Brandon Regional Health Authority Home Care Medication Reconciliation

1. Brandon Regional Health Authority Home Care Medication Reconciliation

2. Background • Brandon Regional Health Authority – covers city of Brandon, MB and surrounding rural municipalities – services to ~ 180,000 people • 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

3. Background • Home Care working group developed in May 2007 • Purpose - implementation of medication reconciliation in the Home Care program • Decision to focus on clients admitted to the service of medication assistance for the Medication Reconciliation process • new or existing clients • Plan to provide education for all home care clients regarding the importance of preparing & maintaining a current medication list

4. Aim Purpose: • To prevent adverse medication occurrences, through the process of medication reconciliation, for Home Care clients receiving medication assistance • To promote various tools for all clients to maintain their own current medication list Aim Statements: • Conduct a BPMH and reconcile discrepancies on 100% of clients receiving medication assistance by April 2008 • Develop a system where 6 month medication reviews occur on 100% of clients receiving medication assistance by October 2008

5. Team Members • Mary Lou Lester – Pharmacist and Team Leader • Dolores McGregor – Manager Home Care • Dianne Strock/Donna McIntyre Hunt – Nursing Resource Managers • Kylie Robinson – Case Coordinator • Leslie Hayward – Intake Coordinator • Kristi Chorney – Quality/Risk Management • Liliana Rodriguez – Planning/Evaluation

6. Changes Tested P D P D A S P D A S P D A S P D A S #5 Develop a BPMH prompt tool to aid staff in obtaining the most accurate medication history from the client #4 Contact Community Pharmacies to inform them of our work and why they may receive calls from home care staff to clarify client’s medication lists A S #3Trial use of Universal Medication Form with 5 regular users of PCH Respite. Evaluate potential benefit of this form as a tool for all clients to maintain their own current medication list #2:Trial using Home Care BPMH and Reconciliation form when collecting new client medication list or updating existing client medication list #1: Compare medication list obtained at admission to Home Care for next 5 patients to DPIN and/or inpatient profile (if recently discharged)

7. Changes Tested P D P D A S P D A S P D A S P D A S #10Look at options for BRHC to have access to med list in Procura system (mainly ER and POAC for admissions) #9 Use BPMH to complete medication list updates with existing med assist clients and formulate a way to flag each client for ongoing 6 month reviews A S #8 Work with Procura to make a user-friendly med list printout that can be given to the patient and their physician #7Work with Procura to attempt to use electronic program for gathering data, incorporate Med Rec process into Procura profiles #6 Provide a “You and your Medication” booklet to all clients encouraging them to be more knowledgeable about their medications

8. Results

9. Results

10. Keys To Success • Good communication with all stakeholders prior to and during implementation of medication reconciliation project is critical • suggest sending letter to local pharmacies and physicians prior to implementation explaining the project • Gather baseline data and report to your team on the current situation prior to implementation to help motivate • Develop easy to follow procedures for the use of new forms • Create an updated process map so staff can see “the whole picture” of Med Rec once a process is developed • Ongoing feedback from staff regarding what is working and what is not to assist with revisions as needed

11. Lessons Learned • Our provincial DPIN database cannot be the sole source to reconcile medications; in our region it should be used in conjunction with the pharmacy and then physician • The entire process of medication reconciliation takes time, but is worthwhile, as discrepancies are present even in blister pack medications • Our greatest source of discrepancies is often on hospital discharge • The universal medication form (or other medication list tools) may not work for all clients (needs a motivated client or caregiver), but is a worthwhile tool to share with all new referrals to program

12. Next Steps • Continue to work on ways to gather data for our indicators by electronic process (Procura) • Work with Procura to create a user-friendly medication list that can be printed and shared with the client and their physician • Promote use of various medication list tools to all clients along with “You and Your Medications” book • UMF (Universal Medication Form) • blue Medication Record booklet • provincial “It’s Safe to Ask Med List” (available June 2nd)

13. Contact Information • Mary Lou Lester – pharmacist • lesterm@brandonrha.mb.ca • Phone: 204-578-4249 • Dolores McGregor – Home Care Manager • mcgregord@brandonrha.mb.ca • Phone: 204-571-8420