pharmacy services providence health care medication reconciliation western node collaborative...

Pharmacy ServicesPharmacy Services

Providence Health Care Medication Reconciliation

Western Node Collaborative

Residential Team

Learning Session 3 Storyboard


Providence Health Care - ResidentialFive 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


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


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


Baseline Data

Measure Baseline

Undocumented Intentional Discrepancies

1.4 per resident

Unintentional Discrepancies

0.9 per resident

Success Index 82%


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


Streamlined Processes:


Moving In Medication Orders - MIMO


Changes Tested

PDSA 1Jan-Feb 06Implemented MIMO at Holy Family ECU

PDSA 2 Mar 06 Evaluation of HFH MIMO Implementation

PDSA 3 Nurse Satisfaction

PDSA 4 Posted RN Instructions

PDSA 5 Apr 06Developed Rx spreadsheet to track MIMOs

PDSA 6Implemented MIMO at Langara Residence

PDSA 7 May 06Implemented MIMO at MSJ ECU

PDSA 8Implemented review of stopped orders

PDSA 9Aug 06Implemented MIMO at Brock Fahrni

P D

A S

P D

A S

P D

A S

P D

A S

P D

A S


Medication Reconciliation IndicatorsPHC Residential Care Admissions

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06

Rat

e (p

er p

atie

nt)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Suc

cess

Inde

x

Undocumented Intentional Discrepancies (per patient)

Target (0.35 per patient) Unintentional Discrepancies (per patient)

Target (0.21 per patient) Medication Reconciliation Success Index Target (96%)

One outliern = 9

MIMO Implemented

at 1st Site Holy Family

MIMO Implemented

at 4th Site

Brock Fahrni MIMO Implemented at 2nd Site

Langara

MIMO Implemented at 3rd Site Mount St. Joseph


Undocumented Intentional Discrepancies Upon Admission

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6


Ra

te

UndocumentedIntentionalDiscrepancies (per patient)

Target (0.35 perpatient)

Baseline

MIMOs Implemented


Unintentional Discrepancies Upon Admission

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90


Ra

te

UnintentionalDiscrepancies (per patient)

Target (0.21 perpatient)

Baseline

MIMOsImplemented

One outliern = 9


Medication Reconciliation Success Index Upon Admission

0%

20%

40%

60%

80%

100%

120%


MedicationReconciliationSuccessIndex

Target (96%)

MIMOsImplemented

Baseline


One Resident’s Story

• 5 drugs omitted on initial admission from home

• At least 3 opportunities for medication reconciliation

• Undetected until admitted to Langara

Home UBCH

May 19

Langara

June 13

VGH

May 8

• TW, 75 year old female


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


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


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 24hr 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.


Next Steps

• Complete MIMO implementation at final PHC Residential Care site

• Develop implementation plan for PharmaNet-based 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 admissionorders to PHC Residential Care


Contact Information

For more information contact:

Pam Kelly, Team LeaderPhone: (604) 322-2601

Email: [email protected]

pharmacy services providence health care medication reconciliation western node collaborative...

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