medrec reality check – moving from intervention to practice elaine orrbine president & ceo...
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MedRec Reality Check – Moving From Intervention to Practice
Elaine OrrbinePresident & CEO
Canadian Association of Paediatric Health Centres
JoAnne WhittinghamCAPHC National Patient Safety Coordinator
CAPHC Patient Safety CollaborativeCAPHC-SHN Paediatric
Medication Reconciliation Collaborative
The CAPHC-SHN Paediatric Medication Reconciliation Collaborative (PMRC)
In June 2005, CAPHC established an important patient safety partnership (Paediatric Clinical Support) with the Safer Healthcare Now! Campaign
Among the six SHN! campaign interventions, CAPHC’s Patient Safety Collaborative identified Medication Reconciliation as their national priority.
The Canadian Association of Paediatric Health Centres – Safer Healthcare Now! Paediatric Medication Reconciliation Collaborative (PMRC) was initiated in August 2005, when seventy-five interdisciplinary child and youth health professionals from across Canada participated in an introductory Orientation and Training Workshop.
The PMRC has been working in partnership with SHN, ISMP Canada and implementation teams across the country to expedite change and quality improvement in medication reconciliation at all paediatric centres and other related organizations across Canada.
The implementation of MedRec has been complex and challenging however there as been tremendous collaboration from teams across the country
Over the last two years, through the PMRC, the implementation teams have learned from each other, sharing challenges, strategies and successes
The CAPHC-SHN Paediatric Medication Reconciliation Collaborative (PMRC)
17 health centres from coast-to-coast representing seven provinces have established 22 paediatric medication reconciliation teams
Patient populations vary across the teams from children admitted to paediatric wards in community hospitals to more complex populations including nephrology, mental health and respiratory medicine within acute care settings
Collectively the teams have made significant progress in implementing practice change and improving medication safety
PMRC: Baseline Data Submissions
Following the inaugural August 2005 workshop, teams began to collect and submit baseline data; By July 2006, 17 teams had submitted baseline
data In 2007, another 5 teams submitted baseline
data As of December 2007, 22 teams have
submitted baseline data 47 monthly submissions of baseline data Data collected on a median of 20 patients (range
10 to 94 patients per team ) and a total of 616 patients were reviewed
PMRC: Implementation Data Submissions
Teams began submitting implementation data in January 2006
As of March 2008, 21 teams have submitted implementation data 211 monthly submissions of implementation data Teams have submitted a range of 1 to 27 months of
audit data Data collected on a median of 92 patients (range 13
to 574 patients) per team and a total of 2898 patients have been reviewed
SHN – Central Measurement Team Measurement Goals
Partial Implementation Stage The team has set a clear aim(s) for the intervention, identified which measures will
indicate if the changes will lead to improvement, and started to implement small tests of change (PDSA) to identify and refine processes, procedures and practices which will lead to improvement and achieving the aim. When the team is close to goal they are ready to move to Full Implementation.
Full Implementation Stage The processes, procedures and practices are finalized and have lead to significant
improvement. These practices on the selected unit are being consistently applied and monitored, showing a sustained performance at or close to goal. The team has achieved their aim(s) and is ready to spread to other areas.
