scaling up medrec measurement – experiences from alberta
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www.saferhealthcarenow.ca
Scaling up MedRec Measurement –
Experiences from Alberta
November 2014
www.saferhealthcarenow.ca
MedRec Quality Audit Month 2015
Throughout February 2015 we are
encouraging all acute and long term care
sites to participate in MedRec Quality Audit
Month to evaluate the quality of their
established admission MedRec processes.
Register to participate at
www.saferhealthcarenow.ca!
2
www.saferhealthcarenow.ca
www.ismp-canada.org
Doc Mike Evans discusses the importance of
keeping a medication list
http://youtu.be/f2KCWMnXSt8
www.saferhealthcarenow.ca
www.ismp-canada.org
MedRec Stay Informed and Connected
Receive ISMP Canada’s MedRec Newsletter
Hear about:
– Upcoming MedRec webinars
– New toolkits
– National MedRec Audit Month
– New MedRec publications
– MedRec related workshops
Join Now!
visit http://www.ismp-canada.org/register/medrec.php
www.saferhealthcarenow.ca
Describe your level of activity with MedRec
auditing in your setting
ce Poll
Just Getting Making
None Started Progress
Almost Fully
there Implemented
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Click on the arrow icon
and then click on the appropriate location/response
on the slide
Scaling up MedRec Measurement -
Experiences from Alberta
Greg Duchscherer, RRT, BHS, PMP
Project Manager, Provincial Medication
Reconciliation
Lynn Whitten, RN, BN, MSA
Project Manager, Calgary Zone Medication
Reconciliation Team
Alim Amershi, DipMM, B.Comm
Project Coordinator, Calgary Zone Medication
Reconciliation Team
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Alberta Health Services
Albertans = 3.9 Million (661,848 km2)
AHS Employees = 96,000
Physicians = 8,400
Sites = 450
Five Zones and Cancer Control
In 2012-2013:
2,116,474 Emergency Department Visits
8,230 Acute Care hospital beds
108,855 Home Care clients
22,533 Continuing Care beds
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Objectives
• Overview of MedRec Implementation in AHS
• Approach to Evaluation of Medrec in AHS
• Results so far…
• Lessons Learned
• Next Steps
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• Major Patient Safety Initiative
• Accreditation Canada Required
Organizational Practice (ROP)
• Varied Past:
– Multiple approaches
• Desired Future:
– Coordinated, integrated
approach
History of MedRec in AHS
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Approach & Zone Implementation
Ambulatory Care settings 2014 - 2015
Discharge / Transfer 2014
Admission Acute Care/ Homecare &
LTC 2011 - 2013
Provincial Planning
2011- 2015
North Zone Implementation
Edmonton Zone Implementation
Central Zone Implementation
Calgary Zone Implementation
South Zone Implementation
Provincial
MedRec
Planning
Phased in Approach “Viral Spread” model
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Our Goal
• To have MedRec completed on all patients
(where appropriate) across the AHS continuum
by the end of 2015.
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“Seeing the Issue”
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Measurement for Improvement
• How will we know a change is an improvement?
• “Measurement is only a handmaiden to improvement,
but improvement cannot act without it”
• “Measurement for the purposes of learning not
judgment”
• “Remember, measurement is a means for answering
questions. It is not an end in itself”
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Approach to Evaluation of MedRec
Success Measure (target 80%, goal 100%) – % patients with MedRec Completed on Admission (Acute Care, LTC &
Corrections)
Quality Measure (target 80% of patient audit sample
have all quality elements) – Two or more sources for BPMH
– Actual med use verified by patient/family
– Complete medication information
– Every med accounted for in orders
– Rationale included for hold and discontinued meds
Outcome Measure (target less than 10%, goal 0) – % patients with one or more outstanding discrepancies
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Acute Care – Measures
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Acute Care – Quality Elements
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Zone Acute Care – Measures
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Reporting & Learning System Data
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Reporting & Learning System Data
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Lessons Learned - Provincial
• Limitations of data representation
• Not having a ‘pure’ patient outcome measure
• Subjectivity of Measure 5
• Inter-rater reliability:
– Evidence from PSM data
– Link to education and ongoing training
• Digestible data to managers
• Support for QI at the “bedside”
Calgary Zone Experience
Lynn Whitten, RN, BN, MSA
Project Manager, Calgary Zone Medication Reconciliation Team
Alim Amershi, DipMM, B.Comm
Project Coordinator, Calgary Zone Medication Reconciliation Team
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Calgary Zone Project Team
Project Manager
Project Coordinators
Physician Lead
Pharmacy consultant
Administrative Support
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Calgary Zone Map
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Our Approach in the Zone
Key Areas Of Focus
•Engagement Strategies
•Use of Objective Data
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Governance Committee Structure
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Early Adopters
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Site/Program Lead Model
• Influential, well known and respected early adopters
• Regular monthly reporting requirements
– % of uptake by individual units & programs
• Each site responsible to conduct their monthly audits
- site determined who would conduct audits
- monitor audit submissions
- use raw data from PSM to develop site
& service reports
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Results so far...
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Progress Reports
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Site/Program Service Comparisons from
PSM
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Hospitalists Measurement
September - October
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Surgery
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Lessons Learned
• Persistence, persistence, persistence….
• Focus on local culture: it’s a team effort, different
process in different units
• Look for common goals Improved Patient Care!
• Metrics helps drive the change
• Internal competition helps
• Break down process into parts to identify gaps and
areas for improvement
• Identify gaps BUT celebrate successes!!
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Next Steps – Calgary Zone
• Focus on Ambulatory Care
• Sustainability
• Share learning's
• Teams must have access to data for
improvement
• Developing solutions to address gaps.
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Next Steps - Provincial
• Homecare and Supportive Living Audit Tool
• Discharge Audit Tool
• Ambulatory Care Audit Tool
• Emergency Department/Urgent Care Audit Tool
• Transfer Audit Tool
• Database and Reporting Dashboard for AHS
• Auditor Education and resources
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Conclusion
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Thank You
www.saferhealthcarenow.ca
Upcoming MedRec Webinars
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Thank you for attending
Our next MedRec webinar will take
place in January 6th, 2015.
Topic: MedRec Quality Audit Month
Information call.
www.saferhealthcarenow.ca
Safer Healthcare Now! website
http://www.saferhealthcarenow.ca/EN/events/
NationalCalls/2014Webinars/Pages/default.aspx
ISMP Canada website
http://www.ismp-canada.org/medrec/#webinars
Safer Healthcare Now! MedRec Community of Practice
http://tools.patientsafetyinstitute.ca/Communities
/MedRec/default.aspx
For real time notification of content posting, “like” the
Medication Reconciliation Network on Facebook
www.facebook.com/MedicationReconciliation
All Safer Healthcare Now! webinars are posted within the
week to the following locations:
www.saferhealthcarenow.ca
www.ismp-canada.org
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We encourage you to report
medication incidents
Practitioner Reporting https://www.ismp-canada.org/err_report.htm
Consumer Reporting www.safemedicationuse.ca/
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