western node collaborative
DESCRIPTION
Western Node Collaborative. Capital Health MEDICATION RECONCILIATION Edmonton, Alberta Suburban / Rural Communities & Sturgeon Community Hospital. Background. WestView Health Centre - PowerPoint PPT PresentationTRANSCRIPT
Western Node Collaborative
Capital HealthMEDICATION RECONCILIATION
Edmonton, AlbertaSuburban / Rural Communities &
Sturgeon Community Hospital
Edmonton and areawww.capitalhealth.ca
Edmonton and areawww.capitalhealth.ca
Background
WestView Health Centre
• 20 bed primary care centre staffed by GP’s serving a population of approximately 60,000 with 36,000 emergency visits annually.
• Integrated site with Rehab, Pharmacy, LTC, PHN, Community Care, Shared Care Maternity, Ambulatory clinics, Out-patient surgeries, Laboratory, and DI services.
Edmonton and areawww.capitalhealth.ca
Background (cont’d)
Sturgeon Community Hospital• 116 bed hospital located in St. Albert serving a
population of approximately 85,000 with 47,000 emergency visits annually.
• Services on site are Surgery, CCU, ICU, Medicine, Pediatrics, ED, L&D, Ambulatory Clinics, Adult Day Program.
• On Site Services include DI, Laboratory, Pharmacy, Social Work, Respiratory and Rehabilitation.
Edmonton and areawww.capitalhealth.ca
Background (cont’d)
Capital Health’s Commitment to Medication Reconciliation
• Started November 2005, projected end November 2006.
• Regional Support and Dedicated FTE’s: • Project Coordinator- 0.5• Nursing - 1.0 • Pharmacy - 0.9 • Admin Support - 0.2 • Data entry - 0.2 • Quality Consultant - as required
Edmonton and areawww.capitalhealth.ca
Aim
• To improve patient care and safety in the pilot sites through the reduction of adverse drug events and the promotion of seamless care between settings. This is based on the assumption that a reduction in medication discrepancies will reduce adverse drug events.
Edmonton and areawww.capitalhealth.ca
Aim Statements
• To decrease the number of unintentional medication discrepancies in the targeted areas by 75% by Oct. 2006 on an incremental basis.
• To decrease the number of undocumented intentional discrepancies in the targeted areas by 75% by Oct. 2006 on an incremental basis.
• Establishment of BPMH on 100% of all inpatient charts by Oct. 2006.
Edmonton and areawww.capitalhealth.ca
• To develop and evaluate a BPMH tool, accompanying processes and related procedures to support implementation and use.
• On the basis of measurements of success, recommend implementation of the BPMH tool and processes for consideration of implementation at interfaces of patient care throughout Capital Health.
Aim Statements (cont’d)
Edmonton and areawww.capitalhealth.ca
Team Members
• Team Lead - Mary James, Senior Operating Officer Suburban / Rural Communities• Project Coordinator - Esther Nelles• Pharmacists
– Kim Spiers, Sturgeon Community Hospital– Shelly Proft, WestView Health Centre
• Nurse Clinician - Linda Cawthorn, Suburban / Rural Communities• Nurse Clinician - Recruiting, SCH• Clinical Quality Consultant - Marilyn Dumkee• Administrative Support - Karen Nickerson• Pharmacy Technician - Isabella Voju• Ad Hoc Physician
Edmonton and areawww.capitalhealth.ca
Changes Tested
• Completed 50 PDSA cycles since beginning of the project.
• Format for Medication Reconciliation in Community Care (home care) is in process, with standards for use implemented.
Edmonton and areawww.capitalhealth.ca
Learning's from Run Charts
• Extreme data fluctuations are dependent on small sample size (every medication counts).
• Fluctuation in results is a reflection of staffing challenges, summer vacations and the inclusion of new professions in the process. (Site 2)
• Changes in undocumented intentional’s increased due to the expectation that reasons for med changes be provided at Site 2. (Assumptions are no longer acceptable for reasons meds are changed)
• Auditing is very subjective.• Multiple physicians make education as a group challenging.
Education is better received from same profession.• Inter-rater reliability can be a factor.
