Transcript IWK Medication Reconciliation MSNU Care Teams

Medication Reconciliation:
MSNU
Origins of Medication Reconciliation as
a Patient Safety strategy
• The Institute for Healthcare Improvement (IHI)
introduced the 100K Lives Campaign in December
2004 to challenge health care providers to join a
national effort to make health care safer and more
effective & ensure hospitals achieve the best
possible outcomes for all patients.
• On April 12, 2005, the Canadian campaign, Safer
Healthcare Now! was created. The IWK Health
Centre is a registered member.
Medication Reconciliation
A formal process for:
• Obtaining a complete and accurate list of each
patient’s current home medications (name, dosage,
frequency, route)
i.e. the Best Possible Medication History -BMPH
• Comparing the physician’s admission, transfer,
and/or discharge orders to that list
(The IWK are currently piloting this process at admission)
• Bringing discrepancies to the attention of the
prescriber and ensuring changes are made to the
orders, when appropriate
Why?
• Concern over patient safety is growing, both among
the Canadian public and among health care providers.
• 53.6% of enrolled patients had 1 unintended discrepancy (61.4%
assessed as having no potential to cause serious harm but
38.6% had potential to cause mod.to severe discomfort or
clinical deterioration)
..the most common error was omission of a regularly used
medication (46.4%)
Cornish PL. Unintended medication discrepancies at the time of
hospital admission. Arch Intern Med 2005;165:424-429.]
• Greater than 50% of all hospital medication errors occur at the
interfaces of care (Admission,Transfer and Discharge)
.Rozich JD. Medication safety: One organization’s approach to
the challenge. JCOM. 2001;8(10):27-34.
Why now?
 Reduces medication error & potential for patient
harm
 Is a key component of seamless care strategies
 Saves time for physicians, nurses, and pharmacists
in the long-term
Medication Reconciliation is a new Canadian Council on
Health Services Accreditation Patient Safety Standard for
2008 / ROP(required organizational practice)
Executive Leadership has endorsed Medication
Reconciliation as a project of high priority
Accreditation : Patient Safety
Communication
• ROP:
Reconcile medications with the
patient/client at referral or transfer, and
communicate the patient’s/client’s
medications to the next provider of service
at referral or transfer to another setting,
service, service provider or level of care
within or outside the organization.
Accreditation
• Tests for compliance:
-Is there a demonstrated , formal process to reconcile
patient medications…
-Does the process involve generating a single
documented ,comprehensive list….
-Does the process include documentation of the
differences between the history and orders list…
-Do processes take place as a shared responsibility,
involving the patient/client, nursing staff, medical
staff, and pharmacists, as appropriate
-Does the organization have a plan for spread
How do we define discrepancies?
What tools will be using ?
Types of Discrepancies
Type O = No discrepancy.
The medication name/dose/frequency taken
at home by patient is the same as what was
ordered for the patient in the admission
orders.
Type 1 = Intentional discrepancy
The physician has made an intentional choice
to add, change or discontinue a medication
and their choice is clearly documented.
*Types 1s are considered to be “best practice”
in medication reconciliation
Type 2 = Undocumented Intentional discrepancy
The physician has made an intentional choice to add, change or
discontinue a medication but their choice is not clearly
documented.
Do not usually represent a serious threat to patient safety but causes
confusion, rework and may lead to medication error.
Can be reduced by standardizing the method for documenting
admission medication orders
* Type 2s account for 25-75% of all discrepancies
Type 3 = Unintentional discrepancy
The physician has unintentionally changed, added or omitted a
medication that the patient was taking prior to admission.
Can be reduced by multidisciplinary training at obtaining in-depth
medication history and involving clinical pharmacists to identify and
reconcile discrepancies
Type 3s can lead to a med.error with the potential for an ADE.
Aim & Scope
Aim
To reduce the number of undocumented intentional
and unintentional discrepancies (Types 2 & 3) for the
inpatient population by 75 %.
~SHN to raise bar for participating teams to 90% in fall
2007 and move toward transfer and discharge interfaces
of care
Scope
Medication reconciliation to be completed within 24
hours of admission for all patients admitted to MSNU
who are currently taking medications.
Steps for shared responsibility
Step 1 Collecting the BPMH- Pharmacy, Nursing
and Physicians
Interview the patient/family on admission to get
the best possible medication history (BPMH)
Complete the Medication History and Order Sheet
listing all home medications.
Sign the record as the interviewer
Nursing :On the Admission/ Visit Assessment Record
(#7070)
Document, “See Medication History and Order sheet”
Ensure that form #6360 is on the chart and completed.
____________________________________________________
Step 2 BMPH becomes admission orders
Physician reviews the BPMH ,reconciles the list and
signs the medication history and order sheet.
The BMPH list becomes the Admission Medication
orders, upon signing.
Potential Impact
• Implementation of medication reconciliation
along with other interventions decreased the
rate of medication errors by 70% and adverse
drug events by 15%, over a seven month period.
Whittington J, Cohen H. OSF healthcare’s journey in patient safety.
Q Manage Health Care 2004;13(1):53-59
• Implementation in a surgical population
reduced potential adverse drug events by 80%
within four months of implementation.
Michels RD, Meisel S. Program using pharmacy technicians to obtain
medication histories. Am J Health System Pharmacy 2003;60:1982-1986
Supporters of this Project
Questions?