Pharmacy Department, Wollongong Hospital

AcknowledgementsMichaela Baginski, Dr Kashmir De Silva, Natalie Elphick, Melissa Inskip, Dr Clair Langford, Veronica Murdoch, Karin Tarne, Erica Wales, Dr Phil Yang, Juliana Zvavanjanja.

Members of Steering and Project Committees

Lessons learnt

Case for changeMedication Reconciliation (Med Rec) is the process of obtaining, updating and communicating an accurate list of a patient’s medicines at transfers of care.

Poor Med Rec leads to:

• Patient harm: Medication errors or suboptimal treatment

• Poor care experience: Not involving patients in the process

• Wasted resources: Poor communication of medication changes can double risk of readmission

At Wollongong hospital a Medication Safety audit (50 patients) conducted in 2015 suggested that the recommended process was followed in only 40% of patients and, between July and December 2015, there was an average of 4 significant incidents reported each month.

Diagnostics – Identified Issues & SolutionsResults

Medication ReconciliationA Prescription for Safety

Mark FarrahPharmacy Department, Wollongong Hospital

GoalTo improve Med Rec on a pilot ward at Wollongong Hospital, through a multi-disciplinary approach, to align with National Accreditation Standards and the Local Health District’s objective of reducing preventable harm and improving the patient care experience.

ObjectivesIncrease the percentage of patients that have their medication reconciled within 48 hours of admission from 58% to 80% by March 2017

Increase the quality of medication reconciliation by increasing the percentage of medication reconciliation with a documented Best Possible Medication History (BPMH) from 42% to 80% by March 2017

Methods used

Sustaining change• Ongoing education and audit to maintain quality

• Report progress through Medication Safety Committee and at ward and pharmacy meetings

• Promote links with other projects and quality initiatives such as eMeds, eMR2 and accreditation standards

• Maintain SharePoint resource site on intranet

• Review pilot solutions and roll out to other wards and areas

• Continue to improve patient involvement in the Med Rec process and provide reward and recognition program for staff

ContactMark Farrah, Project Pharmacist,

Wollongong Hospital

Email: mark.farrah@health.nsw.gov.au

Phone: (02) 4255 1529

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Percentage of patients from pilot ward with documented record of medication reconciliation within 48hrs of admission

Reconciled Target

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Disagree Neutral Agree StronglyAgree

JMO awareness: I am confident that I currently have the skills to take a BPMH for a patient under my care?

(n=28)

JMO Pre-presentation JMO Post-presentation

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Novice Intermediate Expert

Nurse awareness: What level would you describe your knowledge regarding medication

reconciliation? (n=8)

Pre-workshop Post-workshop

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Percentage of patients with a Medication Management Plan (MMP)

MMP Target

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Percentage of MMPs with a Best Possible Medication History (BPMH)

BPMH Target

ISSUE EVIDENCE SOLUTION

Low awareness and training about Med Rec and process.

• Provide Med Rec training

• Develop SharePoint resource site

Documentation not consistent between healthcare professionals

• Promote MMP as preferred documentation source

Medication reconciliation isn’t completed at admission

• Develop referral pathway to support early Med Rec

0% 20% 40% 60% 80% 100%

JMO (57)

Nurse (38)

Have you ever received Med Rec training?

Yes No

0% 20% 40% 60% 80% 100%

Do you reconcile meds on admission? (JMOs - n=38)

Routinely Occasionally Never

0% 20% 40% 60% 80% 100%

JMO (57)

Pharmacist (20)

Where do you document Med Rec?

Medical Record MMP Med Chart

Pharmacist se

lf‐audit

MMP prom

otion

Nurse worksho

p

JMO presentation

Referral to

 Pharm

acist

Time• Things can take longer than anticipated• Once things are agreed – act quickly

Communication• Face to face is important to maintain momentum• Showcase efforts – SharePoint site allowed

colleagues to keep up to date with the project

Teamwork• Supportive project team helped implementation• Use influence of Sponsor to promote action and

identify champions

Intervention

Staff survey (n=148)

Audit (n=612)

Root cause

analysis

Patient experience

tracker (n=20)

Process mapping (n=10)

ShareP

oint site

Clinical redesign

methodology