Western Node Collaborative

1. Western Node Collaborative Brandon Regional Health Authority Medication Reconciliation Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

2. 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

3. 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

4. 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

5. 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

6. 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

7. Team Members • 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

8. Acute Care Working Group • 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

9. 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

10. Results Run Charts Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

11. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

12. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

13. 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

14. 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

15. 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

16. Contact Information • Mary Lou Lester – Pharmacist & Team Leader • lesterm@brandonrha.mb.ca • Kristi Chorney – Quality/Risk Management • chorneyk@brandonrha.mb.ca Kim Wallis – Program Educator (Policy & Procedure • wallisk@brandonrha.mb.ca Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative