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Western Node Collaborative
RIVERVIEW HOSPITAL
Medication Reconciliation
October 2, 2006
Zaheen Rhemtulla B.Sc. (pharm)
Riverview Hospital (RVH)
As part of British Columbia Mental Health and Addiction Services and
governed under the Provincial Health Services Authority, Riverview
Hospital provides specialized tertiary mental health services under 3
core programs:
- Adult Tertiary Psychiatric Program (225 inpatient beds + 20 ICU beds)
specialized tertiary acute care and rehabilitation services to adults living with a serious
mental illness
- Geriatric Psychiatric Program (145 inpatient beds)
assessment and treatment services for inpatients as well as outpatient consultation
services to patients who often have needs relating to end-stage dementing illness with
severe chronic psychiatric and medical conditions
- Neuropsychiatry Program (49 inpatient beds)
care to a specialized group of individuals who have cognitive, affective, and psychotic
symptoms associated with brain injuries or disease that are beyond the capacity of
acute care hospitals and community-based settings
Background Information

Recognizing that Medication Reconciliation is an evidence-based
intervention that can prevent a high percentage of medicationrelated adverse events, Riverview Hospital first convened a MedRec
team June 2005 in response to the Safer Healthcare Now Campaign
and accreditation requirements.

Having supportive executive sponsorship and leadership buy-in,
the project now has a committed team of over 15 members from
various disciplines including physicians, nurse clinicians, unit
managers, pharmacists, and administrative staff as well as a fulltime project leader. The team meet on a monthly basis to discuss
the progress of the project which is being piloted on 5 wards
throughout the hospital.

Goal for incorporating a medication reconciliation process for all
transition points of patient care throughout the hospital stay is
December 2006
Project Charter
Based on studies documenting the high percentage
of adverse events occurring in hospitals due to
medication errors, particularly at points of transition,
Riverview Hospital is focused on providing the best
possible care to the patients it serves by developing
and implementing procedures and systems that
result in better documentation and eliminate
unintentional medication discrepancies at interfaces
of care.
Importance







Efficient transitions in care
Better documentation
Better communication
Better safety
Fewer hospitalizations
Decreased costs
Better patient care
Reason to adopt

To provide the best possible care to a very
vulnerable patient population (e.g. pt’s with
psychosis/Dementia)

Create standardization with all other health-care
providers in order to provide “seamless care”.
Aims



Reduce the mean number of undocumented
intentional discrepancies at admission by 75% from
baseline by October 2006 on the 5 pilot wards (2
geriatric wards, 2 adult tertiary care wards, 1 ICU)
Reduce the mean number of undocumented
unintentional discrepancies at admission by 75%
from baseline by October 2006 on the 5 pilot wards
Increase the medication reconciliation rate (success
index) to 100% by October 2006 on the 5 pilot wards
Riverview Hospital
Medication Reconciliation Team
Project Leader:
Zaheen Rhemtulla
[email protected]
Administrative Leadership:
Marilyn Macdougall
[email protected]
Risk Management:
Peter Owen
[email protected]
Clinical Support:
Jane Dumontet [email protected]
Dr. Heather Cherneski [email protected]
Riola Crawford
[email protected]
Gail Ancill
[email protected]
Lesley Bushell
[email protected]
Richard Sanassy
[email protected]
Tin Au
[email protected]
Program Support:
Ruby Virani
Valerie Eggen
Linda Edwards
[email protected]
[email protected]
[email protected]
Forensic Representatives:
Ellen Haworth
Dave Wharton
[email protected]
[email protected]
Where are we in the process?

Admission:
BPMH reconciliation on all admissions to the hospital.
This process has detected unintended discrepancies
which are resolved in a timely manner.
Implementing the use of the Medication History and
Admission Orders form on all admissions to pilot ward.

Transfer:
Providing a “Medication Review” profile for all internal
transfers between wards. The nurse from the receiving
ward verifies the profile against the current orders. The
verified medication profile is then signed by the
physician and a copy is sent to pharmacy for updating.
Any discrepancies are dealt with immediately.
Where are we in the process?