At Goal The team has reached its measurement goals and has held its gains for six
months and At this point the team now monitors its performance intermittently to avoid
performance slippage. Voluntary quarterly data submission is encouraged
Baseline and Measurement GoalsType 3 Discrepancies (System-wide)
Across the paediatric teams, a total of 616 patients were reviewed during the baseline phase and 358 Type 3 discrepancies were identified – a rate of 0.58 per patient
Based on the SHN! goal of reducing discrepancy rates by 75% we would expect this rate to drop to 0.14
A reduction of discrepancy rates by 50% (system wide) would give a goal rate of 0.29
Baseline data;Distribution of Type 3 Discrepancies
75% reduction = 0.14
50% reduction = 0.29
0
0.2
0.4
0.6
0.8
1
1.2
1.4
Mea
n T
ype
3 D
iscr
epan
cies
per
pat
ient
A B C D E F G H I J K L N O P Q R S T U V W
Team/ Patient Population
Mean Number of UNINTENTIONAL DiscrepanciesNational vs. Paediatric Teams - Goal line represents a 75 % reduction
0.00
0.25
0.50
0.75
1.00
1.25
1.50
1.75
Nov-0
5
Dec-0
5
Jan-
06
Feb-0
6
Mar
-06
Apr-0
6
May
-06
Jun-
06
Jul-0
6
Aug-0
6
Sep-0
6
Oct-06
Nov-0
6
Dec-0
6
Jan-
07
Feb-0
7
Mar
-07
Apr-0
7
May
-07
Jun-
07
Jul-0
7
Aug-0
7
Sep-0
7
Oct-07
Nov-0
7
Dec-0
7
Jan-
08
Feb-0
8
Mar
-08
Apr-0
8
May
-08
Jun-
08
Jul-0
8
Aug-0
8
Sep-0
8
Oct-08
Nov-0
8
Dec-0
8
Month
Mea
n N
um
ber
of
Un
inte
nti
on
al
Dis
crep
anci
es p
er P
atie
nt
Mean Number of UNINTENTIONAL DiscrepanciesNational vs. Paediatric Teams - Goal line represents a 50 % reduction
0.00
0.25
0.50
0.75
1.00
1.25
1.50
1.75
Nov-0
5
Dec-0
5
Jan-
06
Feb-0
6
Mar
-06
Apr-0
6
May
-06
Jun-
06
Jul-0
6
Aug-0
6
Sep-0
6
Oct-06
Nov-0
6
Dec-0
6
Jan-
07
Feb-0
7
Mar
-07
Apr-0
7
May
-07
Jun-
07
Jul-0
7
Aug-0
7
Sep-0
7
Oct-07
Nov-0
7
Dec-0
7
Jan-
08
Feb-0
8
Mar
-08
Apr-0
8
May
-08
Jun-
08
Jul-0
8
Aug-0
8
Sep-0
8
Oct-08
Nov-0
8
Dec-0
8
Month
Mea
n N
um
ber
of
Un
inte
nti
on
al
Dis
crep
anci
es p
er P
atie
nt
Team Example 12.0 Mean Number of Unintentional Discrepancies
0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40
1.60
1.80
Nov
200
5D
ec 2
005
Jan
2006
Feb
2006
Mar
200
6A
pr 2
006
May
200
6Ju
n 20
06Ju
l 200
6A
ug 2
006
Sep
200
6O
ct 2
006
Nov
200
6D
ec 2
006
Jan
2007
Feb
2007
Mar
200
7A
pr 2
007
May
200
7Ju
n 20
07Ju
l 200
7A
ug 2
007
Sep
200
7O
ct 2
007
Nov
200
7D
ec 2
007
Jan
2008
Feb
2008
Mar
200
8A
pr 2
008
May
200
8Ju
n 20
08Ju
l 200
8A
ug 2
008
Sep
200
8O
ct 2
008
Nov
200
8D
ec 2
008
Jan
2009
Feb
2009
Mar
200
9A
pr 2
009
May
200
9Ju
n 20
09Ju
l 200
9A
ug 2
009
Sep
200
9O
ct 2
009
Nov
200
9D
ec 2
009
Month
Mea
n
Actual Goal
Team Example 2
2.0 Mean Number of Unintentional Discrepancies
0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40
1.60
1.80
Nov
200
5D
ec 2
005
Jan
2006
Feb
2006
Mar
200
6A
pr 2
006
May
200
6Ju
n 20
06Ju
l 200
6A
ug 2
006
Sep
200
6O
ct 2
006
Nov
200
6D
ec 2
006
Jan
2007
Feb
2007
Mar
200
7A
pr 2
007
May
200
7Ju
n 20
07Ju
l 200
7A
ug 2
007
Sep
200
7O
ct 2
007
Nov
200
7D
ec 2
007
Jan
2008
Feb
2008
Mar
200
8A
pr 2
008
May
200
8Ju
n 20
08Ju
l 200
8A
ug 2
008
Sep
200
8O
ct 2
008
Nov
200
8D
ec 2
008
Jan
2009
Feb
2009
Mar
200
9A
pr 2
009
May
200
9Ju
n 20
09Ju
l 200
9A
ug 2
009
Sep
200
9O
ct 2
009
Nov
200
9D
ec 2
009
Month
Mea
n
Actual Goal
Team Example 3
2.0 Mean Number of Unintentional Discrepancies
0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40
1.60
1.80
Nov
200
5D
ec 2
005
Jan
2006
Feb
2006
Mar
200
6A
pr 2
006
May
200
6Ju
n 20
06Ju
l 200
6A
ug 2
006
Sep
200
6O
ct 2
006
Nov
200
6D
ec 2
006
Jan
2007
Feb
2007
Mar
200
7A
pr 2
007
May
200
7Ju
n 20
07Ju
l 200
7A
ug 2
007
Sep
200
7O
ct 2
007
Nov
200
7D
ec 2
007
Jan
2008
Feb
2008
Mar
200
8A
pr 2
008
May
200
8Ju
n 20
08Ju
l 200
8A
ug 2
008
Sep
200
8O
ct 2
008
Nov
200
8D
ec 2
008
Jan
2009
Feb
2009
Mar
200
9A
pr 2
009
May
200
9Ju
n 20
09Ju
l 200
