Western Node Collaborative

1. Western Node Collaborative Winnipeg Regional Health Authority Medication Reconciliation Project

2. Background • Six acute care sites (two tertiary care hospitals and four community hospitals), two primary care clinics and two home care sites • October 2005 – December 2006 • Two seconded pharmacists (1.6FTE), twelve nurses (0.4FTE each), one project evaluator

3. Aim • 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 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

4. 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)

5. Gail Roberts (Primary Care Nurse) Ruth Byquist (Primary Care Nurse) Joan Ernst Drosdoski (Home Care Nurse) Lori Chartrand (Home Care Nurse) Dianne Fillion (Acute Care Nurse) Shelley Ripley (Acute Care Nurse) Brenda Gowryluk (Acute Care Nurse) Angela Roy (Acute Care Nurse) Leilani Clarete (Acute Care Nurse) Mary Ann Driver (Acute Care Nurse) Tracey Mastromonoco (Acute Care Nurse) Natalie Nordin (Acute Care Nurse) Keir Johnson (Project Evaluator)

6. Changes Tested • Physician order form to document home meds and initiate inpatient med orders • Screening physicians complete MedRec form in ER • Service physicians complete MedRec form on admission to pilot unit • Nurse/physician complete MedRec form in collaboration • Use of home med form as a document for reference • (NEW not tested) Modification of MedRec form to include “new” medication orders

7. Keys to Success and Lessons Learned • Communication is vital • Physician buy-in is a must • Direction from senior management is required • Front-line staff must see the value • Important team characteristics: • Commitment • Regular meetings and communication • Continuing education • Role clarity

8. Next Steps • Reassess where we are and where we are going • Evaluate the need for standardization amongst all regional sites • Continue team building based on interim evaluation • Continue Med Rec education to all staff

9. Marilyn Kilpatrick, RN, MN, Co-lead mkilpatrick@wrha.mb.ca Nick Honcharik, Pharm D, FCSHP, Co-lead nhoncharik@hsc.mb.ca Lora Jaye Gray, Pharmacist lgray@hsc.mb.ca Beatrice de Rocquigny, Pharmacist bderocqu@sbgh.mb.ca Lorraine Ogilvie RN, BN CQM, Project Manager logilvie@wrha.mb.ca Rob Robson, MD, Project Sponsor rrobson@wrha.mb.ca Contact Information Keir Johnson. Program Evaluator kjohnson1@wrha.mb.ca