Western Node Collaborative Capital Health MEDICATION RECONCILIATION Edmonton, Alberta Suburban /...

Western Node Collaborative

Capital HealthMEDICATION RECONCILIATION

Edmonton, AlbertaSuburban / Rural Communities &

Sturgeon Community Hospital

Edmonton and areawww.capitalhealth.ca


Background

WestView Health Centre

• 20 bed primary care centre staffed by GP’s serving a population of approximately 60,000 with 36,000 emergency visits annually.

• Integrated site with Rehab, Pharmacy, LTC, PHN, Community Care, Shared Care Maternity, Ambulatory clinics, Out-patient surgeries, Laboratory, and DI services.


Background (cont’d)

Sturgeon Community Hospital• 116 bed hospital located in St. Albert serving a

population of approximately 85,000 with 47,000 emergency visits annually.

• Services on site are Surgery, CCU, ICU, Medicine, Pediatrics, ED, L&D, Ambulatory Clinics, Adult Day Program.

• On Site Services include DI, Laboratory, Pharmacy, Social Work, Respiratory and Rehabilitation.


Background (cont’d)

Capital Health’s Commitment to Medication Reconciliation

• Started November 2005, projected end November 2006.

• Regional Support and Dedicated FTE’s: • Project Coordinator- 0.5• Nursing - 1.0 • Pharmacy - 0.9 • Admin Support - 0.2 • Data entry - 0.2 • Quality Consultant - as required


Aim

• To improve patient care and safety in the pilot sites through the reduction of adverse drug events and the promotion of seamless care between settings. This is based on the assumption that a reduction in medication discrepancies will reduce adverse drug events.


Aim Statements

• To decrease the number of unintentional medication discrepancies in the targeted areas by 75% by Oct. 2006 on an incremental basis.

• To decrease the number of undocumented intentional discrepancies in the targeted areas by 75% by Oct. 2006 on an incremental basis.

• Establishment of BPMH on 100% of all inpatient charts by Oct. 2006.


• To develop and evaluate a BPMH tool, accompanying processes and related procedures to support implementation and use.

• On the basis of measurements of success, recommend implementation of the BPMH tool and processes for consideration of implementation at interfaces of patient care throughout Capital Health.

Aim Statements (cont’d)


Team Members

• Team Lead - Mary James, Senior Operating Officer Suburban / Rural Communities• Project Coordinator - Esther Nelles• Pharmacists

– Kim Spiers, Sturgeon Community Hospital– Shelly Proft, WestView Health Centre

• Nurse Clinician - Linda Cawthorn, Suburban / Rural Communities• Nurse Clinician - Recruiting, SCH• Clinical Quality Consultant - Marilyn Dumkee• Administrative Support - Karen Nickerson• Pharmacy Technician - Isabella Voju• Ad Hoc Physician


Changes Tested

• Completed 50 PDSA cycles since beginning of the project.

• Format for Medication Reconciliation in Community Care (home care) is in process, with standards for use implemented.


Learning's from Run Charts

• Extreme data fluctuations are dependent on small sample size (every medication counts).

• Fluctuation in results is a reflection of staffing challenges, summer vacations and the inclusion of new professions in the process. (Site 2)

• Changes in undocumented intentional’s increased due to the expectation that reasons for med changes be provided at Site 2. (Assumptions are no longer acceptable for reasons meds are changed)

• Auditing is very subjective.• Multiple physicians make education as a group challenging.

Education is better received from same profession.• Inter-rater reliability can be a factor.


Mean Number Undocumented Intentional Discrepancies (Site 1)

Summer Interruption in Staffing*

Baseline

*Over summer-Lost 9 senior nurses-Worked with casual staff while recruiting occurred

Physician variability (results vary with style of Admission orders)

Sample Size Range 14-18 pts.


Mean Number Unintentional Discrepancies (Site 1)

Baseline

Departure of full time nurse in ER

Lack of nursing compliance completing the BPMH (13 / 22 intentional discrepancies

were due to incorrect BPMH)

One Patient with ## Meds had

incomplete BPMH and therefore had ## unintentionals



Success Index (Site 1)

Baseline

Implementation of BPMH in ER

Full time nurse and 0.5 pharmacist available to teach / mentor and help complete BPMH

Decreased visibility of team member in ER and confusion among staff about which patients’ to

complete BPMH



Mean Number of Undocumented Intentional Discrepancies (Site 2)

Inconsistent use by all ER physiciansVacation taken by team member = decreased visibility in ER

Implementation of form for Physician medication order. One on one physician teaching.

Baseline



Mean Number of Unintentional Discrepancies(Site 2)

Baseline

1. Increased awareness of project in facility

2. Education of nursing

MD Using as order form

Inconsistent MD use



Medication Reconciliation Success Index (Site 2)

Baseline

Form Testing (PDSA #1-8)

Implementation of BPMH in ED

Form Revisions &Acute Compliance

Not all physicians using form and / or incorrect usage.

1. Rollout to MD’s as order form2. High team visibility

Sample Size = 14-20 pts.


Nursing Progression

• Audit information only addresses the prescriber success in decreasing ADE. Also important to the process is the successful integration of collecting a BPMH into existing nursing processes.

• The following graphs show the progression of nursing improvement in obtaining BPMH for the WestView site.


Average # ER Visits vs. Average Number of Patients with 4 or more

meds


Average % Pts Requiring BPMH vs. % BPMH Completed

0%

5%10%

15%

20%25%

30%

35%

40%45%

50%

April 9-15

May14-20

June15-27

July 9-15

Aug20-26

Sept 6-12

% Patient requiringBPMH

% BPMH Completed


Keys to Success and Lessons Learned

• Site Leadership support and reinforcement of the process is essential.

• PATIENCE: change is slower than the team expects.

• Form development is very time consuming.• Formal education for staff.


Keys to Success and Lessons Learned

• There are 3 levels of reconciliation.

• Inter-disciplinary approach including pharmacists, nursing and physicians requiring clear role definitions to maximize potential.

• Medication Reconciliation is essential to chronic disease management.


Next Steps

• Continue to change the culture.• Plan for sustainability and spread within pilot

sites.• Processes required to ensure reconciliation

occurs at discharge.• Public campaign for patient education and

creating the ‘smart patient’.• Define where pharmacists can have the

greatest impact.


Next Steps

• Recommendations for spread to region.• I.S. involvement for electronic solutions.• Policy development to meet accreditation

standards.• Determine who the most effective provider is

at the any given point in the process. (Roles and responsibility of each provider in the entire process)


Contact Information

• Esther Nelles: WestView Health Centre (780) 968-3770 [email protected]

• Linda Cawthorn: WestView Health Centre (780) 968-3770 [email protected]

• Kim Spiers: Sturgeon Community Hospital (780) 418-8214 [email protected]

• Marilyn Dumkee: Regional Quality Office (780) 735-8072 [email protected]

• Shelly Proft: WestView Health Centre(780) 968-3770 [email protected]

Western Node Collaborative Capital Health MEDICATION RECONCILIATION Edmonton, Alberta Suburban /...

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