Background
• Saskatoon Health Region:– largest health region in Saskatchewan– provides services to almost 300,000 local residents and
thousands of others from across the province who come to Saskatoon for specialized health services.
– On any given day, approximately 35% of hospital care in Saskatoon is provided to people living outside the Health Region.
– As an academic health sciences centre, the Health Region provides learning opportunities to future health care providers and participates in research that will build knowledge and improve care.
SHR Medication Reconciliation Project Structure
Jean Morrison (Executive Sponsor), Sandra Blevins, Brenda Thiessen, Janet Harding, Candice Bryden
Steering Team Project Co-ChairsJackie MannBarb Evans
TeamLeads
Quality ServicesCandice BrydenGerry Belton
Janice Seeley Marlene Strenger
PhysicianChampion (vacant at present)
P r o j e c t T e a m s
St. Elizabeth’sMonique Bollefer (Lead)Russom OckbaghziEllen KachurYvonne BerscheidBrenda HantkeBev Weyland
RUH PediatricsBernie McDonald (Lead)Garth BruceVal GerlachShelley PeacockMargo Elmgren
SPH 6th MedicineBarb Kirkland (Lead)Cheryl FransooCarmen HamptonTrina MuchaSusie HoeppnerDonna StrilaefCaroline Westman Joy MacLaughlinNorma EngeleKaren WormsbeckerMaureen PrestonHolly MansellJudy KlassenJoanne Kappel
RUH 5000Lilah Weinberger (Lead)Leah GilmoreDoris SmithEva Lehnert ThielNoelle RohatinskyKathy BueRenee KennedyCrystal Richter
SCH 4300Jane Richardson (Lead)Mark SheridanAudrey SeredaTess GiegNadine ClarkeMarie GiffordShannon Stone
Advisory Committee
Background
• Pilot sites for medication reconciliation project include:
– Surgery 5000, Royal University Hospital– Pediatrics, Royal University Hospital– Gynecology / PAC, Saskatoon City Hospital– 6th Medicine, St. Paul’s Hospital– St. Elizabeth’s Hospital, Humboldt (rural site)
Background
• Rationale for improving– Enhanced patient safety
• What are you trying to improve?– Clarity and completeness of medication
histories and orders from admission to discharge
– Reduce medication history and ordering workload
Background
• Important dates:– Start date: October / November 2005– Region wide target implementation dates:
• Admission: December 2006• Transfer and discharge: Spring 2007• Link with SK Health Pharmaceutical Information
Program (PIP): June 2007
Background
• Why?– Evidence for improving patient safety is compelling– Requirement for CCHSA accreditation– CEO and Senior Leadership completely endorses– Enhances efficiencies; eliminates duplication of
workload– Key component of seamless care strategies
• Resources:– No dedicated resources– Group of interested, enthusiastic health care
professionals agreed to participate
Aim
• Purpose: Improve patient care by reducing adverse drug events through medication reconciliation
• Scope and Boundaries:– Pilot areas selected. Focus on admission process initially.
• Improvement Objectives (Admission):– Overall: To reduce adverse drug events and patient harm through
the implementation of medication reconciliation on admission throughout SHR.
