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Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative
Medication Reconciliation
“The Good Sam Way”
Southgate Care Centre
Edmonton Alberta
Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative
Where did we start?
• Southgate Care Centre – third floor
Why?• Largest facility with 225 beds
• greatest potential for admissions
• An enthusiastic team • first to respond to the invitation
Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative
Purpose
To establish a multidisciplinary medication reconciliation process on the third floor of the GSS Southgate Care Centre with the intention of improving our process through testing cycles of change, measuring our results and when successful spreading to the other units in the facility.
Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative
We are aiming to …
• ↓ Unintentional Discrepancies (errors)
by 75% by Oct 2007
• ↓ Undocumented Intentional Discrepancies
by 75% by Oct 2007
• ↑ Success Index by 75% by Oct 2007
• Reconcile the BPMH on all admissions
within 7 days by Oct 2007
Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative
Our Southgate Team
• Val Porter
Clinical Pharmacist
• Miki Skendzic
Registered Nurse
Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative
Changes Tested
P
P
P
P
P
S
D
A
D
D
D
D
S
S
S
S
A
A
A
A
Usual admitting orders by RN, pharmacist obtains additional information and team completes BPMH within 3 days.
Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative
Changes Tested
P
P
P
P
P
S
D
A
D
D
D
D
S
S
S
S
A
A
A
A
Physician to reconcile AMO with BPMH on weekly rounds after brief face-to-face explanation by Mec Rec team.
Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative
Changes Tested
P
P
P
P
P
S
D
A
D
D
D
D
S
S
S
S
A
A
A
A
Streamlined the process so both team members are able to the complete the BPMH.
Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative
Changes Tested
P
P
P
P
P
S
D
A
D
D
D
D
S
S
S
S
A
A
A
AIncluded all types of admissions, not just from active treatment, as those numbers were small.Results: Community admissions problematic!
Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative
Changes Tested
P
P
P
P
P
S
D
A
D
D
D
D
S
S
S
S
A
A
A
A Comments added to the right side of BPMH form caused confusion with reconciliation. Results: A “comment section” was added to left side of the form.
Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative
Results1.0 Mean Number of Undocumented Intentional Discrepancies
0.00
0.20
0.40
0.60
0.80
1.00
1.20
Month
Me
an
Actual Goal
August 07 Vacation plans = smaller numbers of reconciliations completed (3) Small sample size gives artificial positive results
August 07 Vacation plans = smaller numbers of reconciliations completed (3) Small sample size gives artificial positive results
Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative
Results2.0 Mean Number of Unintentional Discrepancies
0.00
0.10
0.20
0.30
0.40
0.50
0.60
Month
Me
an
Actual Goal
Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative
Results3.0 Medication Reconciliation Success Index
0%
20%
40%
60%
80%
100%
120%
Month
Per
cen
tag
e
Actual Goal
Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative
Keys to Success …
• A committed team - RN and Pharmacist
• Openness to PDSA model of change
• Support from facility administration
• A realistic LTC approach to Med Rec
• Funding $$$ for team meeting time
• +++ informal PR to staff and physicians
Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative
Lessons learned …
• Timelines established are achievable• 3 days - collection of BPMH • 7 days - physician to reconcile
• Capturing the process on paper helps to• build GSS policy• guide the team• explain Med Rec to others
• Pharmacy medication profiles can be misleading• Is the info current or historical?
Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative
Next Steps
• Trial the Home Medication Form• Residents to complete prior to admission• Staff to use as a worksheet
• Plan the “spread” to other units• Problem solving the variable physician’s
patterns of practice.• Remember to use balancing measures
for these next steps!
Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative
Contact Information
• Kathy James Fairbairn
• Consultant Pharmacist Team Lead
• Kim Wanner
• Nurse Facilitator/Educator
