Admission Medication Reconciliation at Lions Gate Hospital

1. AdmissionMedication Reconciliation at Lions Gate Hospital Lean Transformation Services Laarnie St-Laurent, Lean Coordinator Lorelei Grosser, Lean Coordinator Carissa Looman, Lean Educator

2. Objectives: • What is MedRec? • Why do MedRec? • How was MedRec implemented? • Brief overview of Lean Methodology • How Lean was used for implementation • How are we doing now? • Audit Results • What are key “lessons learned?” • Impacts of MedRec Admission MedRec at Lions Gate Hospital

3. Admission MedRec at Lions Gate Hospital • Ever wondered… • Right medication? • Right dose? • Right time?

4. Admission MedRec at Lions Gate Hospital • What is MedRec?

5. Admission MedRec at Lions Gate Hospital • What is MedRec? “Best Possible” Medication History Reconciliation (Orders) Pharmanet (Prescribed Drugs)

6. Admission MedRec at Lions Gate Hospital • Why do MedRec? • Did you know… • “40-50% of patients on admission” are at risk of unintentional medication discrepancies? • Medication errors may harm patients • Of these, 6% are at risk of harm serious enough to increase length of stay from 2-8 days2.

7. Admission MedRec at Lions Gate Hospital • Why do MedRec? • Some Local Data • At Lions Gate: • About 38.8 daily admissions • 12.5 patients at risk of unintentional discrepancies • 0.75 patients daily at risk of staying 2 to 8 days longer • About $246K additional costs per year • (based on average cost of $450/patient/night)

8. Steps to Achieving Continuous Improvement– sequence to approach the tools Continuous Improvement • -”Without Standards, there can be no improvement“ TaiichiOhno Then: Improve the Process And Then: Repeat! First: Understand the Current State Rather than thinking specific tools do not apply, consider if their concept can provide benefit. See for yourself & collect objective data that becomes the starting point for discussions Adapted from Virginia Mason Lean Leader Certification Materials

9. VCH Improvement System Lean Tollgate Sustainment Audit/Refine Implementation/ Go-Live Future State Development Current State Analysis Project Definition LTS_VCH Improvement System_V1

10. Admission MedRec at Lions Gate Hospital How was MedRec implemented? Observations: Data Collection

11. Admission MedRec at Lions Gate Hospital How was MedRec implemented? Future State Value Stream Map EmergNurse EmergDoctor Admission Triage • BPMH documented by RN or Pharmacist on • MRP reconciles home medications • MedRec Order (MRO) form processed MRO printed for certain areas in Emerg

12. Admission MedRec at Lions Gate Hospital How was MedRec implemented? Standard Operating Procedures: Who What How When Why

13. Admission MedRec at Lions Gate Hospital How was MedRec implemented?

14. Admission MedRec at Lions Gate Hospital How was MedRec implemented? Auditing and Breakthrough Lanes: Did not meet MedRec criteria Met MedRec criteria

15. Admission MedRec at Lions Gate Hospital How was MedRec implemented? Auditing and Breakthrough Lanes: Why did not meet MedRec criteria?

16. Admission MedRec at Lions Gate Hospital How was MedRec implemented? Auditing and Breakthrough Lanes: Did not meet MedRec? Now what????

17. Admission MedRec at Lions Gate Hospital How are we doing now?

18. Admission MedRec at Lions Gate Hospital How are we doing now?

19. Admission MedRec at Lions Gate Hospital How are we doing now?

20. Comparison: Vancouver Coastal

21. Admission MedRec at Lions Gate Hospital How are we doing now? Examples of “good saves” and Qualitative Results…

22. MedRec Success Stories

23. Admission MedRec at Lions Gate Hospital

24. Admission MedRec at Lions Gate Hospital • Reference List: • 1 Canada. Accreditation Canada. Required Organization Practice. Ottawa: Accrediation Canada, 2012. Print. • 2 Canada. Optimizing Medication Safety at Care Transitions – Creating a National Challenge. Toronto: 2011. Print.

25. Admission MedRec at Lions Gate Hospital Thank you for listening! Questions???

26. Admission MedRec at Lions Gate Hospital • What is MedRec? Systematic Partnership Conversation

27. Admission MedRec at Lions Gate Hospital • How was MedRec implemented? 5 Steps to Lean Thinking Source: James P. Womack. Lean Thinking.

28. Admission MedRec at Lions Gate Hospital Medication Management Paper flow Audit & Refine Implement