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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
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
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
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
Aims for Primary Care
1. 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
Aims for Home Care
1. 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.
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.
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)
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
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
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
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
St. Boniface General Hospital
Medication Reconciliation Success Index
Audits results distributed
100
Nephrologists informed
Form completed by medical residents
69.8
75
50
25
Compliance audit completed by
Chief Medical Officer
59.6
72.9
50.9
66.7
56.3
Form not used
50.8
70.6
New ward residents
Form completed by night screening medical
residents
Introduction of form and process to medical staff
0
Baseline
June 06
Jan 06 – Baseline audit
Feb 06 – Draft form shown to physicians
Apr 06 – Baseline audit results distributed
Apr 06 – Form initiated in Emerg for medicine admissions
May 06 – Form completed by night screening residents
June 06 – Forms completed for all medicine admissions
July 06
September 06
June 06 – Nephrologists informed to use the form
July 1/06 – New ward residents and interns
July 27-Aug 9 – form not used
Aug 1-15 – form not used due to cross-coverage
Aug 23 – compliance audit conducted by chief medical officer
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
Keys to Success and
Lessons 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
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
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
Contact Information
Marilyn Kilpatrick, RN, MN, Co-lead
[email protected]
Rob Robson, MD, Project Sponsor
[email protected]
Nick Honcharik, Pharm D, FCSHP,
Co-lead
[email protected]
Keir Johnson. Program
Evaluator
[email protected]
Beatrice de Rocquigny, BScPharm
[email protected]
Lora Jaye Gray, BScPharm
[email protected]
Lorraine Ogilvie RN, BN CQM,
Project Manager
[email protected]