– Pilot Aims:• Reduce # unintentional discrepancies by 75% in 12 months• Reduce # undocumented intentional discrepancies by 75% in 12
months• Increase overall success at reconciling medications by increasing the
Medication Reconciliation Success index by 75% in 12 months
Goals
• Admission to Discharge:– Develop 1 form for admission medication reconciliation
for use in SHR. • Form to serve dual purpose of physician’s order form and
medication history documentation tool.– Develop 1 process for admission medication
reconciliation in SHR.– Utilize PIP to generate on-line admission medication
reconciliation form– Modify the current business process to integrate the
preadmission data with patient’s acute care medication profile
– Develop a new process where automation will generate a patient medication profile on transfer and discharge
Changes Tested
• Preadmission Medication List Physician Order Form
– Focus groups (Pharmacy, Nursing, Physicians)
– Satisfaction survey with each PDSA cycle
– Changes made to content and design based on feedback
• Medication reconciliation process
– Focus groups
– Satisfaction survey with PDSA cycle #1
• Test effectiveness of and reaction to medication reconciliation form
– Survey
– Missing information check-list
– BPMH
Results: Run Charts of Key Measures
1.0 Mean Number of Undocumented Intentional Discrepancies
0.000.200.400.600.801.001.20
Nov
2005
Dec
2005
Jan
2006
Feb
2006
Mar
2006
Apr
2006
May
2006
Jun
2006
Jul
2006
Aug
2006
Sep
2006
Oct
2006
Nov
2006
Dec
2006
Month
Mea
n
Actual Goal
2.0 Mean Number of Unintentional Discrepancies
0.00
0.10
0.20
0.30
0.40
0.50
0.60
Nov
2005
Dec
2005
Jan
2006
Feb
2006
Mar
2006
Apr
2006
May
2006
Jun
2006
Jul
2006
Aug
2006
Sep
2006
Oct
2006
Nov
2006
Dec
2006
Month
Mea
n
Actual Goal
3.0 Medication Reconciliation Success Index
0%20%40%60%80%
100%120%
Nov
200
5
Dec
200
5
Jan
200
6
Feb
200
6
Mar
200
6
Apr
200
6
May
200
6
Jun
200
6
Jul
200
6
Aug
200
6
Sep
200
6
Oct
200
6
Nov
200
6
Dec
200
6
Month
Per
cen
tag
e
Actual Goal
Pediatrics – Includes OTCs and Herbal Products (n=6)
Results: Run Charts of Key Measures
1.0 Mean Number of Undocumented Intentional Discrepancies
0.00
0.20
0.40
0.60
0.80
Nov
200
5
Dec
200
5
Jan
200
6
Feb
200
6
Mar
200
6
Apr
200
6
May
200
6
Jun
200
6
Jul
200
6
Aug
200
6
Sep
200
6
Oct
200
6
Nov
200
6
Dec
200
6
Month
Mea
n
Actual Goal
2.0 Mean Number of Unintentional Discrepancies
0.00
0.10
0.20
0.30
0.40
0.50
0.60
Nov
2005
Dec
2005
Jan
2006
Feb
2006
Mar
2006
Apr
2006
May
2006
Jun
2006
Jul
2006
Aug
2006
Sep
2006
Oct
2006
Nov
2006
Dec
2006
Month
Mea
n
Actual Goal
3.0 Medication Reconciliation Success Index
0%20%40%60%80%
100%120%
Nov
2005
Dec
2005
Jan
2006
Feb
2006
Mar
2006
Apr
2006
May
2006
Jun
2006
Jul
2006
Aug
2006
Sep
2006
Oct
2006
Nov
2006
Dec
2006
Month
Per
cen
tag
e
Actual Goal
Pediatrics – OTCs and Herbal Products Removed (n=4)
Results: Run Charts of Key Measures
1.0 Mean Number of Undocumented Intentional Discrepancies
0.000.501.001.502.002.503.00
Nov
2005
Dec
2005
Jan
2006
Feb
2006
Mar
2006
Apr
2006
May
2006
Jun
2006
Jul
2006
Aug
2006
Sep
2006
Oct
2006
Nov
2006
Dec
2006
Month
Mea
n
Actual Goal
2.0 Mean Number of Unintentional Discrepancies
0.00
0.50
1.00
1.50
2.00
2.50
Nov
2005
Dec
2005
Jan
2006
Feb
2006
Mar
2006
Apr
2006
May
2006
Jun
2006
Jul
2006
Aug
2006
Sep
2006
Oct
2006
Nov
2006
Dec
2006
Month
Mea
n
Actual Goal
3.0 Medication Reconciliation Success Index
0%20%40%60%80%
100%120%
Nov
2005
Dec
2005
Jan
2006
Feb
2006
Mar
2006
Apr
2006
May
2006
Jun
2006
Jul
2006
Aug
2006
Sep
2006
Oct
2006
Nov
2006
Dec
2006
Month
Per
cen
tag
e
Actual Goal
6th Medicine – Includes OTCs and Herbal Products (n=2)
Results: Run Charts of Key Measures
1.0 Mean Number of Undocumented Intentional Discrepancies
0.00
0.50
1.00
1.50
2.00
