continuing the circle of care: medrec in the community
DESCRIPTION
Purpose of the Call: Horizon, Moncton, NB will: 1.Demonstrate the timeline for the development of a provincial bilingual medication reconciliation form and process 2.Identify how technology provided an avenue for a multi-site team collaboration 3.Distinguish the key elements in a provincial bilingual medication reconciliation form Saskatoon Health Region Home Care, SK will: 1.Share how they developed a nurse driven, paper-based MedRec program to support home care clients in medication management. 2.Outline their current MedRec process 3.Showcase their current Med Rec/BPMH form and data collection form for the audit process. Watch the recording here: http://bit.ly/1fOTJwtTRANSCRIPT
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Continuing the circle of care:MedRec in community
March 25, 2014
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Welcome also to our francophone attendees
Bienvenue à nos participants francophones
Hélène RiverinConseillère en sécurité et en améliorationSafety Improvement Advisor
Welcome!
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Pour nos participants francophones..
Pour accéder aux diapositives français:
‐Cliquez sur l'onglet "FRENCH"
OU
‐Envoyer un courriel à [email protected]
Suivre la boîte «Chat» pour les commentaires du conférencière
traduit en français
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Where to find our webinars…
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SHN MedRec Home Care Resources
5
http://www.ismp‐canada.org/medrec/#mrhc
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Please complete our poll
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Speakers• Ann Nickerson, B.Sc. Pharm. FCSHP• Michelle Anglehart, RN, CNS, CON(C)
Horizon Health Network ‐Moncton, NB will:1. Demonstrate the timeline for the development of a provincial bilingual
medication reconciliation form and process2. Identify how technology provided an avenue for a multi‐site team
collaboration3. Distinguish the key elements in a provincial bilingual medication
reconciliation form
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Horizon Health Network - New Brunswick
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Continuing the circle of care: Medication Reconciliation in the
Community
Ann Nickerson, B.Sc. Pharm. [email protected]
Michelle Anglehart, RN, CNS, CON(C)Michelle.Anglehart @horizonnb.caExtra‐Mural Driscoll Unit, Moncton N.B.March 25th, 2014
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“I take a small white pill and a large blue pill”
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Home care in New Brunswick
2 Health Networks
The Extra‐Mural Program• Public‐funded provincial home care program• Multidisciplinary team Social Workers, Clinical Dietitians, Occupational Therapists, Registered Nurses, Physiotherapists,Speech‐Language Pathologists, Medical Advisors
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Evolution of Medication Reconciliation at our Home Care Program
Phase 1Phase 2
Phase 32008‐20122013‐2014
2015
• Safer Healthcare Now! Pilot
• Development of MedRec Form
• Implementation 5/29 units
• Provincial Initiative (EMP Nursing P&P)
• Formed MedRec subcommittee
• Provincial Bilingual MedRec Form
• Complete circle of care
• Goal: Provincial roll out 29 NB home care units
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Phase 1 – Original SHN Pilot
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Phase 2 ‐Medication Reconciliation Profile
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Face‐to‐face(Central location for 2 initials meetings)
Videoconference(Tandberg system – 6 meetings)
Online meeting software(Adobe connect + Teleconference – 3 meetings)
Phase 2 – Using Technology
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Phase 3 ‐ Continuing the circle of care
ADo not takeZopiclone 7.5mg by mouth 1 tablet each night
1 tablet 3 times dayMetformin 500mg by mouth
1
1
Bat meals
Before going To bed anymore
Tylenol 500mg by mouth 1 tablet 4 times a day
2013/09/02Marcus Welby MD
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Phase 3 ‐ Changes/New Orders (Section 2)
Code letter of physicianCode number of pharmacy
List medication (name, strength/unit and route)
Date and initials when discontinued/changed
How the client take the medication, if the same
A
Written of label(dose, frequency/time of administration)
Initials – Professional who is documentingDate started or changed
FN 2013/09/07 FN2013/09/05 1 tabletCiprofloxacin 500mg by mouth1
FN 2013/09/08 A 1 Ativan 1mg by mouth 1 tabletTwice a day
Bedtime, as needed
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Phase 3 ‐ Continuing the circle of care
Implement medication reconciliation inALL 29 provincial home care units
Provide a copy of medication reconciliationto client, attending physician, andcommunity pharmacy
Maintain up‐to‐date medicationreconciliation on client’s home care file
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Barriers to Implementation
TIME!! TIME!! TIME!! ‐ Biggest barrier
Upfront time commitment
=Time saving toward preventingadverse medication events
Reference: Nickerson, A., MacKinnon, N., Roberts, N., Saulnier L. (2005) Drug‐Therapy Problems, Inconsistencies and Omissions Identified During a Medication Reconciliation and Seamless Care Service Healthcare , Quarterly Papers. 8(sp): 65‐72.
