medication reconciliation and accreditation

© Accreditation Canada/Agrément Canada

Accredited by

Agréé par

Optimizing Medications: time to bring the pieces together

January 16 2014

Medication Reconciliation (MedRec):

Accreditation Canada Requirements

Heather Howley, MS

Accreditation Canada


Outline

Overview of MedRec

Review expectations for implementation

Review changes to ROPs

Explore sector-specific customization

Highlight test for compliance

What to look for on-site

FAQs and Key Challenges

2


Required Organizational Practices

(ROPs) in Qmentum

3


What is Med Rec?

MedRec is a three-step process:

COLLECT the Best Possible Medication

History

COMPARE what the client is actually taking

with what is prescribed to identify

discrepancies

CORRECT any medication discrepancies

4


What is NOT MedRec

MedRec is about identifying discrepancies to

prevent adverse drug events

It is needed at transitions where clients are at-risk

It is NOT about appropriateness

Medication review

It is NOT needed at all transitions

Bed relocation

Hand-offs

5

© Accreditation Canada/Agrément Canada 6

History of MedRec

2006 MedRec ROP introduced (service-based)

2008 MedRec ROP requirements scaled back

2010 MedRec ROP introduced (Leadership)

2010 – 2012 customization and clarity

2014 strengthen requirements

change structure to improve applicability


Improved performance

ROP Compliance (%)

2009 2010 2011 2012

Medication reconciliation as an organizational

priority ---- 61 77 82

Medication reconciliation at admission 46 47 60 71

Medication reconciliation at transfer/discharge 44 36 50 62

7


Why Change MedRec

Performance has improved

More support and resources available

Broader scope

Higher expectations = patient safety

Clarification and realignment of expectations

8


Increased Expectations for

Implementation

Broaden definition of “Service”

Includes all teams that use a given set of standards

across all locations

For standards that contain a MedRec ROP

Move beyond „1 + 1 + a plan‟ to full

implementation within two cycles:

Phase 1: 2014-2017, in one service

Phase 2: 2018-2022, in all services

9


Changes to ROP Structure

OLD ROP REVISED ROP

MedRec as an organizational priority

• 1 + 1 + a plan

MedRec as a strategic priority

• What is needed to implement and

sustain MedRec

2 ROPs: MedRec at Admission

MedRec at Transfer/Discharge

1 ROP: MedRec at Care Transitions

• Removes artificial separation

• Improves customization

© Accreditation Canada/Agrément Canada © Accreditation Canada/Agrément Canada

11

Leadership for MedRec


Medication Reconciliation

as a Strategic Priority

Policy and process

Define roles and responsibilities

Plan to implement and sustain MedRec

Led by an interdisciplinary coordination team

Education for staff and physicians

Monitor and make improvements

12


MedRec Leadership:

What does it look like?

Documented policies, processes, and plans

Engaged leadership, including physicians

Common understanding at all levels

What it is (three-step process)

When it is needed (transitions, targets)

Who is responsible for each MedRec step

How it is done (model used, forms/tools)

Monitoring compliance

Adherence and quality

Addressing lessons learned

13


14

MedRec Process


Medication Reconciliation

at Care Transitions

15

Five versions customized to different settings

Acute Care

Ambulatory Care

Home and Community Care

Long-term Care

Substance Misuse (unchanged)


Version STANDARDS SET

Acute Care Acquired Brain Injury Services

Cancer Care and Oncology Services

Correctional Service of Canada Health Services Standards

Critical Care

Emergency Department

Hospice, Palliative, and End-of-Life Services

Medicine Services

Mental Health Services

Obstetrics Services

Provincial Correctional Health Services Standards

Rehabilitation Services

Spinal Cord Injury Acute Services

Spinal Cord Injury Rehabilitation Services

Surgical Care Services

Ambulatory Care Aboriginal Integrated Primary Care Services

Ambulatory Care

Ambulatory Systemic Cancer Therapy Services

Home and Community Care Case Management Services

Community-Based Mental Health Services and Supports Standards

Home Care Services

Long-term Care Long Term Care Services

Residential Homes for Seniors

Substance Misuse Aboriginal Substance Misuse Services Standards

Substance Abuse and Problem Gambling Services


17

MedRec in Acute Care


Overview of Tests for Compliance

(Acute Care)

