continuing the circle of care: medrec in the community

www.saferhealthcarenow.ca

Continuing the circle of care:MedRec in community

March 25, 2014


Welcome also to our francophone attendees

Bienvenue à nos participants francophones

Hélène RiverinConseillère en sécurité et en améliorationSafety Improvement Advisor

Welcome!


Pour nos participants francophones..

Pour accéder aux diapositives français:

‐Cliquez sur l'onglet "FRENCH"

OU

‐Envoyer un courriel à [email protected]

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traduit en français


Where to find our webinars…


SHN MedRec Home Care Resources

5

http://www.ismp‐canada.org/medrec/#mrhc

www.saferhealthcarenow.ca6

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Speakers• Ann Nickerson, B.Sc. Pharm. FCSHP• Michelle Anglehart, RN, CNS, CON(C)

Horizon Health Network ‐Moncton, NB will:1. Demonstrate the timeline for the development of a provincial bilingual

medication reconciliation form and process2. Identify how technology provided an avenue for a multi‐site team

collaboration3. Distinguish the key elements in a provincial bilingual medication

reconciliation form

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Horizon Health Network - New Brunswick

Continuing the circle of care: Medication Reconciliation in the

Community

Ann Nickerson, B.Sc. Pharm. [email protected]

Michelle Anglehart, RN, CNS, CON(C)Michelle.Anglehart @horizonnb.caExtra‐Mural Driscoll Unit, Moncton N.B.March 25th, 2014

“I take a small white pill and a large blue pill”

Home care in New Brunswick

2 Health Networks

The Extra‐Mural Program• Public‐funded provincial home care program• Multidisciplinary team Social Workers, Clinical Dietitians, Occupational Therapists, Registered Nurses, Physiotherapists,Speech‐Language Pathologists, Medical Advisors

Evolution of Medication Reconciliation at our Home Care Program

Phase 1Phase 2

Phase 32008‐20122013‐2014

2015

• Safer Healthcare Now! Pilot

• Development of MedRec Form

• Implementation 5/29 units

• Provincial Initiative (EMP Nursing P&P)

• Formed MedRec subcommittee

• Provincial Bilingual MedRec Form

• Complete circle of care

• Goal: Provincial roll out 29 NB home care units

Phase 1 – Original SHN Pilot

Phase 2 ‐Medication Reconciliation Profile

Face‐to‐face(Central location for 2 initials meetings)

Videoconference(Tandberg system – 6 meetings)

Online meeting software(Adobe connect + Teleconference – 3 meetings)

Phase 2 – Using Technology

Phase 3 ‐ Continuing the circle of care

ADo not takeZopiclone 7.5mg by mouth 1 tablet each night

1 tablet 3 times dayMetformin 500mg by mouth

1

1

Bat meals

Before going To bed anymore

Tylenol 500mg by mouth 1 tablet 4 times a day

2013/09/02Marcus Welby MD

Phase 3 ‐ Changes/New Orders (Section 2)

Code letter of physicianCode number of pharmacy

List medication (name, strength/unit and route)

Date and initials when discontinued/changed

How the client take the medication, if the same

A

Written of label(dose, frequency/time of administration)

Initials – Professional who is documentingDate started or changed

FN 2013/09/07 FN2013/09/05 1 tabletCiprofloxacin 500mg by mouth1

FN 2013/09/08 A 1 Ativan 1mg by mouth 1 tabletTwice a day

Bedtime, as needed

Phase 3 ‐ Continuing the circle of care

Implement medication reconciliation inALL 29 provincial home care units

Provide a copy of medication reconciliationto client, attending physician, andcommunity pharmacy

Maintain up‐to‐date medicationreconciliation on client’s home care file

Barriers to Implementation

TIME!! TIME!! TIME!! ‐ Biggest barrier

Upfront time commitment

=Time saving toward preventingadverse medication events

Reference: Nickerson, A., MacKinnon, N., Roberts, N., Saulnier L. (2005) Drug‐Therapy Problems, Inconsistencies and Omissions Identified During a Medication Reconciliation and Seamless Care Service Healthcare , Quarterly Papers. 8(sp): 65‐72.

Conclusion

System for improvement using: ● PDSA cycle (Plan, Do, Study, Act)

Can be replicated in any health home careprogram Ultimate goal: ● Increase patient safety● Comply with Accreditation Canada

Acknowledgements

Manon Goupil, RN, Manager, ChairKristen Pinsent‐Close, RN, ManagerRhonda Guyader, RTDixie Lapage, RNDarlene MacDonald, RN

Karen Desjardins, RN, [email protected]


Speakers:• Colleen Stoecklein, RN, BSN• Liz Moran-Murray, BScPhm

Saskatoon Health Region Home Care will:1. Share how they developed a nurse driven, paper‐based MedRec program to

support home care clients in medication management. 2. Outline their current MedRec process3. Showcase their current Med Rec/BPMH Form and their data collection form

for the audit process.

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Saskatoon Health Region

Continuing the Circle of Care: MedRec in the Community

Presented by:Colleen Stoecklein, RN, BSN, Clinical EducatorLiz Moran-Murray, BScPhm, Clinical Pharmacist

• Brief history review• Outline the current MedRec process• Review our BPMH/MedRec form• Audit process

Objectives

Brief History• In the spring of 2007 with the support of Safer Healthcare Now! Saskatoon Home Care formed a Medication Reconciliation Committee

• Developed Quality Improvement Charter. – Objective: reduce adverse drug events and minimize client harm through the implementation of medication reconciliation on admission to Home Care

Brief History continued

• Our MedRec process was designed to be part of our daily operations, therefore costs are inherent in operational funding (no new funding!!)

• SHR Home Care strength was that we had a solid med management process in place prior to MedRec

Brief History continued• Piloted the Med Rec form with 6 nurses; changes made

• 2009 Med Rec was rolled out to approximately 150 nurses. Present: 200 nurses

• The form has been revised 28 times so far, this is ongoing…

• Subtle process changes have been made

Current Process• MedRec is targeted at clients requiring medication management

• MedRec is completed on admission, at 6 month reviews, after hospitalization and if significant number of medication changes

• Admission MedRec is completed by the RN and subsequent reviews may be completed by the RN/LPN

Process Once BPMH Has Been Completed

• Faxed to physician/NP for reconciliation• Average time for return of reconciled form is less

than 3 days• If the nurse has not heard back within the week a

phone call is made to prompt physician• medication administration does not begin until

reconciled form has returned. Exception: the nurse has received discharge orders from acute care

MedRec continued• Once the MedRec has been reconciled, the nurse faxes a “fyi” copy to the community pharmacy (our form does not meet requirements to be a prescription)

• Future medication changes are not recorded on this form. Any new physician orders are added to the chart sequentially

• MedRec is completed in the home & provides this “snapshot in time” of current medication use

Audit Process

• MedRec audits are completed quarterly• This is a labour intensive process since we don’t currently have an electronic chart

• On audit days we come in at 0530 so that we have 2.5 h to look at the nursing charts that will be going out for the day. After the nurses leave the office we audit the rest of the med management charts.

What We Measure for Senior Leadership

1) % of clients with completed MedRec2) % of clients identified with 1 or more

discrepancies3) Types of discrepancies identified

What We Measure for Home Care

• In addition we audit several qualitative process measures related to nursing & physician process completion

• This information is shared with nurses & physicians for ongoing education

• We receive feedback from nurses that has also helped refine the process

MedRec Audit

Summary Form

Challenges• Physician engagement: clarification of discrepancies that may be vague, turn around time

• Nursing not prompting unreconciled forms in a timely fashion

• Since there is a high incidence of dementia in this caseload, this can be a barrier to obtaining a definitive medication list if family member is unavailable/not involved

• Audit process time consuming

Our Success

• Nurses find the form easy to use and achieves a more thorough med list

• Physician comments on form indicate increasing engagement with process

• It improves communication within the circle of care – “everyone is in the know”


Questions


Questions

1. Raise your hand and we may be able to open your phone line

2. Send feedback viathe “chat” box

• Select “All participants”• Type message• Click “Send”

All Participants


Please complete our poll


Upcoming MedRec Webinars

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April 8th, 2014 Making a PDiF-ference – Results of the Pharmacy Discharge Facilitator Initiative for high-risk medical inpatients.

May 6th, 2014 Safety, Sleuthing and Students: A Novel Collaborative MedRec Event – University of British Columbia

continuing the circle of care: medrec in the community

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