Western Node Collaborative Providence Health Care Medication Reconciliation Residential Team Learning Session 3 Storyboard Pharmacy Services
Providence Health Care - Residential Five Residential care sites • • • Holy Family Hospital ECU Langara Mount Saint Joseph Hospital ECU Brock Fahrni Pavillion Youville Residence Home to 697 residents Admissions to Residential Care via Priority Access • 40% of PHC residential admissions came from PHC acute sites • Other 60% from: – Other acute care facilities – Other residential care facilities – Direct from the community – Readmissions Pharmacy Services
Residential Team Members • Lynette Best (Sponsor) • Pam Kelly, Residential Section Head, Pharmacy Services (Team Lead) • Fruzsina Pataky, Regional Medication Safety Coordinator • Sue Higginbotham, Clinical Nurse Leader, Holy Family • Julia Duda, QI Specialist • Jody Burrell, Pharmacist Youville • Lisa James, Pharmacist Brock Fahrni • Barb Laurillard, Pharmacist Langara • Ron Wall, Coordinator, Pharmacy IS • Nick Groves, Project Leader - Primary Health Care Transition Fund Pharmacy Services
Aim Statements 1. Reduce the mean number of undocumented intentional discrepancies on residents moving into Residential Neighbourhoods by 75% by October 2006 2. Reduce the mean number of unintentional discrepancies on residents moving into Residential Neighbourhoods by 75% by October 2006 3. Increase our Medication Reconciliation Success Index (MRSI) by 75% by October 2006 Pharmacy Services
Baseline Data Measure Baseline Undocumented Intentional Discrepancies 1. 4 per resident Unintentional Discrepancies 0. 9 per resident Success Index 82% Pharmacy Services
Objectives • To streamline the medication reconciliation process • To examine all moving in processes related to medications • To minimize transcription • To ensure that medications are not overlooked Pharmacy Services
Streamlined Processes: Pharmacy Services
Moving In Medication Orders - MIMO Pharmacy Services
Changes Tested P D A S PDSA 1 Jan-Feb 06 Implemented MIMO at Holy Family ECU P D A S PDSA 2 Mar 06 Evaluation of HFH MIMO Implementation PDSA 3 Nurse Satisfaction PDSA 4 Posted RN Instructions P D A S PDSA 5 Apr 06 Developed Rx spreadsheet to track MIMOs PDSA 6 Implemented MIMO at Langara Residence PDSA 7 May 06 Implemented MIMO at MSJ ECU PDSA 8 Implemented review of stopped orders Pharmacy Services P D A S PDSA 9 Aug 06 Implemented MIMO at Brock Fahrni
Medication Reconciliation Indicators PHC Residential Care Admissions Pharmacy Services
Undocumented Intentional Discrepancies Upon Admission Pharmacy Services
Unintentional Discrepancies Upon Admission Pharmacy Services
Medication Reconciliation Success Index Upon Admission Pharmacy Services
One Resident’s Story • TW, 75 year old female Home VGH UBCH Langara May 8 May 19 June 13 • 5 drugs omitted on initial admission from home • At least 3 opportunities for medication reconciliation • Undetected until admitted to Langara Pharmacy Services
Leadership Support • Organizational commitment to best practice and evidence based care • Early engagement with the Institute for Healthcare Improvement Collaboratives – 2001 Quantum Leaps in Patient Safety • Patient Safety Leader Position created 2004 – Patient Safety Officer Training – IHI • Joined Safer Healthcare Now! Campaign in 2005 implementing all 6 initiatives • Participation in SHN Med Rec Collaborative Pharmacy Services
Keys to Success • Team Accelerators – – – Team Leader - Early Adopter Physician advocate Resources allocated to do the work Quality Support Small Tests of Change Nurse and Physician Buy In – What’s in it for me? • Rolling out – implementing across program – Involving key stakeholders – CNL, UC, Rx – Education – Timely follow-up - communication Pharmacy Services
Lessons Learned • RNs need to be reminded of their role in reconciling the medication list with the residents current/previous medications prior to faxing MIMO to physician’s office • Generating MIMO’s more than 24 hr prior to the arrival of the resident results in confusion and duplication of work. • Nurses need to be reminded to NOT have the physician fax the completed form back to them. The reconciliation needs to take place over the phone in order for Pharmacy to receive a clean, legible copy of the orders • Standing orders tend to be omitted by the nursing staff (bowel protocol) on the MIMO. Pharmacy automatically enters these orders now. Pharmacy Services
Next Steps • Complete MIMO implementation at final PHC Residential Care site • Develop implementation plan for Pharma. Netbased Admission Medication Orders to be used at PHC Residential Care sites for admissions from the community • Adapt printed discharge orders from other VCH Acute Care facilities as admission orders to PHC Residential Care Pharmacy Services
Contact Information For more information contact: Pam Kelly, Team Leader Phone: Email: (604) 322 -2601 pkelly@providencehealth. bc. ca Pharmacy Services
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