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Western Node Collaborative
Brandon Regional Health Authority
Medication Reconciliation
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Background
• Brandon Regional Health Authority – covers city
of Brandon, MB and 3 surrounding rural
municipalities – population of 49,750.
• 1 regional hospital – 315 beds- serving Brandon
RHA and many outside regions
• 5 Long Term Care facilities (PCH) and 1 Primary
Access Center
• Public Health, Home Care, and Mental Health
programs/services
• Approximately 100 physicians and 14
pharmacies
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Background
• Medication Reconciliation project began @ Brandon
Regional Health Centre (BRHC) in 2006
– Pilot project fall of 2006 for all direct admissions to medical
floor using Admission Medication Order (AMO) form
– Joined Western Node Collaborative of SHN April 2007
– Trial of modified AMO form -- the “Home Medication and
Initial Order” (HMIO) form in ER in May
– Baseline data collected during the first 2 weeks of June
– Nursing, Physician, and Pharmacist education for
Medication Reconciliation at Admission occurred in June
– Implementation date of Med Rec at Admission to BRHC
occurred on June 19th, 2007
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Background
• 1 FTE Pharmacist for Medication
Reconciliation project – Team Lead
– Also team lead for long term care and home
care teams (currently active)
• Future plans
– Internal transfer @ BRHC – November 2007
– Discharge from BRHC – Spring 2008
– Community programs -- 2009
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Purpose
• To prevent adverse medication occurrences through
medication reconciliation
• To implement the Home Medication and Initial Orders
form (HMIO) for all patients who are admitted to
BRHC
• To implement the reconciliation of the Best Possible
Medication History (BPMH) for all patients with 5 or
more medications or upon consult to a pharmacist
based on clinical judgement
• To implement the admission, internal transfer, and
discharge medication reconciliation process
throughout BRHC
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Aim Statements
• Reduce unintentional discrepancies by 90% on
admission to BRHC by May 2008
• Reduce undocumented intentional discrepancies by 90%
on admission to BRHC by May 2008
• Complete HMIO form for 90% of patients admitted to
BRHC by February 2008
• Incorporate medication reconciliation for internal
transfers at BRHC by November 2007 (internal transfers
that involve the discontinuation of orders from the
transferring ward and the initiation of new orders on the
receiving ward – ICU, pre-op to post-op, CAP & CGP)
• Incorporate medication reconciliation for discharges from
BRHC by May 2008
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Team Members
•
•
•
•
•
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Mary Lou Lester – Pharmacist & Team Leader
Kristi Chorney – Quality/Risk Management
Dr. Groves – Physician Liaison
Sheldon Kokorudz – Pharmacy Director
Liliana Rodriguez – Planning/Evaluation
Seema Roberts – Program Manager ER/ICU
Kim Wallis – Program Educator (Policy &
Procedure)
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Acute Care Working Group
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Shelley Yorke – ER Clinical Resource Nurse
Denise Woodland – Surgery Program Educator
Kathy Ward – ICU Clinical Resource Nurse
Claudia Nieradka – Extended Care, Rehab & Palliative Care
Program Educator
• Wendy Dryburgh – Geriatric Psych Program Manager
• Michelle Mula – Electronic Health Records
• Peggi McKague – Practice Guidelines Facilitator
– Provides us with positive and negative feedback from the frontline staff
– Assists with PDSA cycles and adaptation/modification of forms, policies
and procedures
– Attends all monthly meetings as schedules allow, optional attendance at
monthly teleconferences
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Changes Tested
• Using AMO (Admission Medication Order) form for
admission orders on direct admit patients
• Using HMIO form for home medication history &
admission orders (modified AMO)
• Completion rate of HMIO form post-implementation
• Flagging completed HMIO in pre-op to make the form
more visible to surgeons when writing post-op orders
• Chart audit for accuracy of completion of HMIO
(starting in surgery – plans to expand to other wards)
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Results
Run Charts
Mean Number of Undocumented Intentional Discrepancies
1
0.8
0.9
0.6
0.5
0.4
0.2
0.2
0
Baseline
Jun-Jul 07
Jul-Aug 07
Aug-Sep 07
Sep-Oct 07
Coming Full Circle: AMI & Med Rec Across the Continuum
Oct-Nov 07
Nov-Dec 07
Dec- Jan 08
Jan-Feb 08
Feb-M ar 08
Western Node Collaborative
Mean Number of Unintentional Discrepancies
1.5
1
1.1
1
0.8
0.5
0
Baseline
Jun-Jul 07
Jul-Aug 07
Aug-Sep 07
Sep-Oct 07
Oct -Nov 07 Nov-Dec 07
Dec- Jan 08
Jan-Feb 08
Feb-Mar 08
Mar-Apr 08
Medication Reconciliation Success Index
100%
80%
60%
40%
20%
0%
83%
87%
Baseline
Jun-Jul 07
86%
Jul-Aug 07 Aug-Sep 07 Sep-Oct 07 Oct -Nov 07 Nov-Dec 07 Dec- Jan 08 Jan-Feb 08
Coming Full Circle: AMI & Med Rec Across the Continuum
Feb-Mar 08 Mar-Apr 08
Western Node Collaborative
Rate of potential harm
80%
73%
60%
41%
40%
43%
20%
0%
Baseline
Jun-Jul 07
Jul-Aug 07
Aug-Sep
07
Sep-Oct 07
Oct-Nov
07
Nov-Dec
07
Dec- Jan
08
Jan-Feb 08
Feb-M ar
08
M ar-Apr
08
HMIO Com pletion Rate
HMIO Complet ion Rat e
Target
100%
80%
60%
40%
63%
60%
67%
67%
63%
62%
48%
20%
0%
1
2
3
4
5
6
7
Week
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Keys to Success and
Barriers
• Major keys to success
– Strong team built
• Well-rounded representation of staff & departments
• Willingness of working group to support data collection
– Support of Executive Management
– 1 FTE Pharmacist dedicated to assisting Med Rec project
• Barriers
– Physician education and buy-in
• Difficult to obtain direct contact with most physicians
– Staff education – HMIO being completed, but not always
accurately &/or complete
– Staff outside the working group not readily supporting data
collection
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Lessons Learned
• Organizational skills and dedicated “Med Rec”
time necessary for smooth implementation,
continuous growth, and data/report submission
to SHN
– Cannot be done “part time”
• Ensure good communication between frontline
staff and Med Rec team
– Ensure positive and negative feedback is addressed
and an appropriate response is made to the staff
• Do not assume a form has been used correctly
just because it was used!!
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Next Steps
• Once our HMIO completion rate audit is
complete we will begin formally evaluating the
accuracy of completion
– Determine need for further education
• Preliminary trials starting for internal transfer
– Compare pharmacy med profile to nursing MAR
for a patient when decision to transfer is made
• Discussion with Electronic Health Records
have begun to evaluate the options for
electronic internal transfer (& discharge)
forms
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Contact Information
• Mary Lou Lester – Pharmacist & Team
Leader
– [email protected]
• Kristi Chorney – Quality/Risk Management
– [email protected]
Kim Wallis – Program Educator (Policy &
Procedure
– [email protected]
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative