canadian medrec quality audit month: results and future direction

www.saferhealthcarenow.ca

Canadian MedRec Quality Audit Month:

Results and Future Direction

Marg Colquhoun, Virginia Flintoft and Alex TiteuDecember 2013


Where to find our webinars…

www.ismp-canada.org/medrec

See “Education and Training”

http://www.saferhealthcare

now.ca/EN/events/National

Calls/Pages/default.aspx


Outline

• Background

• Audit Month results

• Interactive discussion

• Accessing your results in the Patient

Safety Metrics System


BackgroundMedRec Quality Audit Tool

• Launched in June 2013

• Collects data on the quality completion of admission MedRec in acute and long term care settings

• Completed through chart audit post-completion of admission MedRec processes

• Organization specific tools are generated through Patient Safety Metrics System (PSMS)

• Completed tools are faxed, and data is presented in PSMS


• Across Canada, there are ongoing challenges

related to the effective and reliable completion

of MedRec processes.

• Measurement of MedRec processes can help to

identify areas of excellence and areas for

improvements � MedRec Quality Audit Month – October 2013

BackgroundCanadian MedRec Quality Audit Month

5


• Call to action national call/webinar on October 1st, 2013.

• Sites registered to participate

– Central Measurement Team (CMT) facilitated the creation of

audit/data collection forms

• MedRec Audit Month Workbook published

• Sites submitted data to the Patient Metrics System throughout the

month of October

– CMT corrected any data submission error reports and

resubmitted

• Preliminary results (e.g. numbers of participating sites) were

presented October 30th, during Canada’s Virtual Forum

on Patient Safety and Quality Improvement

BackgroundAudit Month Methodology

6


Audit Month Results


Audit Month Results

• Audit participation

• Results by column

• Calculated results

• Relationships between variables

8


Audit “Participants”

9

Sites = 103

Patient/Resident Charts

= 2,340


“Participants” by Province/Territory

10

103 sites

2,340 patients

Number of Patients

Provinces/Territories


“Participants” by Sector

11

103 sites

85%

N=1,992

15%

N=348

Acute Care

LTC

Acute Care

LTC

77%

N=79

23%

N=24

2,340 patients






12

www.saferhealthcarenow.ca13

0


A. ‘Admission via’

14

57%

50%

N=2,298


=

15


B. ‘Med Rec Performed’

16

75%95%

N = 2,328


• A review of published articles found that 10-67% of patients had at least 1 prescription medication history error

– when non-prescription medications were included the frequency of errors was 25-83%

• Authors suggest: “should be a comprehensive medication history that includes an interview, inspection of medication vials or lists, or both and contact with community pharmacies, or family physicians.”

CMAJ, 2005 http://www.cmaj.ca/content/173/5/510.full.pdf+html

Literature suggests…..


C. ‘BPMH -greater than one source’

19

60%

N=2,040

74%


Literature suggests…

• 66% of Canadians have sometimes used non-prescription medication in the past six months.

• 57% sometimes took vitamins and minerals, while 34% sometimes took herbal and natural products.

2004 Survey of Canadians’ Use of OTC Medications http://www.bemedwise.ca/english/usagesurvey.html

• Adherence- “the extent to which a person’s behavior [in] taking medication…corresponds with agreed recommendations from a health care provider” (World Health Organization, 2003).

• 12% of patients don’t fill their prescription at all.

• 12% of patients don’t take medication at all after they fill the prescription.

• 22% of patients take less of the medication than is prescribed on the label. Adult Meducation http://www.adultmeducation.com/OverviewofMedicationAdherence_2.html


D.‘Med Use Verified by Pt/Caregiver’

22

57%

N=2,044

63%


E.‘Each med w/ name dose, route, etc.’

25

77%

N=1982

92%


Literature suggests….

• Medication discrepancy was defined as a difference between the

medication use history (BPMH) and the admission medication

orders.

• In the sample of patients admitted to general medicine unit:

– 54% of patients had at least one unintentional discrepancy

identified (most common type was omission of a regularly used

medication)

– 38% of these discrepancies were judged to have the potential

to cause moderate to severe discomfort or clinical

deterioration


F.‘Meds on BPMH+Admin Order’

28

73%

N=2,006

87%


G.‘Prescriber documented rationale’

30

64%

N=1,946

84%





• Relationships between variable

31

Audit Month Results


To calculate a MedRec Quality Score,

each “Yes” (or “Unable to Perform”) is

assigned 1 point for each of the highlighted

columns


Percentage of Patients by Score

33

29%

N=1,937

55%

Scores






34

Audit Month Results


% Med Rec Performed by Score

36

7% 0%

55%

29%


Compliance w/ 1st 3 elements

by “Admit via”

38


Results Summary Comments

• Because this is the first audit using these criteria, we do

not have historical data to compare our progress�it is

likely that we have collectively improved

• However, audit tool results demonstrate need for ongoing

and specific improvements

• Many people believe they are doing MedRec but they may

not be doing it well

– The foundation of the process – the BPMH needs work

• Validity of the BPMH –results are disappointing

– It will be useful to use the scores and correlations in

future audits to measure improvement


Results Summary Comments

• Need to critically evaluate admission

processes to ensure quality of MedRec

processes at other transitions

• Sites will need to understand the need

for training people to use the audit tool –

materials are available to support this

process

40


Discussion


Accessing Your Data in

the Patient Safety Metrics

System

Virginia Flintoft & Alex Titeu

42


Data Collection (Audit) Form

46


Contact Patient Safety Metrics team at:

[email protected]

Contact ISMP Canada MedRec team at:

[email protected]


Upcoming MedRec Webinars

56

Jan 14, 2014 The MARQUIS Project Dr. Jeffrey

Schnipper

Feb 11, 2014 Engaging Patients in MedRec

March 25, 2014 MedRec in Home Care


On behalf of the ISMP Canada MedRec

Team, CPSI and the Patient Safety

Metrics Team

All the best in 2014!

canadian medrec quality audit month: results and future direction

Health & Medicine