Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
GHAREF HEN Welcome to the MATCH Collaborative PreWork Session July 31, 2013 Medication Reconciliation Using the MATCH Toolkit “Presented to” Georgia Hospitals July 31, 2013 Kristine Gleason, MPH, RPh - Clinical Quality Leader, Northwestern Memorial Hospital Vicky Agramonte, RN, MSN - Project Manager, Healthcare Quality Improvement Program , IPRO Today’s Objectives 1. Provide an introduction of the MATCH Toolkit 2. Discuss pre-work requirements to participate in the MATCH-lite Collaborative 3. Discuss strategies to link medication reconciliation with current initiatives 3 MATCH “lite” Collaborative Timeline • July 17, 2013 HAC Call to introduce collaborative • July 31, 2013 Introduction to the MATCH toolkit and Collaborative Pre-work • August 20, 2012 Regional Meeting – Savannah • August 27, 2013 Regional Meeting – Atlanta • September/October Coaching Calls – Date/Time TBD https://members.gha.org/source/Calendar/ A Focus On Medication Reconciliation A process to decrease medication errors and patient harm by: 1. Obtaining, verifying, and documenting patient’s current prescription and over-the-counter medications; including vitamins, supplements, eye drops, creams, ointments, and herbals 2. Comparing patient’s pre-admission/home medication list to ordered medicines and treatment plans to identify unintended discrepancies 3. Discussing unintended discrepancies (e.g., those not explained by the patient’s clinical condition or formulary status) with the physician for resolution 4. Providing and communicating an updated medication list to patients and to the next provider of service at discharge 5 Adapted from The Joint Commission National Patient Safety Goal 03.06.01 Current Evidence to Reduce Readmissions: Implementing Bundled Interventions Pre-Discharge Intervention Bridging Interventions • Patient education • Transition coaches • Medication Reconciliation • Physician continuity • Discharge planning across settings •Scheduling follow-up • Patient-centered appointment discharge instruction Post-Discharge Intervention • Follow-up telephone calls • Patient-activated hotlines • Timely communication with next provider of service • Timely follow-up with ambulatory provider Note: Individual components of these change packages have not been tested by themselves and might not reduce the risk for 30-day rehospitalization. 6 Source: Hansen et al. Interventions to Reduce 30-Day Rehospitalization: A Systematic Review. Ann Intern Med. 18 October 2011;155(8):520-528. Does Medication Reconciliation Impact the Patient Experience? Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Domains: 7 • • • Communication with Nurses Communication with Doctors Responsiveness of Hospital Staff • • • Pain management* Communication about medicines* Discharge information* • • • • Cleanliness of hospital environment Quietness of hospital environment Overall rating of hospital Willingness to recommend hospital *Impacted by Medication Reconciliation Source: HCAHPS Fact Sheet. Available at: http://www.hcahpsonline.org/facts.aspx (accessed 2012 June 20) Opportunities to Educate and Communicate • Use Medication Reconciliation as an opportunity to educate patients on their medications throughout their hospital stay – Home medications that are continued during the hospitalization – Home medications that were discontinued and why – Ordered medications, include indication and possible side effects – Ordered as-needed (PRN) medications that are available to them by asking • Empower patients to ask questions and become active • 8 partners Trace patients through hospital stays to identify opportunities for interaction ED Admission Intrahospital Transfer Discharge PostDischarge “Bundling” Medication Reconciliation with Current Initiatives Care Transitions ED Admission Intrahospital Transfer Discharge PostDischarge Phases of Medication Management Med History, Reconcile Order, Transcribe, Clarify Procure, Dispense Deliver Administer Monitor Educate, Discharge Measurement / Analysis Harm Estimate/Evidence from Literature Harm Estimate/Evidence from Organization Prioritize / Implement Evidence-Based Interventions 9 Measure Improvements / Monitor for Sustainability A Step-by-Step Guide to Improving the Medication Reconciliation Process MATCH Toolkit, with customizable, actionable information, is available at: http://www.ahrq.gov/qua l/match/match.pdf 10 YOUR Mission (to implement a successful med rec process) if YOU Choose to ACCEPT It Webinar 1 July 11 11 Webinar 2 July 31 Regional Meetings August 20 OR August 27 2 Office Hours Calls Date/Time TBD DEFINE MEASURE ANALYZE IMPROVE CONTROL Build the Project Foundation Establish a Measurement Strategy Design/ Redesign