medication reconciliation and accreditation
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© Accreditation Canada/Agrément Canada
Accredited by
Agréé par
Optimizing Medications: time to bring the pieces together
January 16 2014
Medication Reconciliation (MedRec):
Accreditation Canada Requirements
Heather Howley, MS
Accreditation Canada
© Accreditation Canada/Agrément Canada
Outline
Overview of MedRec
Review expectations for implementation
Review changes to ROPs
Explore sector-specific customization
Highlight test for compliance
What to look for on-site
FAQs and Key Challenges
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© Accreditation Canada/Agrément Canada
Required Organizational Practices
(ROPs) in Qmentum
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What is Med Rec?
MedRec is a three-step process:
COLLECT the Best Possible Medication
History
COMPARE what the client is actually taking
with what is prescribed to identify
discrepancies
CORRECT any medication discrepancies
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© Accreditation Canada/Agrément Canada
What is NOT MedRec
MedRec is about identifying discrepancies to
prevent adverse drug events
It is needed at transitions where clients are at-risk
It is NOT about appropriateness
Medication review
It is NOT needed at all transitions
Bed relocation
Hand-offs
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© Accreditation Canada/Agrément Canada 6
History of MedRec
2006 MedRec ROP introduced (service-based)
2008 MedRec ROP requirements scaled back
2010 MedRec ROP introduced (Leadership)
2010 – 2012 customization and clarity
2014 strengthen requirements
change structure to improve applicability
© Accreditation Canada/Agrément Canada
Improved performance
ROP Compliance (%)
2009 2010 2011 2012
Medication reconciliation as an organizational
priority ---- 61 77 82
Medication reconciliation at admission 46 47 60 71
Medication reconciliation at transfer/discharge 44 36 50 62
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Why Change MedRec
Performance has improved
More support and resources available
Broader scope
Higher expectations = patient safety
Clarification and realignment of expectations
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Increased Expectations for
Implementation
Broaden definition of “Service”
Includes all teams that use a given set of standards
across all locations
For standards that contain a MedRec ROP
Move beyond „1 + 1 + a plan‟ to full
implementation within two cycles:
Phase 1: 2014-2017, in one service
Phase 2: 2018-2022, in all services
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© Accreditation Canada/Agrément Canada 10
Changes to ROP Structure
OLD ROP REVISED ROP
MedRec as an organizational priority
• 1 + 1 + a plan
MedRec as a strategic priority
• What is needed to implement and
sustain MedRec
2 ROPs: MedRec at Admission
MedRec at Transfer/Discharge
1 ROP: MedRec at Care Transitions
• Removes artificial separation
• Improves customization
© Accreditation Canada/Agrément Canada © Accreditation Canada/Agrément Canada
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Leadership for MedRec
© Accreditation Canada/Agrément Canada
Medication Reconciliation
as a Strategic Priority
Policy and process
Define roles and responsibilities
Plan to implement and sustain MedRec
Led by an interdisciplinary coordination team
Education for staff and physicians
Monitor and make improvements
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© Accreditation Canada/Agrément Canada
MedRec Leadership:
What does it look like?
Documented policies, processes, and plans
Engaged leadership, including physicians
Common understanding at all levels
What it is (three-step process)
When it is needed (transitions, targets)
Who is responsible for each MedRec step
How it is done (model used, forms/tools)
Monitoring compliance
Adherence and quality
Addressing lessons learned
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© Accreditation Canada/Agrément Canada © Accreditation Canada/Agrément Canada
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MedRec Process
© Accreditation Canada/Agrément Canada
Medication Reconciliation
at Care Transitions
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Five versions customized to different settings
Acute Care
Ambulatory Care
Home and Community Care
Long-term Care
Substance Misuse (unchanged)
© Accreditation Canada/Agrément Canada 16
Version STANDARDS SET
Acute Care Acquired Brain Injury Services
Cancer Care and Oncology Services
Correctional Service of Canada Health Services Standards
Critical Care
Emergency Department
Hospice, Palliative, and End-of-Life Services
Medicine Services
Mental Health Services
Obstetrics Services
Provincial Correctional Health Services Standards
Rehabilitation Services
Spinal Cord Injury Acute Services
Spinal Cord Injury Rehabilitation Services
Surgical Care Services
Ambulatory Care Aboriginal Integrated Primary Care Services
Ambulatory Care
Ambulatory Systemic Cancer Therapy Services
Home and Community Care Case Management Services
Community-Based Mental Health Services and Supports Standards
Home Care Services
Long-term Care Long Term Care Services
Residential Homes for Seniors
Substance Misuse Aboriginal Substance Misuse Services Standards
Substance Abuse and Problem Gambling Services
© Accreditation Canada/Agrément Canada © Accreditation Canada/Agrément Canada
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MedRec in Acute Care
