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Western Node Collaborative WINNIPEG REGIONAL HEALTH AUTHORITY MEDICATION RECONCILIATION PROJECT TEAM (team picture)

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Page 1: Western Node Collaborative WINNIPEG REGIONAL HEALTH AUTHORITY MEDICATION RECONCILIATION PROJECT TEAM (team picture)

Western Node Collaborative

WINNIPEG REGIONAL HEALTH AUTHORITY

MEDICATION RECONCILIATION

PROJECT TEAM

(team picture)

Page 2: Western Node Collaborative WINNIPEG REGIONAL HEALTH AUTHORITY MEDICATION RECONCILIATION PROJECT TEAM (team picture)

Background

• Six acute care sites (two tertiary care hospitals and four community hospitals)

• Two primary care clinics and two home care sites

• Trial period from October 2005 to December 2006

• Team is comprised of physician sponsor, two co-leaders, project manager, two pharmacists (1.6FTE), twelve nurses (0.4FTE each), one project evaluator

Page 3: Western Node Collaborative WINNIPEG REGIONAL HEALTH AUTHORITY MEDICATION RECONCILIATION PROJECT TEAM (team picture)

Rationale for project

• To develop and implement a regional Medication Reconciliation Process throughout the continuum of care including: admission to an acute care unit, referral to home care and within primary care by December 2006

Page 4: Western Node Collaborative WINNIPEG REGIONAL HEALTH AUTHORITY MEDICATION RECONCILIATION PROJECT TEAM (team picture)

GOALS AND OBJECTIVES

• To develop a Medication Reconciliation Admission Order Form for use in the acute care sites

• To maintain an up-to-date medication record in the client’s chart in the primary care and home care setting

• To educate clients in the primary care and home care setting to maintain a current medication list and provide tools for documenting home medications

Page 5: Western Node Collaborative WINNIPEG REGIONAL HEALTH AUTHORITY MEDICATION RECONCILIATION PROJECT TEAM (team picture)

Aims for Acute Care

1. Decrease the mean # of undocumented intentional discrepancies by 75% by December 31, 2006

2. Decrease the mean # of unintentional discrepancies by 50% by December 31, 2006

3. Increase the MedRec Success Index by 50% by December 31, 2006

4. Spread the MedRec admission process to 100% of Medicine/Family medicine acute care units by December 31, 2006

5. The MedRec Process is completed within 24 hours in 90% of patients upon admission to acute care units by December 31, 2006

Page 6: Western Node Collaborative WINNIPEG REGIONAL HEALTH AUTHORITY MEDICATION RECONCILIATION PROJECT TEAM (team picture)

Aims for Primary Care1. Increase the number of primary care patients in the pilot sites who

have a current medication list with them on clinic visit by 50% by June 30, 2006– Long term goal of 100% by December 31, 2006

2. Decrease the mean number of undocumented intentional discrepancies in the pilot sites by 25% by March 31, 2006– Long term goal to decrease by 75% by December 31, 2006

3. Decrease the mean number of unintentional discrepancies in the pilot sites by 25% by March 31, 2006– Long term goal to decrease by 50% by December 31, 2006

4. Increase the Med Rec Success Index in the pilot sites by 25% by March 31, 2006– Long term goal to increase by 50% by December 31, 2006

5.Spread the MedRec process to two other primary care sites by December 31, 2006

Page 7: Western Node Collaborative WINNIPEG REGIONAL HEALTH AUTHORITY MEDICATION RECONCILIATION PROJECT TEAM (team picture)

Aims for Home Care1. Increase the number of home care clients in the pilot

sites who have a current personal medication to 50% by September 30, 2006.– Long-term goal to 95 % by December 31, 2006.

2. Visiting nurses will complete medications reviews and reconciliation every 6 months, or with any medication changes on 50% of their clients by December 31, 2006.

3.Spread Medication Reconciliation to the Transcona and Inkster visiting nurses by September 30, 2006

4.Home care case coordinators will complete medication reviews and reconciliation with every review visit on 95% or their clients by December 31, 2006.

Page 8: Western Node Collaborative WINNIPEG REGIONAL HEALTH AUTHORITY MEDICATION RECONCILIATION PROJECT TEAM (team picture)

Aims for Home Care

5.Decrease the mean # unintentional discrepancies in the pilot site by 25 % by September 30, 2006. – Long term goal to decrease by 50 % by December 31, 2006.

6.Increase the MEDRec Success Index in the pilot sites by 25 % by September 30, 2006.– Long term goal to increase by 50 % by December 31, 2006.

7.Spread to all other Home Care offices by December 31, 2007.

Page 9: Western Node Collaborative WINNIPEG REGIONAL HEALTH AUTHORITY MEDICATION RECONCILIATION PROJECT TEAM (team picture)

Team Members

• Jan Currie (Executive Sponsor)

• Rob Robson (Project Sponsor)

• Nick Honcharik (Project Co-Lead)

• Marilyn Kilpatrick (Project Co-Lead)

• Lorraine Ogilvie (Project Manager)

• Beatrice de Rocquigny (Pharmacist)

• Lora Jaye Gray (Pharmacist)

Page 10: Western Node Collaborative WINNIPEG REGIONAL HEALTH AUTHORITY MEDICATION RECONCILIATION PROJECT TEAM (team picture)

Team members

Acute care Nurses:• Diane Fillion • Shelly Ripley• Brenda Gawryluk • Angela Roy • Leilani Clarete • Mary Ann Driver • Tracey Mastromonaco • Natalie Nordin

