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Medication Reconciliation in the Medical Floor A Patient Safety Quality Improvement Initiative Background Key Steps continued • Hospital admission, transfer and discharge are key medication-related vulnerable moments (history taking & ordering) where patients are at increased risk of medication discrepancies that potentially can lead to adverse drug events. 1. Failure Mode Effects Analysis Step 1 Development of Process Patient Safety Committee, 2006 Key Steps continued Key Steps continued Figure 7. Mean # of Unintentional Discrepancies (Type 3) Figure 4. Automated Discharge Prescription (Meditech) Mean Number of Unintentional Discrepancies Table 1. Summary of Failure Mode Effects Analysis Hospital Information 2.5 2 Figure 1. Summary of Process Map TDH Mean # 1.5 Vulnerable Moment #1 Patient Information Vulnerable Moment #4 Vulnerable Moment #3 Vulnerable Moment #2 Admission to Medical Floor OR National 0 Return to Medical Floor Physician Name & Signature ICU = Intensive Care Unit ER = Emergency Room Medication reconciliation is defined as a formal process of obtaining a compete and accurate list of each patient’s current home medications (including name, dosage, frequency and route and comparing the physicians admission, transfer and/or discharge orders to that list. The process involves: • Verification (collection of medication history) • Clarification (ensuring the medications & doses are appropriate) • Reconciliation (documentation of changes in the orders) Patient Reminder Table 2. Failure Mode Summary Figure 5. Automated Discharge Summary (Meditech) Disseminated information through various mediums Improvement Objectives: • To decrease the number of undocumented intentional and unintentional discrepancies for patients admitted to the Medical Floor from ER by 75% by June 2007. No Need to Dictate Medications – Information Flows Through to Discharge Summary 2. Tools Developed Figure 3. Best Possible Medication History-Baseline Audit Tool Figure 6. Mean # of Undocumented Intentional Discrepancies (Type 2) M ean Number of Undocumented Intentional Discrepancies Step 3 Evaluation -Audits -Success Index -Hospital-wide roll out 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% TDH Mean # TDH Goal Ontario Node National Jun-06 3. Baseline Data Collected – Audit Results Figure 2. Project Plan Step 3 Evaluation Medication Reconciliation Success Index • To increase the number of BPMH completed by nurses, pharmacists, and physicians admitted to the Medical Floor by 75% by June 2007. Key Steps Step 2 Implementation of Med Rec • Presentations to TDH Quality Council, Hospital Board, pharmacists, program core team, staff meetings • Inservices to Medical Floor Resource Nurses outlining process for completing a BPMH & medication reconciliation • Media campaign (newspaper & television) • Signage & email Figure 8. Medication Reconciliation Success Index (Pre-Implementation) Goal: • To develop and implement a Medication Reconciliation process that incorporates the best possible medication history (BPMH) and facilitates timely and accurate admission/transfer/discharge orders. - Develop Team/FMEA - Design of tools - Baseline data collection Jul-06 Evaluation/Discussion Goals & Objectives Step 2 Implementation of Med Rec (Pilot in Medical Floor) Jun-06 Complete List of Medications Home Surgical Step 1 Development of Process Ontario Node 1 0.5 ICU ER TDH Goal 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0 TDH Mean # TDH Goal Ontario Node National Jun-06 Jul-06 Jul-06 Chart audits of 20 patients, revealed a mean Success Index of 75%. This is within the National Mean. This is prior to implementation of the Med. Rec. Process. Our goal is to improve our success index in 1 year by 75% of our baseline (95%). We will continue to monitor our success (on a monthly basis) using the same performance measurement. We will continue to implement Medication Reconciliation, Test Results, Spread and Evaluate. We will know this change is an improvement using our 3 performance measures (compare future changes with current performance) and by measuring nursing satisfaction, physician satisfaction, pharmacy satisfaction & patient satisfaction. Identified Potential Barriers to Success Include: • No clear owner of process, roles & responsibilities • Lack of understanding of potential impact • Use of various forms in various areas/no standardized process