Coming Full Circle: AMI and Med Rec Across the Continuum

Enrollment Package Conference Call April 18, 2007

Western Node Breakthrough Series Collaborative

May 2007 – May 2008

Supported by the Western Node of SHN!

The funding for this Collaborative has been provided by the:• BC Patient Safety Task Force• Health Quality Council of Alberta• Saskatchewan Health Quality Council• Manitoba Patient Safety Task Force

Objectives for the Call• Review the BTS Collaborative Model (Christina

Krause)

• The What and Why of Pre-work (Christina Krause)

• Team in Pre-Work (Tanis Rollefstad)

• Review the Collaborative Goal & Charter (Tanis Rollefstad)

• Learning Session #1 Activities (Marlies van Dijk)

• Discussion & Questions

Learning

Session One

Learning

Session One

Learning

Session Two

Learning

Session Two

Learning

Session Three

Learning

Session Three

Breakthrough SeriesCollaborative

Planning & Pre-work

Action Period One Action Period Two

Closing Congress & Distribute Findings

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Action Period Three

Support

Communities of Practice Email Teleconferences Monthly Team Reports

May 14 &15, 2007 Saskatoon, SK

Sept 24 & 25, 2007Victoria, BC

Feb 4 & 5, 2008Edmonton, AB

May 5 & 6, 2008Winnipeg

Why Do We Do Pre-Work?

• Assures that teams come prepared for Learning Session #1

• Builds the assets of a Collaborative– Assess strengths and needs– Finding early adopters– Identifying challenging issues– Build relationships among teams and

between teams and faculty

Team’s Preparation: Enrollment Package

Review the Enrolment materials and identify the individuals who will be working on this improvement effort (both initial site team and senior leaders)

Meet at least once prior to Learning Session #1 (May 14 & 15, 2007, Saskatoon, SK).

Meet with your organization’s senior leadership to determine direction for your aim and to arrange needed resources for the team.

Form your improvement team. Identify your team’s aims (goals). Plan your measurement strategy and collect baseline data. If you have a Storyboard created, consider bringing to share Optional: call Collaborative co-Director for a teleconference

meeting to “catch up” (250.492.3319 to make an appointment). Register on-line (www.saferhealthcarenow.ca) for Learning

Session #1. Phone Delta Bessborough and make a reservation for

accommodations. Join the SHN! Communities of Practice

www.saferhealthcarenow.ca

Teams in Pre-Work

• Get the right people at the table

• Begin building the team

• Send the right people to the Learning Sessions – clinical leaders and day-to-day leaders

Three Components of an Effective Team

System Leadership (Organizational

Leaders)

Technical Expertise

(Clinical Leaders)

Day-to-Day Coordination (Day-to-

Day Leaders)

Team Leader

• Make sure to send in your Team Enrollment Form with you team’s key contact information

• Key contact role : – ensure communication with collaborative

staff/Faculty & team members– Prepares the Monthly Report for the

Collaborative– Submits the SHN! data

Medication ReconciliationMission and Collaborative Goals

• Mission: – Over the course of the next year, a breakthrough improvement in

medication reconciliation.

• Goals: – Aligned with that stated in the Medication Reconciliation Getting

Started Kit available on the Safer Healthcare Now! website (www.saferhealthcarenow.ca).

– The primary goal of medication reconciliation is to eliminate undocumented intentional discrepancies and unintentional discrepancies by reconciling all medications, at all interfaces of care, for all patients.

– Develop a process which provides an accurate list across the continuum of care, from admission to an acute care setting, transfer within the setting or to another facility, discharge to the community, and ongoing in the home.

• The primary emphasis is to create systems of care that dramatically reduce the number of ADEs through the reconciliation of medications.

Medication ReconciliationMeasures

1. Mean # of undocumented intentional discrepancies (documentation accuracy).

Target: Reduce baseline in area of focus by 75%.