Generate a BPMH upon admission

Reconcile medications at admission

Retain a current medications list

Use the BPMH to generate transfer/discharge

orders

Provide a complete list of medications upon

discharge

*Special consideration in emergency departments

18


Evidence of a good MedRec process

(Acute Care)

A complete BPMH (not just a primary medications list)

Home medications, including OTC

Source(s) of medication information identified

Actual medication use (not just as prescribed)

Method and tools to identify and resolve discrepancies

Use BPMH (not just MAR) to generate transfer/discharge orders

Transitions where discrepancies may be introduced (e.g., orders are re-written)

Accurate understanding of medications upon discharge

Client, family, next care provider

19


Key Questions/Challenges

(Acute Care)

Quality MedRec vs. just a form in a chart

Internal transfers that require MedRec

What is a „service‟

The MAR is probably not sufficient

Physicians reluctant to reconcile medications

Access to pharmacy

Client arrives with BPMH - no need to repeat

20


21

MedRec in Ambulatory Care

and Home and Community Care


Tests for Compliance

(Ambulatory Care)

22

Documented rationale for targeting MedRec

and frequency of MedRec

BMPH at or prior to the first visit

Identify and document discrepancies

At or prior to the first visit

Subsequent visits, as per the policy

Work with client to resolve discrepancies

Retain current medications list in client record



(Home and Community Care)

23

Documented rationale for targeting MedRec

BPMH at the beginning of service

Work with client to resolve discrepancies

Update current medications list

Educate client and family to share complete

medications list


Evidence of a good MedRec process

(Ambulatory & Home and Community)

24

Targeting is standardized and appropriate

Clients at-risk of medication discrepancies

Complete BPMH (not a primary meds list)

Method to identify discrepancies

Comparing prescriptions, not orders

Understand everything a client is taking

Efforts to resolve discrepancies (with client)

Client empowered to maintain and share list



(Ambulatory & Home and Community)

25

Where to start - how to identify targets for

MedRec

Engage front-line

Organizations may start small with a plan for spread

How often to repeat MedRec in ambulatory care

Appropriate for risk

Access to prescriber

Prescribers reluctant to resolve discrepancies


26

MedRec in Long-term Care



(Long-term Care)

27

BPMH upon admission

Compare BPMH and admission orders to

identify and resolve discrepancies

Retain a complete meds list in client record

Identify and resolve discrepancies at re-

admission

Provide a complete list of client medications

upon transfer out


Evidence of a good MedRec Process

(Long-Term Care)

BPMH (not just admission orders or the MAR)

Home medications, including OTC

Source(s) of medication information identified

Actual medication use (not just as prescribed)

Method to identify and resolve discrepancies

Repeat MedRec at re-admission

Use the complete meds list to generate transfer/discharge orders (MAR may not be enough)

Accurate understanding of medications upon discharge

Client, family, next care provider

28



(Long-Term Care)

29

Once generated, BPMH „disappears‟

Becomes complete list of medications

May be different from the MAR

Resident arrives with BPMH - no need to repeat

The MAR may not be sufficient

Need to reconcile against BPMH (admission) or

complete meds list (re-admimssion)

Internal transfers requiring MedRec are rare


30

MedRec Resources


MedRec Resources

Accreditation Canada

2014 ROP Handbook (updated)

Backgrounder

FAQ (updated)

Webcast

Webinar Series

Accreditation Specialist

[email protected]

Safer Healthcare Now! Getting Started kits

31

mailto:[email protected]


32

Thank you!


33

Proud to be a

Top 25 Employer

in 2010, 2011, and 2012.

Fier de faire partie des

25 meilleurs employeurs

en 2010, 2011 et 2012.

medication reconciliation and accreditation

Health & Medicine

medrec medrec

care transitions medrec

medrec leadership

medrec step

history of medrec

ms accreditation canada

medrec rop requirements

change medrec performance