MEDICATION RECONCILIATION in a Pre-Admission Clinic CRITICAL SUCCESS FACTORS

1. MEDICATION RECONCILIATION in a Pre-Admission Clinic CRITICAL SUCCESS FACTORS Cynthia Turner, B. Pharm, R.Ph. Medication Reconciliation Pharmacist Vancouver Island Health Authority (VIHA)

2. What It Takes To Produce Successful Results • At the end of this presentation: • IF you are looking for ideas to improve your results • THEN complete the checklist to guide where your team might need to focus their continuous improvement efforts

3. VIHA • Serving all of Vancouver Island, British Columbia, population 730,000 • 15 acute care hospitals • 1461 acute care beds • 4760 long term care beds Royal Jubilee Hospital

4. Med Rec Process Overview • See Same Day Surgical Admission pts., Royal Jubilee Hospital • In Pre-Admission Clinic (PAC) • Document BPMH • Use multiple sources of medication information • Involves Multidisciplinary Team • Reconcile meds on wards < 24h post-op

5. The Results tell the Story • Implemented: Aug 06 – 1 ward • Now – 4 surgical wards involved Our Results are: • Sustainable [month to month] • Reproducible [ward to ward] • Consistently  goal • Consistently  national average

6. Royal 2; 1st ward – Sustainability Unintentional Discrepancies Sample size small Discrepancies occurred over weekend

7. West 3; 3rd ward - Reproducibility Unintentional Discrepancies

8. Unintentional DiscrepanciesLocal Teams better than National average

9. Unintentional Discrepancies “Then and Now” – < Target Goal

10. Med Rec Steering Group • Bob Clark - Executive Director, Pharmacy, Diagnostic & Surgical Services • Dr. Con Rusnak - Executive Medical Director, Pharmacy, Diag. & Surgical Services • Leslie Moss - Executive Director, Quality & Patient Safety • Michele Babich - Director of Pharmacy • David McCoy – Director, Post-Surgical Care Programs • Dr. Richard Bachand – Manager, Clinical Pharmacy Services • Ev Pearce – Manager, Quality and Safety • Andrea Bentley – Manager, Booking and Pre-Admission

11. Team Members • Cynthia Turner - Medication Reconciliation Pharmacist • Lori Brodie - Facilitator • Alyse Capron - Quality Improvement Consultant • Dr. Hans Cunningham - Chief of Surgery; Surgical Services • Sarah Crawford - Clinical Nurse Leader, Royal 2 • Robyne Maxwell - Clinical Nurse Educator, Royal 2/Royal 3, BU • Andrea Taylor - Clinical Nurse Leader, Royal 3 • Kristie Waterman – Clinical Nurse Leader, West 3 • Marian Chalifoux - Clinical Nurse Educator, West 3 • Rhonda Porter - Clinical Nurse Leader, Surgical Daycare • Claire Fisher - RN, Pre-Admission Clinic • Dr. Richard Bachand - Manager, Clinical Pharmacy Services

12. CRITICAL SUCCESS FACTORS • Documentation • Communication • Education • Program Sustainability • Spread Mentor

13. CRITICAL SUCCESS FACTORS • Documentation • Build in process to double check BPMH • BPMH same place in chart every time • Accuracy of medication information TRUST is KEY

14. 1. Documentation • Build in process to double check BPMH if BPMH not used right away  keeps info. current our process: SDC Nurse notifies both Physician and Med Rec Pharmacist of med. changes

15. 1. Documentation • BPMH in same place in chart every time  Ensure the physician can find the BPMH  Process to alert physicians to presence of BPMH  Reminder notice where to find  Form in Physician Order section of chart PDSA cycles REMINDER Please Complete Home Medication Reconciliation Physician Order Form

16. 1.Documentation c) Accuracy of BPMH Use multiple sources of info.  Family Physician History  Patient Clinic Questionnaire  B.C. PharmaNet profile (14 mos)  Pt. Interview ~ 100%

17. Case StudyNEW PROCESS: Pharmacist involved BPMH Source Accuracy: 68% 79% 76% 100 % (Based on 49 pt.)

18. Intro. Med Rec Form: BPMH documentation/Rx at present – Draft 21 PDSA Cycle #2 To identify Form as an Order PDSA Cycle #5 To clearly define area of responsibility on Form PDSA Cycle #3 To focus Physician to their area (yellow highlighting) PDSA Cycle #4 To eliminate SDC Nurses from documenting medications on Form (new process) 18

19. Documentation Summary TRUST IS KEY!!! • Physicians, nurses, pharmacists all need to TRUST the documentationis accurate • At our site – becomes a Physician Order • Time saving step for multidisciplinary team

20. CRITICAL SUCCESS FACTORS • Communication • Speak language of audience • Preparation and Follow-up are critical • Show-off your results BIGGER THAN 1ST THOUGHT

21. 2. Communication • Speak language of audience Two examples • IMPACT of program on  patient safety • IMPACT of program on patient admissions

22. OVERVIEW of UnintentionalDiscrepancies • 6 month review 615 patients (3570 meds reconciled) • BASELINE PREDICTION:615 • WHAT REALLY HAPPENED WITH MED REC? 24 • DIFFERENCE = potential avoided discrepancies: 591

23. Impact of Process at RJH ALL Admissions Jan to Jun 2007 Med Rec Process 8 % Non Med Rec 92 %

24. Impact of Process at RJH Non-Emergency admissions Jan to Jun 2007 Med Rec Process 18% Non Med Rec 82%

25. 2. Communication • Preparation and follow-up is critical Before: Attend physician meetings, nurse staff meetings etc. After: Ensure everyone is performing their role - problems occur with new residents, physicians, nurses etc.

26. 2. Communication • Show-off your results - Before & after measures on wards - Poster in Senior Executive area - Display in cafeteria, newsletter etc.

27. Patients: Brochure Fine tuned questions Pharmacy: UBC presentation RJH/VGH/Aberdeen 3-5 days training Students rotate in Senior Team: Poster VIHA Board “Big Dot” Nurses: Cafeteria Day/Newsletter Monthly staff meetings Muffin “thank you” day Physicians: Surgical Executive Presentations Chief of Surgery Dept. meetings Training Video Communication examples

28. CRITICAL SUCCESS FACTORS • Education • On-going – new staff, new processes • Standardize material e.g. ward package,educational video etc. • Make use of educational moments

29. CRITICAL SUCCESS FACTORS • Program Sustainability • Program still functions when key personnel away • People seek you out to be included • Use FACTS to sell program

30. … one person needs time off

31. CRITICAL SUCCESS FACTORS • Spread Mentor Med Rec = part of VIHA Strategic Plan • VGH Pre-Admission Clinic • Residential Long Term Care • Dialysis/renal pts. • Pediatric ward • Total Joint Clinic TRUST is KEY

32. Med Rec – Critical Success Factors ChecklistWould you like to improve your team’s Med Rec measures?Are your measures:qSustainable (month to month)qReproducible as you spread to other areasqMeeting or beating your goal targetsqShowing better results than the National Average?If you do not answer “Yes” in the above four boxes, then this checklist might offer guidance as to where to focus your continuous improvement efforts. Any tick in a “NO” box below indicates where improvements in this area may improve your Med Rec measures. 32

33. Med Rec – Critical Success Factors ChecklistPage 2

34. Med Rec – Critical Success Factors ChecklistPage 3 34

35. Contact Information • Cynthia Turner, Med Rec Pharmacistcynthia.turner@viha.ca • Lori Brodie, Facilitatorlori.brodie@viha.ca • Richard Bachand Manager, Clinical Pharmacy Services richard.bachand@viha.ca