Edmonton and areawww.capitalhealth.ca
Mean Number Undocumented Intentional Discrepancies (Site 1)
Summer Interruption in Staffing*
Baseline
*Over summer-Lost 9 senior nurses-Worked with casual staff while recruiting occurred
Physician variability (results vary with style of Admission orders)
Sample Size Range 14-18 pts.
Edmonton and areawww.capitalhealth.ca
Mean Number Unintentional Discrepancies (Site 1)
Baseline
Departure of full time nurse in ER
Lack of nursing compliance completing the BPMH (13 / 22 intentional discrepancies
were due to incorrect BPMH)
One Patient with ## Meds had
incomplete BPMH and therefore had ## unintentionals
Sample Size Range 14-18 pts.
Edmonton and areawww.capitalhealth.ca
Success Index (Site 1)
Baseline
Implementation of BPMH in ER
Full time nurse and 0.5 pharmacist available to teach / mentor and help complete BPMH
Decreased visibility of team member in ER and confusion among staff about which patients’ to
complete BPMH
Sample Size Range 14-18 pts.
Edmonton and areawww.capitalhealth.ca
Mean Number of Undocumented Intentional Discrepancies (Site 2)
Inconsistent use by all ER physiciansVacation taken by team member = decreased visibility in ER
Implementation of form for Physician medication order. One on one physician teaching.
Baseline
Sample Size Range 14-20 pts.
Edmonton and areawww.capitalhealth.ca
Mean Number of Unintentional Discrepancies(Site 2)
Baseline
1. Increased awareness of project in facility
2. Education of nursing
MD Using as order form
Inconsistent MD use
Sample Size Range 14-20 pts.
Edmonton and areawww.capitalhealth.ca
Medication Reconciliation Success Index (Site 2)
Baseline
Form Testing (PDSA #1-8)
Implementation of BPMH in ED
Form Revisions &Acute Compliance
Not all physicians using form and / or incorrect usage.
1. Rollout to MD’s as order form2. High team visibility
Sample Size = 14-20 pts.
Edmonton and areawww.capitalhealth.ca
Nursing Progression
• Audit information only addresses the prescriber success in decreasing ADE. Also important to the process is the successful integration of collecting a BPMH into existing nursing processes.
• The following graphs show the progression of nursing improvement in obtaining BPMH for the WestView site.
Edmonton and areawww.capitalhealth.ca
Average # ER Visits vs. Average Number of Patients with 4 or more
meds
Edmonton and areawww.capitalhealth.ca
Average % Pts Requiring BPMH vs. % BPMH Completed
0%
5%10%
15%
20%25%
30%
35%
40%45%
50%
April 9-15
May14-20
June15-27
July 9-15
Aug20-26
Sept 6-12
% Patient requiringBPMH
% BPMH Completed
Edmonton and areawww.capitalhealth.ca
Keys to Success and Lessons Learned
• Site Leadership support and reinforcement of the process is essential.
• PATIENCE: change is slower than the team expects.
• Form development is very time consuming.• Formal education for staff.
Edmonton and areawww.capitalhealth.ca
Keys to Success and Lessons Learned
• There are 3 levels of reconciliation.
• Inter-disciplinary approach including pharmacists, nursing and physicians requiring clear role definitions to maximize potential.
• Medication Reconciliation is essential to chronic disease management.
Edmonton and areawww.capitalhealth.ca
Next Steps
• Continue to change the culture.• Plan for sustainability and spread within pilot
sites.• Processes required to ensure reconciliation
occurs at discharge.• Public campaign for patient education and
creating the ‘smart patient’.• Define where pharmacists can have the
greatest impact.
Edmonton and areawww.capitalhealth.ca
Next Steps
• Recommendations for spread to region.• I.S. involvement for electronic solutions.• Policy development to meet accreditation
standards.• Determine who the most effective provider is
at the any given point in the process. (Roles and responsibility of each provider in the entire process)
Edmonton and areawww.capitalhealth.ca
Contact Information
• Esther Nelles: WestView Health Centre (780) 968-3770 [email protected]
• Linda Cawthorn: WestView Health Centre (780) 968-3770 [email protected]
• Kim Spiers: Sturgeon Community Hospital (780) 418-8214 [email protected]
• Marilyn Dumkee: Regional Quality Office (780) 735-8072 [email protected]
• Shelly Proft: WestView Health Centre(780) 968-3770 [email protected]