Thunder Bay Regional Health Sciences Centre (TBRHSC)

Medication Reconciliation

Background

• Is a 375 bed academic health science centre with a mission to advance world-class Patient and Family Centred Care in an academic, researched-based acute care environment.

• We provide service to Northwestern Ontario with a population of 250,000 residents scattered over a geographical area the size of France.

• Rationale – Improve patient safety by developing a consistent approach to obtain BPMH and reconcile medications upon admission and transfer

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Aim

• Improve patient safety and risk for adverse medication events

• Educate and engage critical care staff on the medication reconciliation process

• Ensure Best Possible Medication History (BPMH) is obtained and documented on all critical care patients upon admission (process vs individual driven)

• To reconcile and document all medication discrepancies on admission and transfer from critical care

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Team Members

• Chad Johnson, Clinical Nurse Specialist – Critical Care• Wendy Winslow, Manager – Critical Care• Larry Bertoldo, Pharmacist• Lisa Beck, Director – Trauma Program, ED & ICU• Marios Roussos, Intensivist• Adam Vinet, Manager – Emergency Department• Cece Girard, Critical Care Staff Nurse• Katrina Niemi, Critical Care Staff Nurse

Results

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• Development of e-based Med Rec course on hospital learning system– Course content had input from staff and outlined key med

rec components and expected process

• Development of 24/7 BPMH process upon admission using Pharmacist-Nurse collaborative model– Nurses do BPMH on weekends and when pharmacist is off

Results

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• Development of tools and resources to facilitate BPMH completion and involvement of family– Paper form for family– Triggers and reminders for staff to complete

• Development of process, forms and tools to facilitate med rec upon transfer– Pre-printed transfer orders with med rec section– Availability of medication lists (BPMH vs current meds) for

patient rounds

Results

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• Re-education of staff after 8 months of implementation to reinforce med rec key concepts and utilize actual case based scenarios – Using actual cases helped staff see relevance to change

and importance of med rec• Ongoing engagement and recruitment of frontline

staff, including ward clerks to champion project– Important to have several staff involved to sustain

processes after project completed

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Changes Tested

• Audited staff for completion and comprehension of e-based Med Rec course– Results reveal 100% completion, course easily understood

• Audited opportunities for RN to do BPMH within 24 hrs of admission to ICU– Results revealed more opportunity required

• Audits & interviews with staff to identify and address barriers– Approaches modified based on feedback

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Changes Tested

• Monthly audits done to assess completion rates for nurse generated BPMHs on weekends and when pharmacist is off– Results reveal 75-80% completion rates

• Audit quality of nurse generated BPMHs compared to pharmacist generated– Areas for improvement identified and areas to refocus

education

• Audit compliance with med rec upon transfer process planned for November

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Lessons Learned

• Need to follow-up individually (vs e-mail) with nursing staff to assess barriers to BPMH completion

• Review and re-evaluate process frequently– Changed BPMH completion timeframe extended to 48

hours• Need a collaborative team approach model for

success • Need to further engage physicians in process • Takes time to integrate process changes into practice

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Lessons Learned

• Audit data helpful to demonstrate results of specific strategies– Impact when manager notifies staff that audit will follow– Provides visual representation of successes

• Current computer charting system does not facilitate streamline efficient med rec process– Need to further work with IT/IS to develop solutions

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Next Steps

• Focus on refining a consistent medication reconciliation process for all ICU transfers– Get buy-in from Intensivist group– Audit practice

• Integrate med rec throughout other areas of the hospital– Utilize lessons learned, tools and resources to

organizational strategy