your discharge is someone’s admission
TRANSCRIPT
YOUR DISCHARGE IS SOMEONE’S ADMISSION
Kim Streitenberger Project Lead, ISMP Canada
Today’s Facilitator
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Welcome
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Mike Cass Patient Safety Improvement Lead, CPSI
Welcome to our francophone
attendees
Bienvenue à nos participants
francophones
Hélène Riverin
Conseillère en sécurité et en amélioration
Safety Improvement Advisor
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Pour nos participants francophones..
Pour accéder aux diapositives
français:
-Cliquez sur l'onglet "FRENCH"
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-Envoyer un courriel à
Suivre la boîte «Chat» pour les
commentaires du
conférencière traduit en
français
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Audio Access Only
WebEx does not support Windows XP If you have Windows XP
– Slides are available under “Medication Reconciliation” on the ISMP Canada website
– Q&A – email questions to [email protected]
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Questions ISMP Canada (Host)
Stay on after this call
MedRec Open Mike - Need help with MedRec?…stay on the line
and join the discussion - Meet and connect with others in MedRec - Submit your questions to medrec@ismp-
canada.org or ask them live
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By the end of this webinar you will: Understand the Accreditation Canada requirements
for medication reconciliation at discharge Learn from the experience of patients and
receiving healthcare providers Gain insight into practical strategies for
communicating accurate medication information at discharge
Objectives
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Please complete our poll
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Today’s Speakers
Colleen Cameron Clinical Pharmacist at Grand River
Hospital in Kitchener Ontario
Heather Howley Accreditation Canada
Lynette Zielinski Clinical Nurse Educator Home Care Saskatoon Health Region,
Saskatchewan
Devin Elias Community Pharmacist,
Saskatoon Health Region
Cynthia Berry Lead Medication Reconciliation
Pharmacist for the Saskatoon Health Region, Saskatchewan
Alice Watt Medication Safety
Specialist, ISMP Canada
Michael Hamilton Community and Long Term Care physician,
Newmarket Health Centre, Newmarket, Ontario Physician Lead and Medication Safety
Specialist, ISMP Canada
Your Discharge is Someone’s Admission: How the Patient’s Truth can be a MedWrecker
Colleen Cameron, RPh, Pharm.D. Grand River Hospital, Kitchener ON November 10, 2015
Hospital
Home
LTC
Retirement Home
Primary Care
Rehab
Ms. C is 72 years of age
Admitted to hospital for acute delirium, UTI, new onset diabetes, new onset atrial fibrillation.
PMH – HTN, seizures, recurrent DVTs on warfarin Social Hx: widowed, lives alone in home, Gr. 8 education, manages meds
& ADLs independently Meds – phenobarbital, carbamazepine, telmisartan/HCTZ, warfarin
Warfarin history – on between 7-8 mg/day for > 15 years. Has always had 5mg and 1mg tablets dispensed.
INRs pre-admission – consistently stable for years between 2.3-3.0
= 27mg
I put the 5mg vial behind my back and again asked her to put 7mg in her hand using only 1mg tablets.
= 7mg
I confirmed with her “Is that 7mg?” “Yes”
On discharge – delirium clearing and getting close to baseline, I took the home warfarin bottles out of her bag. “Can you please show me how you would take 7mg of
warfarin?”
Why the confusion?
COUNTING
MATH
Taking 7mg using is
Taking 7mg using is
On the next admission for hematuria pulmonary hemorrhage, GI bleed and an INR > 10, when we ask her what her warfarin dose is for her BPMH:
“I take 7 mg of warfarin every day.”
The Patient’s Truth
Outcome
Ms. C has been back in her home for 6 months.
She is independent with her ADLs and is managing her medications using warfarin
1mg tablets
She is still my Aunt
Morals of the story…
1. What we tell the patient is often very different than what their truth ends up being.
2. A medication history or list is simply a hint of what the patient may actually be doing.
Morals of the story…
3. The only hope we have of finding out the patient’s truth
– Talk and listen – Dialogue – Demonstrate (us and them) – Keep sleuthing…
4. The patient’s truth is often cause for
someone else’s admission.
Thank you for listening to my story!
Medication Reconciliation at Discharge Accreditation Canada Requirements
Heather Howley
Accreditation Canada
November 10, 2015
Qmentum: A quality improvement framework
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A process for organizations to regularly and consistently examine and improve their services
A tool to identify areas for improvement
A measure of an organization’s services compared against standards
Required Organizational Practices (ROPs) in Qmentum
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History of Medication Reconciliation ROPs
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2006:
At admission & discharge
(Service standards)
2010:
As an organizational priority
(Leadership standards)
2014:
Improved customization
Expanded requirements
MedRec at care transitions: Discharge requirements
• Unique to inpatient acute care
• Two medication lists need to be reconciled: – BPMH generated at admission
– Current medication list (e.g., MAR)
• The result is a single list (updated BPMH) of all medications the client should be taking
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MedRec at Care Transitions ROP (acute care version)
2015 ROP Handbook
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MedRec at Care Transitions ROP (discharge requirements)
Major The prescriber uses the Best Possible Medication History (BPMH) and the current medication orders to generate transfer or discharge medication orders.
Major The team provides the client, community-based health care provider, and community pharmacy (as appropriate) with a complete list of medications the client should be taking following discharge.
2015 ROP Handbook
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Care transitions that benefit from MedRec
• Admission
• Discharge (external transfer)
• Internal transfers where there is the potential to introduce medication discrepancies, e.g.:
– Medications are re-ordered or re-written
– Change in service environments where the most responsible prescriber changes
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The On-site Survey: Discharge requirements for MedRec
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REVIEW
TALK and LISTEN
RECORD
OBSERVE
Thank you!
