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Background. Key Steps continued. Key Steps continued. Key Steps continued. Step 3 Evaluation. Step 2 Implementation of Med Rec (Pilot in Medical Floor). Step 2 Implementation of Med Rec. Step 1 Development of Process Develop Team/FMEA - PowerPoint PPT Presentation
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Medication Reconciliation in the Medical Floor Medication Reconciliation in the Medical Floor A Patient Safety Quality Improvement Initiative A Patient Safety Quality Improvement Initiative
Medication reconciliation is defined as a formal process of obtaining a compete and accurate list of each patient’s current home medications (including name, dosage, frequency and route and comparing the physicians admission, transfer and/or discharge orders to that list.
The process involves:• Verification (collection of medication history)• Clarification (ensuring the medications & doses are appropriate)• Reconciliation (documentation of changes in the orders)
BackgroundBackground Key Steps continuedKey Steps continued Key Steps continuedKey Steps continuedKey Steps continuedKey Steps continued
Goals & ObjectivesGoals & Objectives
Key StepsKey Steps
Goal:• To develop and implement a Medication Reconciliation process that
incorporates the best possible medication history (BPMH) and facilitates timely and accurate admission/transfer/discharge orders.
Improvement Objectives:• To decrease the number of undocumented intentional and
unintentional discrepancies for patients admitted to the Medical Floor from ER by 75% by June 2007.
• To increase the number of BPMH completed by nurses, pharmacists, and physicians admitted to the Medical Floor by 75% by June 2007.
• Hospital admission, transfer and discharge are key medication-related vulnerable moments (history taking & ordering) where patients are at increased risk of medication discrepancies that potentially can lead to adverse drug events.
Figure 1. Summary of Process MapFigure 1. Summary of Process Map
Admission to Admission to Medical Floor Medical Floor
ICUICU
SurgicalSurgical
Vulnerable Vulnerable Moment #1Moment #1
Vulnerable Vulnerable Moment #1Moment #1
Vulnerable Vulnerable Moment #3Moment #3
Vulnerable Vulnerable Moment #3Moment #3
Vulnerable Vulnerable Moment #4Moment #4
Vulnerable Vulnerable Moment #4Moment #4
ERER ORORReturn to Return to Medical Medical
FloorFloorHomeHome
3. Baseline Data Collected – Audit Results3. Baseline Data Collected – Audit Results
Step 1Step 1Development of ProcessDevelopment of Process
Step 1Step 1Development of ProcessDevelopment of Process
Step 2Step 2Implementation of Implementation of
Med RecMed Rec
Step 3Step 3EvaluationEvaluation
Evaluation/DiscussionEvaluation/Discussion
Chart audits of 20 patients, revealed a mean Success Index of 75%. This is within the National Mean. This is prior to implementation of the Med. Rec. Process. Our goal is to improve our success index in 1 year by 75% of our baseline (95%). We will continue to monitor our success (on a monthly basis) using the same performance measurement.
We will continue to implement Medication Reconciliation, Test Results, Spread and Evaluate. We will know this change is an improvement using our 3 performance measures (compare future changes with current performance) and by measuring nursing satisfaction, physician satisfaction, pharmacy satisfaction & patient satisfaction.
Identified Potential Barriers to Success Include:• No clear owner of process, roles & responsibilities• Lack of understanding of potential impact• Use of various forms in various areas/no standardized process
Figure 6. Mean # of Undocumented Intentional Discrepancies (Type 2)Figure 6. Mean # of Undocumented Intentional Discrepancies (Type 2)
Figure 7. Mean # of Unintentional Discrepancies (Type 3)Figure 7. Mean # of Unintentional Discrepancies (Type 3)
ICU = Intensive Care Unit
ER = Emergency Room
Mean Number of Undocumented Intentional Discrepancies
00.20.40.60.8
11.21.41.61.8
Jun-06 Jul-06
TDH Mean #
TDH Goal
Ontario Node
National
Mean Number of Unintentional Discrepancies
0
0.5
1
1.5
2
2.5
Jun-06 Jul-06
TDH Mean #
TDH Goal
Ontario Node
NationalVulnerable Vulnerable Moment #2Moment #2
Vulnerable Vulnerable Moment #2Moment #2
Step 2Step 2Implementation of Implementation of
Med Rec (Pilot Med Rec (Pilot in Medical in Medical
Floor) Floor)
Step 1Step 1Development of ProcessDevelopment of Process
- Develop Team/FMEADevelop Team/FMEA- Design of tools Design of tools - Baseline data collectionBaseline data collection
Step 1Step 1Development of ProcessDevelopment of Process
- Develop Team/FMEADevelop Team/FMEA- Design of tools Design of tools - Baseline data collectionBaseline data collection
Step 3Step 3EvaluationEvaluation
-AuditsAudits-Success IndexSuccess Index-Hospital-wide roll outHospital-wide roll out
Table 1. Summary of Failure Mode Effects AnalysisTable 1. Summary of Failure Mode Effects Analysis
Figure 2. Project PlanFigure 2. Project Plan
Table 2. Failure Mode SummaryTable 2. Failure Mode Summary
Figure 3. Best Possible Medication History-Baseline Audit ToolFigure 3. Best Possible Medication History-Baseline Audit Tool
Figure 4. Automated Discharge Prescription (Meditech)Figure 4. Automated Discharge Prescription (Meditech)
2. Tools Developed 2. Tools Developed
Hospital InformationHospital Information
Complete List of Complete List of MedicationsMedications
Physician Name Physician Name & Signature& Signature
Patient ReminderPatient Reminder
Patient InformationPatient Information
Figure 5. Automated Discharge Summary (Meditech)Figure 5. Automated Discharge Summary (Meditech)
No Need to Dictate No Need to Dictate Medications – Medications – Information Flows Information Flows Through to Through to Discharge SummaryDischarge Summary
1. Failure Mode Effects Analysis1. Failure Mode Effects Analysis
Disseminated information through Disseminated information through various mediumsvarious mediums
• Presentations to TDH Quality Council, Hospital Board, pharmacists, program core team, staff meetings
• Inservices to Medical Floor Resource Nurses outlining process for completing a BPMH & medication reconciliation• Media campaign (newspaper & television)• Signage & email
Figure 8. Medication Reconciliation Success Index Figure 8. Medication Reconciliation Success Index (Pre-Implementation)(Pre-Implementation)
Medication Reconciliation Success Index
0%10%20%30%40%50%60%70%80%90%
100%
Jun-06 Jul-06
TDH Mean #
TDH Goal
Ontario Node
National
Patient Safety Committee, 2006