9A
ug 2
009
Sep
200
9O
ct 2
009
Nov
200
9D
ec 2
009
Month
Mea
n
Actual Goal
Baseline and Implementation Data;Type 3 Discrepancies (System-wide)
From a system-wide lens there has been an overall decrease in Type 3 discrepancies
Across the paediatric teams, a total of 616 patients were reviewed during the baseline phase and 358 Type 3 discrepancies were identified – a rate of 0.58 per patient
During implementation of MedRec, a total of 2898 patients have been reviewed, to date, and 811 Type 3 discrepancies have been identified 0.28
Overall, for teams that have submitted partial implementation data, the mean number of Type 3 discrepancies per patient has decreased 56.9%
Baseline and Measurement GoalsType 2 Discrepancies (System-wide)
Across the paediatric teams, a total of 616 patients were reviewed during the baseline phase and 271 Type 2 discrepancies were identified – a rate of 0.44 per patient
Based on the SHN! goal of reducing discrepancy rates by 75% we would expect this rate to drop to 0.11
A reduction of discrepancy rates by 50% (system wide) would give a goal rate of 0.22
Baseline data;Distribution of Type 2 Discrepancies
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
Mea
n T
ype
3 D
iscr
epan
cies
per
pat
ient
A B C D E F G H I J K L N O P Q R S T U V W
Team/ Patient Population
75% reduction = 0.119
50% reduction = 0.22
Mean Number of UNDOCUMENTED DiscrepanciesNational vs. Paediatric Teams - Goal line represents a 75 % reduction
0.00
0.50
1.00
1.50
2.00
No
v-0
5
De
c-0
5
Jan
-06
Fe
b-0
6
Ma
r-0
6
Ap
r-0
6
Ma
y-0
6
Jun
-06
Jul-
06
Au
g-0
6
Se
p-0
6
Oct
-06
No
v-0
6
De
c-0
6
Jan
-07
Fe
b-0
7
Ma
r-0
7
Ap
r-0
7
Ma
y-0
7
Jun
-07
Jul-
07
Au
g-0
7
Se
p-0
7
Oct
-07
No
v-0
7
De
c-0
7
Jan
-08
Fe
b-0
8
Ma
r-0
8
Ap
r-0
8
Ma
y-0
8
Jun
-08
Jul-
08
Au
g-0
8
Se
p-0
8
Oct
-08
No
v-0
8
De
c-0
8
Month
Mea
n N
um
ber
of
Un
do
cum
ente
d I
nte
nti
on
al
Dis
crep
anci
es p
er P
atie
nt
Local Team National Goal
Mean Number of UNDOCUMENTED DiscrepanciesNational vs. Paediatric Teams - Goal line represents a 50 % reduction
0.00
0.50
1.00
1.50
2.00
No
v-0
5
De
c-0
5
Jan
-06
Fe
b-0
6
Ma
r-0
6
Ap
r-0
6
Ma
y-0
6
Jun
-06
Jul-
06
Au
g-0
6
Se
p-0
6
Oct
-06
No
v-0
6
De
c-0
6
Jan
-07
Fe
b-0
7
Ma
r-0
7
Ap
r-0
7
Ma
y-0
7
Jun
-07
Jul-
07
Au
g-0
7
Se
p-0
7
Oct
-07
No
v-0
7
De
c-0
7
Jan
-08
Fe
b-0
8
Ma
r-0
8
Ap
r-0
8
Ma
y-0
8
Jun
-08
Jul-
08
Au
g-0
8
Se
p-0
8
Oct
-08
No
v-0
8
De
c-0
8
Month
Mea
n N
um
ber
of
Un
do
cum
ente
d I
nte
nti
on
al
Dis
crep
anci
es p
er P
atie
nt
Baseline and Implementation Data;Type 2 Discrepancies (System-wide)
From a system-wide lens there has been an overall decrease in Type 2 discrepancies
Across the paediatric teams, a total of 616 patients were reviewed during the baseline phase and 271Type 2 discrepancies were identified – a rate of 0.44 per patient
During implementation of MedRec, a total of 2898 patients have been reviewed, to date, and 885 Type 2 discrepancies have been identified 0.31
Overall, for teams that have submitted partial implementation data, the mean number of Type 3 discrepancies per patient has decreased 30.7%
As we continue our journey
The CAPHC Patient Safety Collaborative would like to recognize the ongoing work of all of the participating centres, for without their commitment, extraordinary efforts and leadership, this work would not be possible!
Children's & Women's Health Centre of BC
Alberta Children's Hospital
Stollery Children's Hospital
Saskatoon Health Region
Winnipeg Children's Hospital
Bloorview Children’s Rehab
Children's Hospital of Eastern Ontario
Children's Hospital of Western Ontario
Credit Valley Hospital
Grand River Hospital
Hospital for Sick Children
Kingston General Hospital
McMaster Children's Hospital
North York General Hospital
Quinte Healthcare Corporation
IWK Health Centre
Janeway Child Health Centre