smooth safer medica:on outcomes on safer medication ... safer medication outcomes on transfer home

SMOOTH Safer Medica:on Outcomes On Safer Medication ... Safer Medication Outcomes On Transfer Home
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  • SMOOTHSafer Medication Outcomes On Transfer Home

    www.koawatea.co.nzH E A L T H S Y S T E M I N N O V A T I O N A N D I M P R O V E M E N T

    Background:The SMOOTH programme included:Improving Patient and Whaanau Welfare by Ensuring accuracy and reliability of information at discharge Providing tailored patient and whaanau centred education and empower patients to self manage medications Coordination of timely access to discharge medicines Establishing a phone call follow up service within 7 days of discharge

    Collaborating with other health professionals within Counties Manukau Health to: Improve the satisfaction of stakeholders through more timely and accurate flow of information regarding medicines and improving acute care demand management through a reduction in readmissions

    A safer journey from hospital to home

    SMOOTH Safer Medica:on Outcomes On

    Transfer Home Aim The aim of the SMOOTH Programme is to reduce medica6on related readmissions by providing 90% of high risk adult medical and surgical pa6ents with a medica6on management service at discharge and during the immediate post discharge period (7 days) by June 2013. Background The SMOOTH programme included: Improving Pa6ent and Whaanau Welfare by

    Ensuring accuracy and reliability of informa6on at discharge Providing tailored pa6ent and whaanau centred educa6on and empower

    pa6ents to self manage medica6ons Coordina6on of 6mely access to discharge medicines Establishing a phone call follow up service within 7 days of discharge.

    Collabora6ng with other health professionals within Coun6es Manukau District Health Board (CMDHB) to

    Improve the sa6sfac6on of stakeholders through more 6mely and accurate flow of informa6on regarding medicines and improving acute care demand management through a reduc6on in readmissions.

    Last Updated 23 April 2012

    20,000 Days C ampaig n

    90% of high risk patients from adult

    medical and surgical

    wards will receive

    medicine management services at discharge and post discharge (7days) by June 2013

    High Risk Pt discharge

    Discharge Planning Process

    Medication Processes

    Training Resources

    Safer Medicines Outcomes on Transfer to Home Driver Diagram

    Processes SOP/Checkli

    st

    Pt Identification

    1 2

    Identification of patients at greatest risk of harm and greatest potential for benefits

    Change Concepts

    Timing of discharge

    Defined Process with Checklist

    VHIU concept familiarisation

    Specific Pharmacists dedicated to service

    Use ART Tool to identify patients/cf other factors that may influence patient populations

    Work of Transitions of Care group

    Modify EDS template to identify high risk pts

    Identification Process Magnets on Pt boards (Enrol pts)

    MR, Concerto, MUR training

    Use of Checklist as prompt and to collect information

    Specific Change Ideas

    Pharmacist Resource

    Recruitment

    Coordination

    Referral mechanism Accuracy of meds information at discharge

    Access of meds

    Meds Resource Pack

    Med Rec on DischargeMed Review/EDS meds review

    Fax script, access/transport, check testsafe if picked upIdentify barriers to access

    Med card, PILs, Checklist, Compliance Aid

    Medication Passport (mylist)

    Communication

    Follow up patient after d/c

    Follow up significant issues with GP/comm pharm

    Tools

    Pharmacists with right skills

    Learnings - Phase 1 Small, inexpensive tests of change via Plan-Do-Study-Act cycles can provide

    valuable return in overall learning Applying improvement science principles to these learning's will lead to

    mul6ple system refinements Achievements

    Successful tes6ng and development of a change package to deliver at discharge

    Preven6on of 447 medica6on related errors - 134 errors were graded as having the poten6al to result in rehospitalisa6on

    Es6mated financial savings for CMDHB $291,696 per annum. Cumula6ve bed days saved is 582 days Funding secured to spread and implement package in Phase 2