the Process Implement the Process Assess and Evaluate Identify Team Members Data Collection Plan Flow Chart Implementation Plan Monitor Performance Process Map Collect Data Pilot Test Develop a Charter Identify Key Drivers Address low compliance Gap Analysis Process Design Education / Training Sustainability A Systematic Approach to Improvement DMAIC is a step by step process improvement methodology used to solve problems by identifying and addressing root causes Define Measure Identify the problem and goal Measure current performance 12 Analyze Validate key drivers of error Improve Control Use mechanisms to sustain improvement Fix the drivers of poor performance For more DMAIC information, including free access to a toolkit and project templates, visit the Society for Healthcare Improvement Professionals website at www.shipus.org Define 13 Build the Project Foundation Assemble Your Team Executive Sponsor Project responsibilities: provide overall guidance and accountability, remove barriers, provide strategic oversight and appropriate resources, review progress Sponsors Project responsibilities: accountable for success, responsible for implementation of recommendations, provide tactical oversight, reach clinical consensus Improvement Leader Project responsibilities: Accountable for using DMAIC to manage project and complete deliverables in a timely manner, partner with Process Owner Process Owner Project responsibilities: Accountable for implementing, controlling and measuring the project outputs and improvements Team Members: Make significant and focused contributions to timely and successful implementation 14 EVERYONE Is Involved and Accountable! Map the Current Process A High Level Process Map is a simple picture of a complex process represented by 4-8 key steps. It is essential to better understand the process being improved and to gain agreement on project scope. Physician places discharge order Physician writes new prescription Physician prepares d/c instructions Nurse collects the d/c instructions and prescription and counsels the patient 15 Patient discharged How to construct a high level process map: 1. Get Team together - include all stakeholders 2. Define and agree to a process 3. List all participants of the process – depts., mgrs, and job performers 4. Define beginning and end points 5. Brainstorm key process steps 6. Determine order of process steps 7. Validate by physically walking through process 16 Develop a Charter Strategic Linkage • Clearly ties the project to organizational goals Problem Statement • Concise description of the issues Goal Scope • Area to be covered – avoid scope creep Deliverables • Tangible end-products, must align with goal Resources • Necessary requirements for project success Metrics Milestones 17 • Describes planned accomplishments • Objective measurement of progress • Used to monitor progress and maintain focus Medication Reconciliation Phase III Linkage to NMH Goal: Best Patient Experience – Deliver care that is safe and without error. Advancing Excellence in Problem Health Care Statement: NMH has made significant strides in developing and implementing a Medication Reconciliation process organization-wide. Through close measurement and monitoring, we have identified the need for additional efforts including: process reassessment and refinement (SDS, Prentice, Discharge). With the proposed 2009 revision to The Joint Commission standard we are presented with new process design opportunities (ED, Outpatient Areas); and, a renewed focus on transfers (internal and external). Goal/Benefit: 1) To measurably decrease the number of discrepant medication orders (both inpatient and outpatient) and the associated potential and actual patient harm. 2) Fully meet the Joint Commission’s National Patient Safety Goal #8, documentation and reconciliation of all medications at admission, transfer and discharge for all inpatients, ED visits and outpatient encounters and external transfers. Scope: Focus on outpatient Same Day Surgery, Prentice, ED, and procedural areas, transfer and discharge processes Deliverables: • Improved compliance of medication reconciliation through refined processes in areas stated above. • A sustainable measurement and monitoring approach to be embedded in current reporting infrastructure. Resources Required: • We will need leadership to prioritize med rec work and facilitate manager involvement in design and implementation efforts Key Metric(s): • % inpatient Med Rec compliance at admission, transfer and discharge by discipline (MD, RN, RPh) • % inpatient Med Rec compliance by service • % outpatient Med Rec compliance at admission and discharge 18 #1 #2 #3 #4 Exec Sponsor: C Watts Sponsors: DDerman-MD, CPayson-RN, DLiebovitz–IS, NSoper-Surgery JFoody, KOLeary–Medicine, KNordstrom–Pharmacy Milestones: Description Date (month, 2008-9) Define Phase July Measure/Analyze August Improve December Control January 18 Subject Matter Expert: K Gleason Process Owner: H Brake Improvement Leader: ML Green A Word About Scope Begin by identifying all areas within your facility where patients receive medication. 