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Proud to be a Top 25 employer for five consecutive years
Fier de faire partie des 25 meilleurs employeurs depuis 5 années consécutives
Thank you! Merci!
Accredited by Agréé par
Cynthia Berry Lead Medication Reconciliation Pharmacist for the
Saskatoon Health Region, Saskatchewan
Discharge Medication Reconciliation
2011 Call to Action!
• Accreditation!
• SK MoH
Provincial
Strategic and
Operational
Directive
• Recognition of
a flawed
system
Discharge/Transfer MedRec Timeline
2011-present
Autumn 2011: Interdisciplinary working group struck
to develop and implement MedRec for patients
discharged from acute care and newly admitted to
LTC
• PDSA cycles
• Role definition
• Rural versus urban
• Form
• Education and communication
• Measuring
Discharge/Transfer MedRec Timeline
2011-present
Autumn 2013: Interdisciplinary working group struck
to develop and implement MedRec for ALL patients
discharged from acute care to “home”.
• Baseline audit – discrepancies, practices
• Role definition
• Process exploration
• Form revision
Discharge/Transfer MedRec Timeline
2011-present
Winter – Spring 2014
• Buy in from Cardiologists and Clinical Nurse
Specialists = revised pre-printed discharge order
set
• Hesitation from our next targeted groups
• HURDLE: time to complete form well
Discharge/Transfer MedRec Timeline
2011-present
Spring 2014 onward:
• Exploration form generated from in-patient
pharmacy software
• Pilot with CTU Team Silver
• PDSA cycles with Silver, Red, Blue
• Evaluation of workload
• Fully implemented for all patients discharged from
RUH CTU (medicine)
Discharge/Transfer MedRec Timeline
2011-present
Spring 2014 onward:
• Creation of a form generated from in-patient
pharmacy software
• Pilot with CTU Team Silver
• PDSA cycles with Silver, Red, Blue
• Evaluation of workload
• Fully implemented for all patients discharged from
RUH CTU (medicine)
Current Discharge/Transfer Med Rec Form
Current Discharge/Transfer Med Rec Form
Current Discharge/Transfer Med Rec Form
• An accurate BPMH is VITAL to Discharge Med
Rec.
• Electronic tools are helpful in many ways
(reduction of transcription error), but come with
their own set of challenges (resources).
• Most discrepancies occur when the physician is
rushed. (Patient flow!)
• Physician champions and rapid PDSAs are keys
to success.
• Involve a community pharmacist!
Critical Learning Moments
Lynette Zielinski, RN Clinical Nurse Educator Home Care, Saskatoon
Health Region, Saskatchewan
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Devin Elias Community Pharmacist
Willow Grove Pharmacy, Saskatoon, SK
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Michael Hamilton Community and Long Term Care physician, Newmarket Health
Centre, Newmarket, Ontario Physician Lead and Medication Safety Specialist, ISMP Canada
Alice Watt Medication Safety Specialist, ISMP Canada
A Toolkit and Checklist for Healthcare Providers
Hospital to Home - Facilitating Safe Medications at Transitions
“A superb, comprehensive guide to implementing effective medication reconciliation, which is a key component of high quality healthcare transitions.”
Dr. Kenneth Boockvar
"... was really helpful for getting discharge medication lists to the service providers, like myself in a timely manner. Not having a discharge medication list can be
troublesome especially if there are cognitive challenges and/or poor patient support in the home, or no family doctor.“
CCAC Rapid Response Nurse
"... one of the most rewarding parts of my job is improving the patient's understanding of their medications and to help them feel more confident about
taking their medications when they go home. The checklist prompts me to systematically go through each step so that the medication information we send with
the patient and to their healthcare providers is accurate and complete. It's about passing the baton to ensure the patient can succeed at home.“
Clinical Pharmacist
Testimonials
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Questions ISMP Canada (Host)
Upcoming MedRec Webinars
February 9, 2015 BOOMR: Care Coordinated Cross Sectional Medication Reconciliation Initiative for LTC residents
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How can I access a previous Safer Healthcare
Now! MedRec webinar/national call? How do I access the Safer Healthcare Now!
MedRec Quality Audit Tool? Where can I find information about MedRec in the
home care setting? Where can I find patient and family resources for
medication reconciliation? Where can I find videos, eLearning modules or
onsite training on how to create a Best Possible Medication History (BPMH)?
Where can I find discharge MedRec resources? What is the purpose of the MedRec Quality Audit? How do I prepare for the MedRec Quality Audit? How do I complete the MedRec Quality Audit and
submit the results?
New Frequently Asked Questions
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Visit http://www.ismp-canada.org/medrec/#tab7 http://www.patientsafetyinstitute.ca/en/Topic/Pages/medication-reconciliation-%28med-rec%29.aspx
MedRec Communities of Practice Post your questions Respond to questions Share tools and
resources
http://tools.patientsafetyinstitute.ca/Communities/MedRec/default.aspx
Online Community Dedicated to MedRec
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We are here to help!
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For MedRec Content (MedRec Intervention Lead)
Institute for Safe Medication Practices Canada (ISMP Canada)
CPSI Patient Safety Intervention Lead
Mike Cass [email protected]
Stay on after this call
MedRec Open Mike - Need help with MedRec?…stay on the line
and join the discussion.
- Submit your questions to [email protected] or ask them live
62
Please complete our poll
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MedRec Open Mike
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Your opportunity to: Ask MedRec related questions to the
ISMP Canada MedRec Team Pose questions to teams on the line to
get their input Share stories and tools/resources Exchange ideas about are doing and
what you have learned
What is Open Mike?
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How to ask questions?
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Lets start the discussion