    Driver Diagram

    Ideal to be SMOOTH discharge process

    SM

    OO

    TH

    phar

    mac

    yC

    linic

    al

    Pha

    rmac

    yA

    llied

    Hea

    lthN

    ursi

    ngM

    edic

    al S

    taff

    Pat

    ient

    SMOOTH magnet/sticker used to

    make HR pt visible

    EDS started

    Admission Med Rec

    Calls SMOOTH team

    Patient goes home

    EDS completed

    SMOOTH statement in EDS

    SMOOTH team informed of discharge

    Contact community

    pharmacy/primary care

    HR Pt identified in ART

    Prints HR list

    EDD allocated to patient entered on

    WiMs and/or whiteboard

    SMOOTHs the patient

    Patient in Hospital

    MDT sign off of patient for

    discharge/decision made

    Discharge med rec

    Telephone follow up post discharge

    if appropriate

    SMOOTH discharge process map

    Results

    Unintended Discrepencies Identified by SMOOTH

    149

    164

    122

    11

    10

    20

    40

    60

    80

    100

    120

    140

    160

    180

    Grade ONE Grade TWO Grade THREE Grade FOUR Grade FIVE

    Grade

    Num

    ber o

    f Err

    ors

    Grade Descrip6on 5 An error that resulted in SERIOUS/CATASTROPHIC HARM to

    patient.

    4 An error that resulted in MAJOR HARM to patient. Major harm is that requiring increased hospital stay or significant morbidity.

    3 An error that resulted in MODERATE HARM to patient. Moderate harm is that requiring treatment with another drug OR cancellation/postponement of

    2 An error that resulted in MINOR HARM to patient. Minor harm is that requiring minor (non-drug) treatment or treatment change.

    1 No harm or only minor harm not requiring treatment

    Grading of errors (Using Epifany Grading System)

    From 447 medica6on errors 134 errors were graded as having the poten6al to result in rehospitalisa6on

    Ideally I wish everyone would have SMOOTH discharge planning because in terms of the discharge they really are a warrant of fitness for the patient before they leave

    Dr Suluama Fuimaono-Sapolu (House Officer)

    It was really helpful when they (SMOOTH) came in and explained every one of the pills I have..the medication side of it is actually falling into place

    Agnes Marshall (Patient)

    A safer journey from hospital to home

    SMOOTH Safer Medica:on Outcomes On

    Transfer Home Aim The aim of the SMOOTH Programme is to reduce medica6on related readmissions by providing 90% of high risk adult medical and surgical pa6ents with a medica6on management service at discharge and during the immediate post discharge period (7 days) by June 2013. Background The SMOOTH programme included: Improving Pa6ent and Whaanau Welfare by

    Ensuring accuracy and reliability of informa6on at discharge Providing tailored pa6ent and whaanau centred educa6on and empower

    pa6ents to self manage medica6ons Coordina6on of 6mely access to discharge medicines Establishing a phone call follow up service within 7 days of discharge.

    Collabora6ng with other health professionals within Coun6es Manukau District Health Board (CMDHB) to

    Improve the sa6sfac6on of stakeholders through more 6mely and accurate flow of informa6on regarding medicines and improving acute care demand management through a reduc6on in readmissions.

    Last Updated 23 April 2012

    20,000 Days C ampaig n

    90% of high risk patients from adult

    medical and surgical

    wards will receive

    medicine management services at discharge and post discharge (7days) by June 2013

    High Risk Pt discharge

    Discharge Planning Process

    Medication Processes

    Training Resources

    Safer Medicines Outcomes on Transfer to Home Driver Diagram

    Processes SOP/Checkli

    st

    Pt Identification

    1 2

    Identification of patients at greatest risk of harm and greatest potential for benefits

    Change Concepts

    Timing of discharge

    Defined Process with Checklist

    VHIU concept familiarisation

    Specific Pharmacists dedicated to service

    Use ART Tool to identify patients/cf other factors that may influence patient populations

    Work of Transitions of Care group

    Modify EDS template to identify high risk pts

    Identification Process Magnets on Pt boards (Enrol pts)

    MR, Concerto, MUR training

    Use of Checklist as prompt and to collect information

    Specific Change Ideas

    Pharmacist Resource

    Recruitment

    Coordination

    Referral mechanism Accuracy of meds information at discharge

    Access of meds

    Meds Resource Pack

    Med Rec on DischargeMed Review/EDS meds review

    Fax script, access/transport, check testsafe if picked upIdentify barriers to access

    Med card, PILs, Checklist, Compliance Aid

    Medication Passport (mylist)

    Communication

    Follow up patient after d/c

    Follow up significant issues with GP/comm pharm

    Tools

    Pharmacists with right skills

    Learnings - Phase 1 Small, inexpensive tests of change via Plan-Do-Study-Act cycles can provide

    valuable return in overall learning Applying improvement science principles to these learning's will lead to

    mul6ple system refinements Achievements

    Successful tes6ng and development of a change package to deliver at discharge

    Preven6on of 447 medica6on related errors - 134 errors were graded as having the poten6al to result in rehospitalisa6on

    Es6mated financial savings for CMDHB $291,696 per annum. Cumula6v

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