2.50N
ov20
05
Dec
200
5
Jan
200
6
Feb
200
6
Mar
200
6
Apr
200
6
May
200
6
Jun
200
6
Jul
200
6
Aug
200
6
Sep
200
6
Oct
200
6
Nov
200
6
Dec
200
6
Month
Mea
n
Actual Goal
2.0 Mean Number of Unintentional Discrepancies
0.00
0.50
1.00
1.50
2.00
2.50
Nov
2005
Dec
2005
Jan
2006
Feb
2006
Mar
2006
Apr
2006
May
2006
Jun
2006
Jul
2006
Aug
2006
Sep
2006
Oct
2006
Nov
2006
Dec
2006
Month
Mea
n
Actual Goal
3.0 Medication Reconciliation Success Index
0%
20%
40%
60%
80%
100%
Nov
2005
Dec
2005
Jan
2006
Feb
2006
Mar
2006
Apr
2006
May
2006
Jun
2006
Jul
2006
Aug
2006
Sep
2006
Oct
2006
Nov
2006
Dec
2006
Month
Per
cen
tag
e
Actual Goal
Gynecology / PAC – includes OTCs and Herbal Products (n=4)
Results: Run Charts of Key Measures
1.0 Mean Number of Undocumented Intentional Discrepancies
0.00
0.50
1.00
1.50
Nov
2005
Dec
2005
Jan
2006
Feb
2006
Mar
2006
Apr
2006
May
2006
Jun
2006
Jul
2006
Aug
2006
Sep
2006
Oct
2006
Nov
2006
Dec
2006
Month
Mea
n
Actual Goal
2.0 Mean Number of Unintentional Discrepancies
0.00
0.50
1.00
1.50
2.00
2.50
Nov
200
5
Dec
200
5
Jan
200
6
Feb
200
6
Mar
200
6
Apr
200
6
May
200
6
Jun
200
6
Jul
200
6
Aug
200
6
Sep
200
6
Oct
200
6
Nov
200
6
Dec
200
6
Month
Mea
n
Actual Goal
3.0 Medication Reconciliation Success Index
0%20%40%60%80%
100%120%
Nov
2005
Dec
2005
Jan
2006
Feb
2006
Mar
2006
Apr
2006
May
2006
Jun
2006
Jul
2006
Aug
2006
Sep
2006
Oct
2006
Nov
2006
Dec
2006
Month
Per
cen
tag
e
Actual Goal
St. Elizabeth’s Hospital – includes OTCs and Herbal Products (n=1)
Results: Run Charts of Key Measures
1.0 Mean Number of Undocumented Intentional Discrepancies
0.000.200.400.600.801.001.20
Nov
200
5
Dec
200
5
Jan
200
6
Feb
200
6
Mar
200
6
Apr
200
6
May
200
6
Jun
200
6
Jul
200
6
Aug
200
6
Sep
200
6
Oct
200
6
Nov
200
6
Dec
200
6
Month
Mea
n
Actual Goal
2.0 Mean Number of Unintentional Discrepancies
0.00
0.50
1.00
1.50
2.00
2.50
Nov
2005
Dec
2005
Jan
2006
Feb
2006
Mar
2006
Apr
2006
May
2006
Jun
2006
Jul
2006
Aug
2006
Sep
2006
Oct
2006
Nov
2006
Dec
2006
Month
Mea
n
Actual Goal
3.0 Medication Reconciliation Success Index
0%20%40%60%80%
100%120%
Nov
2005
Dec
2005
Jan
2006
Feb
2006
Mar
2006
Apr
2006
May
2006
Jun
2006
Jul
2006
Aug
2006
Sep
2006
Oct
2006
Nov
2006
Dec
2006
Month
Per
cen
tag
e
Actual Goal
Surgery 5000 – includes OTCs and Herbal Products (n=11)
Keys to Success & Lessons Learned
• Major Keys to Success– Enthusiastic and committed Advisory, Steering, and Ward team
members– 1:1 and small group educational sessions with staff– Increasing number of staff engaged in the process
• Barriers– Dedicated resources– Staff buy-in on certain pilot areas– Process – obtaining a complete and accurate medication history– Timelines – balance between Safer Healthcare Now / Quality
Improvement Methodology and Accreditation deadline– PDSA cycle turn around time
Keys to Success & Lessons Learned
• Lessons learned to date about these changes– Large scale change in process required. Not as easy as
anticipated.– Preadmission Medication List Physician Order Form
appears to be working well.– Medication reconciliation process requires further
development.• Further education on “How to Perform a Medication History”
required– Education sub-committee formed
Next Steps
• Changes we are planning on testing to help us achieve our goals: – Effect of a standardized method for providing education– Ability of staff to take a complete and accurate
medication history– Use of PIP to generate on-line Preadmission
Medication List Physician Order Form – Use of automation to generate a patient medication
reconciliation and order form on transfer and discharge
Contact Information
• Barb Evans– [email protected] – Phone: 306-655-2268
• Jackie Mann– [email protected]– Phone: 306-655-7946
• Janice Seeley– [email protected] – Phone: 306-655-6832