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Conclusion
System for improvement using: ● PDSA cycle (Plan, Do, Study, Act)
Can be replicated in any health home careprogram Ultimate goal: ● Increase patient safety● Comply with Accreditation Canada
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Acknowledgements
Manon Goupil, RN, Manager, ChairKristen Pinsent‐Close, RN, ManagerRhonda Guyader, RTDixie Lapage, RNDarlene MacDonald, RN
Karen Desjardins, RN, [email protected]
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Speakers:• Colleen Stoecklein, RN, BSN• Liz Moran-Murray, BScPhm
Saskatoon Health Region Home Care will:1. Share how they developed a nurse driven, paper‐based MedRec program to
support home care clients in medication management. 2. Outline their current MedRec process3. Showcase their current Med Rec/BPMH Form and their data collection form
for the audit process.
21
Saskatoon Health Region
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Continuing the Circle of Care: MedRec in the Community
Presented by:Colleen Stoecklein, RN, BSN, Clinical EducatorLiz Moran-Murray, BScPhm, Clinical Pharmacist
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• Brief history review• Outline the current MedRec process• Review our BPMH/MedRec form• Audit process
Objectives
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Brief History• In the spring of 2007 with the support of Safer Healthcare Now! Saskatoon Home Care formed a Medication Reconciliation Committee
• Developed Quality Improvement Charter. – Objective: reduce adverse drug events and minimize client harm through the implementation of medication reconciliation on admission to Home Care
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Brief History continued
• Our MedRec process was designed to be part of our daily operations, therefore costs are inherent in operational funding (no new funding!!)
• SHR Home Care strength was that we had a solid med management process in place prior to MedRec
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Brief History continued• Piloted the Med Rec form with 6 nurses; changes made
• 2009 Med Rec was rolled out to approximately 150 nurses. Present: 200 nurses
• The form has been revised 28 times so far, this is ongoing…
• Subtle process changes have been made
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Current Process• MedRec is targeted at clients requiring medication management
• MedRec is completed on admission, at 6 month reviews, after hospitalization and if significant number of medication changes
• Admission MedRec is completed by the RN and subsequent reviews may be completed by the RN/LPN
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Process Once BPMH Has Been Completed
• Faxed to physician/NP for reconciliation• Average time for return of reconciled form is less
than 3 days• If the nurse has not heard back within the week a
phone call is made to prompt physician• medication administration does not begin until
reconciled form has returned. Exception: the nurse has received discharge orders from acute care
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MedRec continued• Once the MedRec has been reconciled, the nurse faxes a “fyi” copy to the community pharmacy (our form does not meet requirements to be a prescription)
• Future medication changes are not recorded on this form. Any new physician orders are added to the chart sequentially
• MedRec is completed in the home & provides this “snapshot in time” of current medication use
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Audit Process
• MedRec audits are completed quarterly• This is a labour intensive process since we don’t currently have an electronic chart
• On audit days we come in at 0530 so that we have 2.5 h to look at the nursing charts that will be going out for the day. After the nurses leave the office we audit the rest of the med management charts.
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What We Measure for Senior Leadership
1) % of clients with completed MedRec2) % of clients identified with 1 or more
discrepancies3) Types of discrepancies identified
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What We Measure for Home Care
• In addition we audit several qualitative process measures related to nursing & physician process completion
• This information is shared with nurses & physicians for ongoing education
• We receive feedback from nurses that has also helped refine the process
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MedRec Audit
Summary Form
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Challenges• Physician engagement: clarification of discrepancies that may be vague, turn around time
• Nursing not prompting unreconciled forms in a timely fashion
• Since there is a high incidence of dementia in this caseload, this can be a barrier to obtaining a definitive medication list if family member is unavailable/not involved
• Audit process time consuming
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Our Success
• Nurses find the form easy to use and achieves a more thorough med list
• Physician comments on form indicate increasing engagement with process
• It improves communication within the circle of care – “everyone is in the know”
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Questions
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Questions
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Upcoming MedRec Webinars
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April 8th, 2014 Making a PDiF-ference – Results of the Pharmacy Discharge Facilitator Initiative for high-risk medical inpatients.
May 6th, 2014 Safety, Sleuthing and Students: A Novel Collaborative MedRec Event – University of British Columbia