Enhancing Medication Reconciliation in Acute Care: The Western Node Collaborative Experience

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

2. Background • Brandon Regional Health Authority – covers city of Brandon, MB and surrounding rural municipalities – ~180,000 people • 1 regional hospital – 315 beds- serving Brandon RHA and many outside regions • Approximately 100 physicians and 14 pharmacies • Medication Reconciliation project began @ Brandon Regional Health Centre (BRHC) in May 2006 • Joined Western Node Collaborative of SHN in April 2007 Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

3. Aim • Purpose: To prevent adverse medication occurrences through medication reconciliation • To implement the admission, internal transfer, and discharge medication reconciliation process throughout BRHC • 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 discharges from BRHC by June 2009 • Incorporate medication reconciliation for internal transfers at BRHC by November 2009 Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

4. 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 – Manager ER/ICU • Kim Wallis – Program Educator (Policy & Procedure) Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

5. 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 Manager • Janet Petkau – Electronic Health Records • Peggi McKague – Practice Guidelines Facilitator • Suzanne Clark – Medical Floor Clinical Resource Nurse • Jane Lamont – Pharmacy Manager • 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

6. Changes Tested P D P D A S P D A S P D A S P D A S #5 Compare pharmacy Centricity med profile to nursing MAR to determine the accuracy of pharmacy profile – important to know before pursuing electronic Med Rec at transfer & discharge #4 POAC & pre-op flagging completed HMIO with green plastic post-it flag to make the form more visible to surgeons when writing post-op orders -- help identify patients with an HMIO available A S #3 Completion rate of HMIO form followed to identify areas that needed to improve on use of the form, audit done by unit clerks when chart dismantled #2: Trial of the “Home Medication and Initial Order” (HMIO) form (modified AMO form based on results from pilot project) and new Med Rec policy in ER in May #1: Pilot project fall of 2006 for all direct admissions to medical floor & knee replacement patients in POAC using Admission Medication Order (AMO) form Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

7. Changes Tested P D P D A S P D A S P D A S P D A S #10: gather data on current discharge process #9: bi-monthly audit of 10 charts on each unit to determine the accuracy of completion of the HMIO – results used to evaluate need for further education A S #8 Provide a “You and your Medication” booklet to all patients on admission encouraging them to be more knowledgeable about their medications #7: BPMH prompt card & educational pamphlet developed for staff to use when interviewing the patient – POAC & ER trial ongoing #6: audit of random charts on surgery unit done to determine the accuracy of completion of the HMIO Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

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

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

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

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

12. Results 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 • 0.6 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 • Difficult to 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!! • Request funding for mandatory paid education time for front line staff on the upcoming implementation of a discharge Med Rec process • did not have for admission – only 25% of nurses recorded as attending education inservice which was offered repeatedly over a 2 week period Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

15. Next Steps • Test revised HMIO form with ER physicians to help obtain a more complete medication history at admission • Develop training DVD for frontline staff to assist with obtaining med history and completing HMIO form • Expand education to patients regarding the importance of keeping a current medication list and knowing their medications through the media as well as to inpatients • Begin trial of electronic Med Rec discharge process on one unit using small group of physicians (6 to 8) 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