Western Node Collaborative Brandon Regional Health Authority Medication

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

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

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

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

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 Mc. Kague – 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

Changes Tested P P P D A D A S S #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 S S S #1: Pilot project fall of 2006 for all direct admissions to medical floor & knee replacement patients in POAC using Admission Medication Order (AMO) form A A D D #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 Coming Full Circle: AMI & Med Rec Across the Continuum #4 POAC & preop 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 #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 Western Node Collaborative

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

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

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

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 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

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

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