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Vicky Agramonte, RN, MSNProject Manager
Healthcare Quality Improvement Program Island Peer Review Organization, Inc. (IPRO)
Albany, NY 12211-2370(518) 426-3300 [email protected]
Kristine Gleason, MPH, RPhClinical Quality Leader
Northwestern Memorial Hospital Chicago IL 60611
Questions and Discussion
THANK YOU!THANK YOU!
If you want to learn more about IPRO, please visit our website at: http://www.ipro.org If you want to learn more about Northwestern Memorial Hospital, please visit our website at http://www.nmh.org