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Overview of Tests for Compliance
(Acute Care)
Generate a BPMH upon admission
Reconcile medications at admission
Retain a current medications list
Use the BPMH to generate transfer/discharge
orders
Provide a complete list of medications upon
discharge
*Special consideration in emergency departments
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© Accreditation Canada/Agrément Canada
Evidence of a good MedRec process
(Acute Care)
A complete BPMH (not just a primary medications list)
Home medications, including OTC
Source(s) of medication information identified
Actual medication use (not just as prescribed)
Method and tools to identify and resolve discrepancies
Use BPMH (not just MAR) to generate transfer/discharge orders
Transitions where discrepancies may be introduced (e.g., orders are re-written)
Accurate understanding of medications upon discharge
Client, family, next care provider
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© Accreditation Canada/Agrément Canada
Key Questions/Challenges
(Acute Care)
Quality MedRec vs. just a form in a chart
Internal transfers that require MedRec
What is a „service‟
The MAR is probably not sufficient
Physicians reluctant to reconcile medications
Access to pharmacy
Client arrives with BPMH - no need to repeat
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© Accreditation Canada/Agrément Canada © Accreditation Canada/Agrément Canada
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MedRec in Ambulatory Care
and Home and Community Care
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Tests for Compliance
(Ambulatory Care)
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Documented rationale for targeting MedRec
and frequency of MedRec
BMPH at or prior to the first visit
Identify and document discrepancies
At or prior to the first visit
Subsequent visits, as per the policy
Work with client to resolve discrepancies
Retain current medications list in client record
© Accreditation Canada/Agrément Canada
Tests for Compliance
(Home and Community Care)
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Documented rationale for targeting MedRec
BPMH at the beginning of service
Work with client to resolve discrepancies
Update current medications list
Educate client and family to share complete
medications list
© Accreditation Canada/Agrément Canada
Evidence of a good MedRec process
(Ambulatory & Home and Community)
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Targeting is standardized and appropriate
Clients at-risk of medication discrepancies
Complete BPMH (not a primary meds list)
Method to identify discrepancies
Comparing prescriptions, not orders
Understand everything a client is taking
Efforts to resolve discrepancies (with client)
Client empowered to maintain and share list
© Accreditation Canada/Agrément Canada
Key Questions/Challenges
(Ambulatory & Home and Community)
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Where to start - how to identify targets for
MedRec
Engage front-line
Organizations may start small with a plan for spread
How often to repeat MedRec in ambulatory care
Appropriate for risk
Access to prescriber
Prescribers reluctant to resolve discrepancies
© Accreditation Canada/Agrément Canada © Accreditation Canada/Agrément Canada
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MedRec in Long-term Care
© Accreditation Canada/Agrément Canada
Tests for Compliance
(Long-term Care)
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BPMH upon admission
Compare BPMH and admission orders to
identify and resolve discrepancies
Retain a complete meds list in client record
Identify and resolve discrepancies at re-
admission
Provide a complete list of client medications
upon transfer out
© Accreditation Canada/Agrément Canada
Evidence of a good MedRec Process
(Long-Term Care)
BPMH (not just admission orders or the MAR)
Home medications, including OTC
Source(s) of medication information identified
Actual medication use (not just as prescribed)
Method to identify and resolve discrepancies
Repeat MedRec at re-admission
Use the complete meds list to generate transfer/discharge orders (MAR may not be enough)
Accurate understanding of medications upon discharge
Client, family, next care provider
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© Accreditation Canada/Agrément Canada
Key Questions/Challenges
(Long-Term Care)
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Once generated, BPMH „disappears‟
Becomes complete list of medications
May be different from the MAR
Resident arrives with BPMH - no need to repeat
The MAR may not be sufficient
Need to reconcile against BPMH (admission) or
complete meds list (re-admimssion)
Internal transfers requiring MedRec are rare
© Accreditation Canada/Agrément Canada © Accreditation Canada/Agrément Canada
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MedRec Resources
© Accreditation Canada/Agrément Canada
MedRec Resources
Accreditation Canada
2014 ROP Handbook (updated)
Backgrounder
FAQ (updated)
Webcast
Webinar Series
Accreditation Specialist
MedRec@accreditation.ca
Safer Healthcare Now! Getting Started kits
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© Accreditation Canada/Agrément Canada © Accreditation Canada/Agrément Canada
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Thank you!
© Accreditation Canada/Agrément Canada © Accreditation Canada/Agrément Canada
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