19 Tips for Successful Chartering • • • • • • • 20 Keep it simple … anyone should be able to review your charter and know what you are looking to do and why it is important Include data … If you do not have initial data, use placeholders Identify where the project “Starts – Stops” Ensure your scope reflects your time horizon Try to avoid projects over 12 months long Estimate where necessary, refine over time … ‘something’ provides a guide, ‘nothing’ causes delays Focus on outcomes Measure 21 Establish a Measurement Strategy Data Collection Plan Caution: Jumping into data collection without a clear plan wastes time, energy, resources, etc. What to Operational Collection Measure Definition Method What Question the Specific System, existing Elements to be data will answer Definition forms, new collected handwritten forms, etc. “Medication Copy of Atinstructions Home Meds Was an updated were reviewed List form, medication list with the reasons for provided to the patient” nonpatient and checked on AtManual compliance. reviewed at Home Meds collection from Use Med Rec discharge? List form existing forms audit form 22 Sampling Plan Where When How Many Physical Timing and Number of location frequency of data points collection to be collected GI Lab 2-weeks all shifts. August 15 - 31 All visits Collect Data • • Work with the team and staff to identify potential drivers and build a data collection form Seek assistance from the team and staff in collecting the data to increase buy-in • Observe the data collection process periodically to identify issues, errors • Graph the data you intend to collect to (1) confirm how you plan to use the data and (2) identify any missing data elements Identify Key Drivers The backside of the baseline data collection form: Identifying (& addressing) the problematic issues that drive outcomes will lead to lasting improvement 24 Involvement of Frontline Staff is KEY Analyze 25 Design/Redesign the Process Flow Chart A flowchart outlines current workflow and helps identify: •Successful medication reconciliation practices •Current roles and responsibilities for each discipline at admission, transfer, and discharge •Potential failures •Unnecessary redundancies and gaps in the process 26 Gap Analysis • • • • 27 Assess the current state of your facility’s medication reconciliation process Identify gaps between your current process and one that comprises best practices Collect policies, procedures, programs, metrics, and personnel that support the current process Describe barriers and rate implementation feasibility Design a Successful Med Rec Process Best Practice: Develop a single medication list, "One Source of Truth” 28 Guiding Principles • • • • • • 29 Clearly define roles and responsibilities Standardize, simplify, and eliminate unnecessary redundancies Make the right thing to do the easiest thing to do Develop effective forcing functions, prompts, and reminders Educate workforce, and patients, families, and caregivers Ensure process design meets all pertinent local laws or regulatory requirements Strategies to Overcome Lack of Resources and Time 1. Get Leadership Buy-In • Let them know why they should care: Patient Safety, Public Reporting, Financial Incentives 2. Bundle the Work • Identify similarities among projects – get 2 things accomplished for the price of 1 3. Identify Opportunities for “Quick Wins” • Prioritize changes that may be easily developed and implemented 30 Homework Complete prior to the regional meeting: 1. Put together a High Level Process Map for med rec. Remember: Keep it high level – No more than 8 steps 2. With your team, create a project charter. Use the template on the next slide 3. Adopt a plan to collect baseline data and audit 5 medical records for compliance with the current process 31 32 Questions and Discussion Vicky Agramonte, RN, MSN Project Manager Healthcare Quality Improvement Program Island Peer Review Organization, Inc. (IPRO) Albany, NY 12211-2370 (518) 426-3300 X115 [email protected] Kristine Gleason, MPH, RPh Clinical Quality Leader Northwestern Memorial Hospital Chicago IL 60611 312.926.9172 [email protected] THANK YOU! If you want to learn more about IPRO, please visit our website at: http://www.ipro.org If you want to learn more about Northwestern Memorial Hospital, please visit our website at http://www.nmh.org