Admission Medication Reconciliation at Lions Gate Hospital

AdmissionMedication Reconciliation

at Lions Gate HospitalLean Transformation Services

Laarnie St-Laurent, Lean CoordinatorLorelei Grosser, Lean Coordinator

Carissa Looman, Lean Educator

Admission MedRec at Lions Gate Hospital

Objectives:

• What is MedRec?• Why do MedRec?• How was MedRec implemented?

Brief overview of Lean Methodology How Lean was used for implementation

• How are we doing now? Audit Results

• What are key “lessons learned?” Impacts of MedRec

Ever wondered…

• Right medication?• Right dose?

• Right time?


What is MedRec?


What is MedRec?

“Best Possible”

Medication History

Reconciliation (Orders)

Pharmanet(Prescribed

Drugs)


Why do MedRec?

Did you know…• “40-50% of patients on admission” are at risk of

unintentional medication discrepancies? Medication errors may harm patients Of these, 6% are at risk of harm serious enough to

increase length of stay from 2-8 days2.


Why do MedRec?

Some Local Data

• At Lions Gate: About 38.8 daily admissions 12.5 patients at risk of unintentional discrepancies

0.75 patients daily at risk of staying 2 to 8 days longer About $246K additional costs per year

(based on average cost of $450/patient/night)


Steps to Achieving Continuous Improvement– sequence to approach the tools

Observe and Collect Data

Standard Work

Unit Layout/ Cell Design (Flow)

Mistake ProofingVisual Controls

Other tools to improve flow and implement pull

See for yourself & collect objective data that becomes the starting point for

discussions

-”Without Standards, there can

be no improvement“ Taiichi

Ohno

Adapted from Virginia Mason Lean Leader Certification

Materials

Continuous

Improvement

First:

Understand the Current

State

Then:

Improve the Process

Rather than thinking specific tools do not apply, consider if their concept can provide

benefit.

And Then:

Repeat!

VCH Improvement SystemLean Tollgate

LTS_VCH Improvement System_V1

Project Definition

Current State Analysis

Future State Development

Implementation/Go-Live

Audit/Refine

Sustainment

Observations: Data Collection

How was MedRec implemented?


Future State Value Stream Map

Triage Emerg Nurse Emerg Doctor Admission

MRO printed

for certain areas in Emerg

• BPMH documented

by RN or Pharmacist

on • MRP

reconciles home

medications• MedRec Order (MRO)

form processed



Standard Operating Procedures:


Who

WhyWhen

How


What

How was MedRec implemented?Auditing and Breakthrough Lanes:

Met MedRec criteria

Did not meet

MedRec criteria



Why did not meet

MedRec criteria?



Did not meet MedRec?

Now what????


How are we doing now?

Organizational TargetsCompletion Rate 75%

BPMH Completion 75%

Reduction in unintentional discrepancies 75%

Reduction in undocumented intentional discrepancies 75%



Area Quantitative ResultsElective Surgery: • Implemented on November 2011

•100% have complete, accurate medication histories•100% receive post-op medication orders• 75% reduction in unintentional discrepancies• 85% reduction in undocumented intentional discrepancies



Area Quantitative ResultsEmergent/Direct Admissions• Implemented on May 23, 2012

•77.5% to 80% reconciliation rate (exceeded target of 75%)•47.5% “best possible medication history” completion rate•50% reduction in unintentional medication discrepancies•55% reduction in undocumented intentional medication discrepancies


Comparison: Vancouver CoastalSite Average Completion Rate

• Since Implementation

Richmond Hospital 60%

Vancouver General 78%

Coastal

Squamish General 60%

St. Mary’s Hospital 65%

Powell River General TBA

Lions Gate Hospital 78%

How are we doing now? Examples of “good saves” and Qualitative Results…


MedRec Success Stories

Unit Good saves…Emergency MD ordered only one of patient’s home meds at half the dose the patient was

taking. When med history was taken by RN, MD ordered the rest of home meds (5 pages were missed).

Pediatrics Patient’s Pharmanet only showed one medication. When BPMH was taken, patient was taking medication at a different dose than on Pharmanet and was also taking a number of other medications NOT on the Pharmanet.

Daycare Surgical patient was seen in PSSU 2 weeks prior to surgery, but had filled other prescriptions since then. Daycare RN picked up on new meds when BPMH was done prior to surgery.

Reference List:

1 Canada. Accreditation Canada. Required Organization Practice. Ottawa: Accrediation Canada, 2012. Print.

2 Canada. Optimizing Medication Safety at Care Transitions – Creating a National Challenge. Toronto: 2011. Print.


Questions???Thank you for listening!


February 27, 2013

What is MedRec?

SystematicPartnership

Conversation


February 27, 2013


2 Map the

Value Stream

3Establish

Flow

4Implement

Pull

5Work to

Perfection

1Specify Value

2 Map the

Value Stream

3Establish

Flow

4Implement

Pull

5Work to

Perfection

1Specify Value

Source: James P. Womack. Lean Thinking.

5 Steps to Lean Thinking


February 27, 2013

Audit & Refine

Paper flow

Implement

Medication Management


Admission Medication Reconciliation at Lions Gate Hospital

Documents

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