Primary care Nurses:• Gail Roberts • Ruth Byquist

Home Care Nurses:

Joan Ernst Drosdoski

Lori Chartrand

Project Evaluator• Keir Johnson

Page 11: Western Node Collaborative WINNIPEG REGIONAL HEALTH AUTHORITY MEDICATION RECONCILIATION PROJECT TEAM (team picture)

Changes Tested in Acute Care

• Format and content of the physician admission order form

• Use of the form in medical admissions from Emergency (4 sites)

• Use of the form upon admission to a medical unit (1 site but abandoned due to re-work and does not conform to current process)

• Use of a medication list instead of an order form (1 site but abandoned due to need for standardization across region)

• Pharmacist facilitated medication history taking (1 site)

• Use of discharge order form for selected group of home care patients (1 site)

• Use of an addendum form for capturing variances from admission form

Page 12: Western Node Collaborative WINNIPEG REGIONAL HEALTH AUTHORITY MEDICATION RECONCILIATION PROJECT TEAM (team picture)

Changes Tested in Primary Care

• Patient population targeted • Compliance with primary care assistants in

informing clients to bring in medications at scheduled appointment

• Compliance with patients told to bring in medications

• Use of different tools for clients to record home medications

• Impact of posters in clinic rooms

Page 13: Western Node Collaborative WINNIPEG REGIONAL HEALTH AUTHORITY MEDICATION RECONCILIATION PROJECT TEAM (team picture)

Changes Tested in Home Care

• Accuracy of client’s medication list in the chart/database kept by the visiting nurse or case coordinator

• Accuracy of the client’s personal medication list

• Impact of educating client on importance of carrying an up-to-date medication list (follow-up)

• Scheduling medication histories every 6 months using software program

• Accuracy of medication list in patients recently discharged from hospital

Page 14: Western Node Collaborative WINNIPEG REGIONAL HEALTH AUTHORITY MEDICATION RECONCILIATION PROJECT TEAM (team picture)

St. Boniface General Hospital

Medication Reconciliation Success Index

56.3 50.8

66.7 70.6

59.669.8 72.9

50.9

0

25

50

75

100

Baseline June 06 July 06 September 06

Jan 06 – Baseline auditFeb 06 – Draft form shown to physiciansApr 06 – Baseline audit results distributedApr 06 – Form initiated in Emerg for medicine admissionsMay 06 – Form completed by night screening residentsJune 06 – Forms completed for all medicine admissions

Introduction of form and process to medical staff

Audits results distributed

Form completed by medical residents

Form completed by night screening medical residents

Nephrologists informed

New ward residents

Form not used

Compliance audit completed by Chief Medical Officer

June 06 – Nephrologists informed to use the formJuly 1/06 – New ward residents and internsJuly 27-Aug 9 – form not usedAug 1-15 – form not used due to cross-coverageAug 23 – compliance audit conducted by chief medical officer

Page 15: Western Node Collaborative WINNIPEG REGIONAL HEALTH AUTHORITY MEDICATION RECONCILIATION PROJECT TEAM (team picture)

Keys to Success and Lessons Learned

• Physician involvement at the onset• Ongoing communication with management and

direct care staff • Support from senior management• Buy-in from front-line staff• Circulating audit results with interpretation of

measurements (lay man terms)• Development of site implementation teams to

sustain gains and facilitate spread

Page 16: Western Node Collaborative WINNIPEG REGIONAL HEALTH AUTHORITY MEDICATION RECONCILIATION PROJECT TEAM (team picture)

Keys to Success andLessons Learned

• Involve all stakeholders (physicians, nurses, ward clerks, pharmacists, medical information) in decision making

• Update sites on progress with the utilization of the form (compliance audits)

• Frequent communication amongst the team regarding role clarity and responsibilities

Page 17: Western Node Collaborative WINNIPEG REGIONAL HEALTH AUTHORITY MEDICATION RECONCILIATION PROJECT TEAM (team picture)

Steps for implementation

Acute care• Complete education to staff on all medical

wards, Emergency and pharmacy• Attain full support from attending

physicians, chief residents, director of family medicine and chief medical officer

• Solidify process for using the order form at various sites

• Finalize the form content and layout

Page 18: Western Node Collaborative WINNIPEG REGIONAL HEALTH AUTHORITY MEDICATION RECONCILIATION PROJECT TEAM (team picture)

Next Steps and Plans for Spread

• Meet with physicians and unit nurse managers of remaining medical units in all acute care sites

• Meet with home care nursing directors and management team to spread to other diads within the region

• Spread to additional pods within a primary care facility and to other primary care sites within the region

• Continue developing and preparing site teams in anticipation of project closure

• Phase II of project– January 2007 to December 2007 involving 7 patient safety officers (6 acute care, 1 long term care) and one pharmacist

Page 19: Western Node Collaborative WINNIPEG REGIONAL HEALTH AUTHORITY MEDICATION RECONCILIATION PROJECT TEAM (team picture)

Contact InformationMarilyn Kilpatrick, RN, MN, [email protected]

Nick Honcharik, Pharm D, FCSHP, Co-lead

[email protected]

Beatrice de Rocquigny, [email protected]

Lora Jaye Gray, [email protected]

Lorraine Ogilvie RN, BN CQM, Project Manager

[email protected]

Rob Robson, MD, Project [email protected]

Keir Johnson. Program [email protected]