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Western Node Collaborative

BC Children’s Hospital

Medication Reconciliation

Penticton – October 2006

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continued………

Background

• BC Children’s Hospital – part of Children’s & Women’s Health Centre of BC

• Multidisciplinary team (RN, MD, Pharmacist, QS&RM, Family Rep)

• Emergency Department (ED) with spread to Oncology Clinic Oncology Inpatient Unit then site-wide

• Start December 2005 and end December 2006

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• Aligns with Provincial Health Services Authority Strategic Plan which states that “we

must implement systems and processes that ensure safe clinical and work environments”.

• Med Rec and Accreditation – Patient Safety Goals

• Project led by Department of Quality, Safety & Risk Management; team members from each clinical area join and leave the team as initiative spreads.

Background

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Aim

• Purpose: to prevent adverse drug events at BCCH by implementing a medication reconciliation process.

• Goals/Objectives or Aim Statements: To reduce the number of:

a) undocumented intentional discrepancies &

b) unintentional discrepancies at admission by 95% by December 2006.

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Team Members• Emergency - Physician (Quality Initiatives), Educator, Charge Nurse, Quality &

Safety Coordinator

• Oncology Clinic and Inpatient Unit Physician, Nurse Educators and Clinicians

• Quality Safety & Risk Management• Pharmacy• Family Representative• Decision support• Communications

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Changes Tested

Emergency - form trialed by Educator in different places:• Triage desk (no time)• Fast Track area (very few admissions)• Family completing form (too stressed)• In the cubicle area of ED after order to admit received

(adopted)

Oncology Clinic - form trialed by Oncology staff nurse who first used the form then taught clinic nurses to complete it (very successful)

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Keys to Success & Lessons Learned

• Ask unit leadership and staff how they would best like to proceed with implementation

• Obtain buy-in from unit (Physician, Nursing Leadership, Pharmacy)

• Find unit staff to act as a champion and able to provide one-to-one training

• Remain flexible in scheduling meetings and maximize use of electronic communication tools

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Next Steps and Plans for Spread

• Confirm education plans for ED and Oncology

• Train staff re: completion and use of Medication History form and reconciliation process

• Finalize generic Power Point Presentation with video clips from staff and families

• Laminated poster for clinical areas

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continued…….Next Steps and Plans for Change

• Explore electronic and paper discharge forms already in use

• Consider how electronic tools can support the medication reconciliation process long term

• Standardize Discharge Form as much as possible for parents to use when/if readmitted. Close the Loop!

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Contact Information

• Judy Komori, Leader Quality & Safety jkomori@cw.bc.ca. 604.875.2105

• Anne Compton, Leader, Quality & Safety acompton@cw.bc.ca 604.875.2345 local 7002

• Denise Hudson, Emergency Quality Initiatives• dhudson@cw.bc.ca 604.875.2354 local 5341

• Irene Matsui, Leader, Quality & Safety imatsui@cw.bc.ca 604.875.2354 local 6261