Medicines%Reconcilia7on%on%Admission%as%a% …...Development & Governance (NBT MSO) and Rachel...
Transcript of Medicines%Reconcilia7on%on%Admission%as%a% …...Development & Governance (NBT MSO) and Rachel...
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13:30 – 14:30 Bryanston Medicines Reconcilia7on on Admission as a key aspect of Medicines Op7misa7on
Jane Smith, Principal Pharmacist, Service Development & Governance (and Medica9on Safety Officer), North Bristol NHS Trust
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Jane Smith, Principal Pharmacist,
Development & Governance (NBT MSO) and Rachel Johnson, Specialist Pharmacist Gastro
National Forum Workshop 2015 20th November 2015
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Disclosure Statement "Conflict of interest: nothing to disclose"
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Learning Objec7ves Participants should be able:
• To describe the importance of Medication Reconciliation process
• To present the principles and strategies to spread and measure the improvements in Medication Reconciliation beyond pilot unit
• To recognise the pharmacist and pharmacy technician’s role in this process
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Meds Rec on Admission: Defini7on: Medicines reconcilia-on ensures that the medicines prescribed on pa-ents admission correspond to those taken before admission. This process involves discussion with pa-ents and/or carers and using primary care records
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Who are we ? NBT – North Bristol Pa7ent Safety: Medicines Management work stream
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North Bristol NHS Trust (NBT) All of our work started on: § Acute Teaching Trust: 2 sites § 1087 beds 53 wards 9100 staff
§ Safer Pa7ents Ini7a7ve (SPI2): 2007 – 2009 § Southwest Quality and Pa7ent Safety Improvement programme: 2009 – 2013
End of May 2014: New Hospital: § Now approx. 850 beds and 27 ward areas
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Who are we ? NBT – Pa7ent Safety: Medicines Management work stream
§ SPI2 project team
§ SWQPSI project team
§ Medicines Governance Group – Pa9ents
§ NBT staff – Consultants; Other Doctors; Pharmacists; Nurses; Ward recep9onists; Clinical Audit; etc.
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NBT Team
Pharmacy Jane Smith
Alison Mundell Julie Hamer
Natasha Mogford Robert Brown
Execu7ve Lead: Medical Director
Chris Burton Clinical Audit Frank Hamill Calvin Turp
Rebecca Lewis
Consultants / Doctors Arla Gamper Ruth Gillam James Calvert
Nurses Lorraine Motuel Andrea ScoW
Medicines Governance Group Director of Pharmacy
Pharmacists Matrons
Heads of Nursing Consultants Training Dept
Pa9ent Panel Members
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Why is this important ? Globally
§ WHO High 5s (2006) § IHI Saving Lives Campaign (2006)
UK: Na7onally/Regionally
§ SPI1 and SPI2 (2006 – 2009) § SWQPSI / Safer Care Southwest
(2009 – now)
Pa7ent Safety
§ Reduced harm
§ Reduce length of stay
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Key Drivers (1) UK: Na7onally
§ NPSA/NICE – Medicines Reconcilia7on guidance (2007)
§ NPSA/2010/RRR009: “Reducing harm from omided and delayed medicines in hospital” (2010)
§ Francis Report: (February 2013)
§ Medica7on Safety Thermometer (July 2013)
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Key Drivers (2) UK: Na7onally § Medicines Op7misa7on Dashboard
(June 2014) § Sign up to Safety (June 2014) § PSA 014: “Risks arising from breakdown and
failure to act on communica7on during handover at the 7me of discharge from secondary care (August 2014)
§ NHSBN: Pharmacy: Acute Trusts (November 2014)
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What have we done (1) • Ongoing measurement
• Tests of change
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What have we done (2) § Phase 1: Feb 2007–July 2008: (1 -‐ 8 wards)
Introduced a Medicines Admissions Proforma Developed an e-‐audit tool
§ Phase 2: Aug 2008–Jul 2009 (8 -‐ 11 wards) Training DVD was designed Analysed admissions data
§ Phase 3: Aug 2009–Feb 2011: SWQPSI (11–30 wards) New Pharmacist post enabled increased spread Tests of change on accuracy of Medicines Reconcilia7on
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What have we done (2) § Phase 4: Feb 2011-‐Feb 2013: SWQPSI (31-‐20 wards) Audited Sunday admissions Surgical Pharmacist funding agreed
§ Phase 5: Feb 2013 -‐now: SWQPSI (20-‐15 wards) Reviewed NBT cost avoidance savings Piloted “Connec7ng Care” Extended clinical services to the emergency zone Publicising work to spread good prac7ce
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What have we done (3) • Review data • Display results
• Record Pharmacist Interven7ons
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Medicines Reconcilia7on Process
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Medicines Reconcilia7on Process
Patient admitted
Clerked by Doctor (one source for medication history)
Seen by MMT - if trained (2nd source used)
- Discrepancies highlighted to Pharmacist
Seen by Pharmacist (2nd source used)
- Discrepancies highlighted, documented and Doctor informed - Chart clinically signed off
Audited by Medicines Management Technician
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Role of Pharmacist
§ All pharmacists
§ Priority target
§ Drug history -‐ at least two sources
§ Discrepancies highlighted to the doctor
§ Training of nurses and doctors
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Aiding Medicines Reconcilia7on
§ Medicines proforma designed -‐ admissions booklet
§ Procedure wriden for doctors/ pharmacists/MMTs
§ Pharmacy interven7on slips
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Medicines Proforma
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Data collec7on form
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e-‐Audit tool
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Improving quality of Medicines Reconcilia7on
§ DVD -‐ for junior doctors
§ Admission pharmacist teaching junior doctors
§ Junior doctors shadowing admissions pharmacist
§ Pre-‐op clinic nurses training
§ Audit of quality of process
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Role of MM tech § Obtaining informa7on:
§ Summary Care Record § Connec7ng care § GP faxes
§ PODs – recording/assessing § Obtaining compliance device informa7on § Pa7ent interac7on § Accuracy check against drug chart § Referral to pharmacist § Accredita7on
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Data collec7on process § % of emergency and elec7ve admissions >2%
§ 5 pa7ents per week (20 per month)
§ Random data collec7on
§ Completed by MM technician -‐ part of ward visit
§ Uploaded on to e-‐tool
§ Monthly report shared
§ Currently audi7ng 15 wards (300 pa7ents)
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Results
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QIPP: % reconcilia7on: all Trusts
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QIPP: Cost Avoidance
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Pa7ent’s Own Drugs
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Pa7ent’s Own Drugs
Patient Own Drugs Savings – North Bristol NHS Trust Apr 1992 – Mar 2014
Total Savings - £ 4 , 800 ,8 59
92/93 – 05/06
£359,408
06/07 £390,536
07/08 £4 21,074
08/09 £598,050
09/10 £592,280
10/11 £705,902
11/12 £ 730,551
1 2 /1 3 £ 598 , 030
13/14
£405,026
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Results: What have we done ?