2. Mean # of unintentional discrepancies (medication error). Target: Reduce baseline in area of focus by 75%.

3. Percentage of Patients Reconciled at Discharge (Acute Care Measure only)

Target: To increase the percentage of patients with a Best Possible Medication Discharge Plan (BPMDP) by 75%.

Home Care – Learning Goals

• Explore the process of obtaining, updating and communicating a complete Best Possible Medication History (BPMH)

• Identify core processes to aid in the BPMH and identification of medication errors

• Develop a BPMH tool for the home care environment for SHN!

• Develop and test 2 measures which have relevance to monitoring the process and outcomes to prevent harm in the Home Care environment

Improved Care for Acute Myocardial Infarction

Mission and Collaborative Goals

• Mission: – Over the course of the next year, a breakthrough

improvement in AMI care.

• Goals: – Aligned with that stated in the AMI Getting Started Kit

available on the Safer Healthcare Now! website (www.saferhealthcarenow.ca).

– Prevent deaths among patients hospitalized for AMI by ensuring reliable delivery of evidence-based care.

– Develop a system by which all seven of the key components of care for AMI are provided reliably to all patients.

Improved Care for Acute Myocardial InfarctionMeasures

Process Measures (8):

• % AMI patients who received ASA within 24 hours before or after hospital arrival

• % AMI patients prescribed ASA at discharge

• % of AMI patients prescribed beta-blocker at discharge.

• % of AMI patients who received either thrombolytics within 30 minutes of hospital arrival or Percutaneous Coronary Intervention (PCI) within 90 minutes of hospital arrival.

• % ACE-inhibitor or angiotensin receptor blockers (ARB) at discharge for patients with systolic dysfunction

• % AMI patients who were prescribed ACEI or ARB at discharge.

• % AMI patients (cigarette, cigar and pipe smokers) who received smoking cessation advice, counselling and/or cardiac rehabilitation program during hospital stay.

• % AMI patients who were prescribed a statin at discharge.

Improved Care for Acute Myocardial Infarction

Measures

Outcome Measures (2): • % AMI patients with Perfect Care (provision of all

key components of care, or documentation of clear contraindication).

• % AMI patients who died during hospital stay.

Measurement in Pre-Work

• Collecting Baseline Data– Just enough measurement, sampling– Provides information to set clearer goals in the

aim statement– Introduces the concept of run charts– Measures may change during the collaborative

– it’s about learning

Learning Session #1 Activities

• Hear and work directly with Faculty during breakout sessions

• Refine Aims, start building charter• Learn more about the Improvement Model• Work through measurement issues• Team meetings provide opportunities for

you to develop plans and receive input from Faculty

• Connect and learn from other participating teams

Next Steps

• If you haven’t yet done so: – Enroll your team using the Team Enrollment

Form (found in the Call to Action .pdf)– Register on-line for Learning Session 1 at

www.saferhealthcarenow.ca– Book travel and accommodation (Delta

Bessborough SHN! rate extended until April 18th)

• Participate in Office Hours – schedule attached

• Prepare for Learning Session 1 (May 14 & 15th, Saskatoon, SK)

Upcoming Calls

Med Rec in Home CareApril 23, 10 - 11am MDT1-866-368-6248; Participant Code:  2132760

Med Rec in Long-Term CareApril 24, 10 - 11am MDT1-866-368-6248; Participant Code:  2132760

Office Hours *open time for teams to call and ask questions about measurement, Enrollment

Activities, etc)

Med Rec May 2, 1 - 2 pm MDT 1-866-368-6248, Participant Code 2132760#

AMIMay 4, 12 - 1 pm MDT 1-866-368-6248, Participant Code 4238262#

Discussion Questions

• Where are you at?• What are your challenges?• If you’d like, schedule an individual follow-

up teleconference with Christina Krause, Collaborative Co-Director:

christina.krause@hqca.ca or 250.492.3319