Discharge
Trialing a pharmacy computer generated discharge profile
indicating all regularly scheduled medications the patient is to be
taking upon discharge. The form is to be verified against current
orders and signed by the physician(s) upon discharge.
PRN medications are to be written in by the physician only if the
patient requires them upon discharge.
Included on the discharge profile is the last given and next due
date of any long-acting injections.
Ensuring all wards are sending a copy of the current MAR from
the ward in the discharge package or at discharge, leave or
temporary transfer to another facility.
Changes Tested

Tested the “pre-printed” Medication History and Admission
Orders Form on new admissions to pilot ward. Process
involves Admitting sending the same day MAR from
previous institution to the pharmacy. Pharmacy enters the
MAR onto a Medication History and Admission Orders form
and faxes back to ward for physician to reconcile with
admitting orders. Any clarifications are done in pharmacy
prior to submitting pre-printed order form.

Form is effective in reconciling medications, however,
process needs to be built into regular pharmacy and ward
routine – ie. Ward needs to notify pharmacy when patient
arrives and “pre-printed” form is required; pharmacy needs
proper staff trained to complete the form
1.0 Mean Number of Undocumented Intentional Discrepancies
2.50
2.00
BPMH audits
started
Mean
1.50
1.00
Pilot admissions form
started on one ward –
data inconsistencies as
many regular staff on
vacation
Better
documentation
results in
decreased
undocumented
discrepancies
No data collected
for Dec and Jan
Month
Actual
Goal
20
06
D
ec
20
06
N
ov
O
ct
20
0
6
20
06
Se
p
20
06
Au
g
Ju
n
Ju
l2
6
20
0
06
M
ay
20
20
06
06
ar
M
Fe
b
20
20
06
6
Ja
n
20
0
20
05
D
ec
N
ov
20
05
0.00
00
6
No data collected
for April
Ap
r
0.50
2.0 Mean Number of Unintentional Discrepancies
2.50
BPMH audits started
2.00
Mean
1.50
1.00
0.50
No data collected
for Dec and Jan
Month
Actual
Goal
20
06
D
ec
20
06
N
ov
O
ct
20
0
6
20
06
Se
p
20
06
Au
g
Ju
n
Ju
l2
6
20
0
06
M
ay
20
20
06
Ap
r
06
ar
M
Fe
b
20
20
06
6
Ja
n
20
0
20
05
D
ec
N
ov
20
05
0.00
00
6
No data
collected
for April
3.0 Medication Reconciliation Success Index
120%
Pilot admissions form
started on one ward –
data inconsistencies
as many regular staff
on vacation
100%
Better
documentation
increases
success index
BPMH audits
started
60%
40%
20%
No data collected
for April
No data collected for Dec
and Jan
Month
Actual
Goal
20
06
D
ec
20
06
N
ov
O
ct
20
0
6
20
06
Se
p
20
06
Au
g
00
6
Ju
n
Ju
l2
6
20
0
06
M
ay
20
20
06
Ap
r
06
ar
M
Fe
b
20
20
06
6
Ja
n
20
0
20
05
D
ec
20
05
0%
N
ov
Percentage
80%
Keys to Success and
Lessons Learned

Successes: Leadership buy-in and support, team commitment,
funding for project

Barriers: time constraints, individual preferences of methods for
documentation, varying needs on individual wards

Lessons Learned: Do as many; Plan, Do, Study, Act (PDSA)
cycles as possible
Next Steps


Admissions:
Trial Medication History and Admissions Form on all
admissions one ward at a time to determine if it is
universal for all patients
Educate staff how to use to utilize form and
procedures involved
Do audit to see if procedure is effective
Transfers
Follow-up for with staff for any issues arising from
the new procedure of providing reviews at transfer
Next Steps

Discharges
Review the results of the trial and expand to all
wards. Implement a process of including a patient
profile from pharmacy for all discharges.

GOAL
Implement a sustainable and effective Medication
Reconciliation process at every transition point of
patient care
Contact Information
Zaheen Rhemtulla
Project Team Leader/Clinical Pharmacist
Riverview Hospital
2601 Lougheed Highway
Coquitlam, BC
V3C 4J2
604-524-7892
[email protected]