1) We have improved the quality of the service NBT provides to all pa7ents by:
§ Achieving our 95% target § Maintaining/Improving 95% target on up to 30 wards
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Results: What have we done ?
Frank Federico: Execu7ve Director: IHI:
2) We are the best acute Trust as shown by (QIPP) benchmarking
... and possibly one of the best in the world
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Results: What have we done ? 3) We are successful in carrying out Medicines Reconcilia7on, and demonstra7ng savings Clare Howard, Deputy Chief Pharmaceu7cal Officer: NHS England
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How are we sharing ? Posters § WEAHSN Annual conference
(Cheltenham: October 2015)
§ Bristol Pa9ent Safety Congress (Bristol: May 2015)
§ Pa9ent Safety Congress (Birmingham: May 2013)
§ European Hospital Pharmacy Congress (Paris: March 2013)
§ Pharmacy Management Forum (London: Nov 2012)
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How are we sharing ? Presenta7ons and Workshops § Changing Prac9ce to Improve Safety (Nov 2015) § European Associa9on of Hospital
Pharmacists (EAHP) Academy Seminar Zagreb (September 2015)
§ EAHP Congress, Hamburg (March 2015)
§ West of England Academic Health Science Network Annual Conference (October 2014)
§ Na9onal Pharmacy Management Forum (London: Nov 2015; 2014 and Nov 2013)
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How are we sharing ? Journal Ar7cles
§ NICE’s Local Prac9ce Collec9on (March 2015) hWp://www.nice.org.uk/savingsandproduc9vityandlocalprac9ceresource
§ “Improving medicines reconcilia9on on admission” Hospital Pharmacy Europe (v. 074: Summer 2014) § “Medicines Reconcilia9on on Admission – other issues -‐ at North Bristol NHS Trust (NBT)” Hospital Pharmacy Europe (v. 075: Autumn 2014)
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Achievements
UK Awards: Shortlisted Finalists
§ “I love my Pharmacist”!! (Oct 2015) § Pharmaceu9cal Care Awards (Jul 2015) § HSJ Awards (Nov 2014) § HQIP Awards (Nov 2014) § LEAN Healthcare Academy Awards (Feb 2014)
§ HSJ Pa9ent Safety Award (July 2013)
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Achievements
UK Awards: Winners
§ APTUK Awards (June 2014) § Clinical Pharmacy Congress (March 2014)
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Key Learning points § SPI2 -‐ support from experts/peers -‐ improvement methodology; “learn from others”; “share success” and “steal shamelessly”!!
§ Con7nuous Measurement is ESSENTIAL “In God we Trust – all others bring data!”
§ “Buy-‐in” of staff // start with enthusiasts // leave laggards.
§ Temp7ng to spread too quickly. Plan, con7nue to embed and gain support as the project evolves.
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Discussion points
• Ongoing vs snapshot data collec7on
• Improvement methodology vs Safety Thermometer
• Benchmarking – need clear defini7ons
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Medica7ons Safety Thermometer
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Other / Future work Medicines Reconcilia7on on Admission
• Working / Poten7al working with: § AHSN Medicines Op7misa7on work stream § Professor Tamasine Grimes, Associate Professor in Prac7ce of Pharmacy, Trinity College, Dublin
§ NICE: Quality and Produc7vity Case Study • Discussions with Mike Durkin, Director of Pa7ent Safety, NHS England
• Hos7ng a Meds Rec conference -‐ WEASHN
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Other / Future work Medicines Reconcilia7on on Discharge
• Working with • CCGs • GP prac7ce Pharmacists • Community Pharmacists
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SUMMARY Learning Objectives for today: • Importance of Medication Reconciliation process
• Principles/strategies to spread/measure improvements
• Pharmacist and pharmacy technician’s role
Learning for NBT from ongoing measurement: § We have improved the quality of the service NBT provides to all
pa7ents § We are the best acute Trust (QIPP data) § We are successful in carrying out Medicines Reconcilia7on, and
demonstra7ng savings
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Ques7ons? #pharmanforum