medication reconciliation recent changes introduced by accreditation canada

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© Accreditation Canada/Agrément Canada Accredited by Agréé par Safer Healthcare Now! National Call March 5 2013 Heather Howley Health Services Research Specialist, Accreditation Canada Safer Healthcare Now! National Call March 5 2013 Heather Howley Health Services Research Specialist, Accreditation Canada Medication Reconciliation Recent changes introduced by Accreditation Canada Medication Reconciliation Recent changes introduced by Accreditation Canada

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Objectives: 1.Review the changes in Accreditation Canada expectations for implementing MedRec beginning in 2014. 2.Overview of changes to the ROP structure, for Medication Reconciliation ROPs in the leadership and service-based standards. 3.Direct organizations to additional information, resources, and support. Click the link to read more http://bit.ly/10LqxjQ

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Page 1: Medication Reconciliation Recent changes introduced by Accreditation Canada

© Accreditation Canada/Agrément Canada

Accredited byAgréé par

Safer Healthcare Now! National CallMarch 5 2013

Heather HowleyHealth Services Research Specialist, Accreditation Canada

Safer Healthcare Now! National CallMarch 5 2013

Heather HowleyHealth Services Research Specialist, Accreditation Canada

Medication ReconciliationRecent changes introduced by Accreditation Canada

Medication ReconciliationRecent changes introduced by Accreditation Canada

Page 2: Medication Reconciliation Recent changes introduced by Accreditation Canada

© Accreditation Canada/Agrément Canada

Required Organizational Practicesfor 2013

Required Organizational Practicesfor 2013

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Page 3: Medication Reconciliation Recent changes introduced by Accreditation Canada

© Accreditation Canada/Agrément Canada 3

Why Med Rec?Why Med Rec?

Prevent adverse drug events

Recognized by: WHO = five patient safety challenges

CPSI = core objective

Canadian Health Jurisdictions = key patient safety priority

Page 4: Medication Reconciliation Recent changes introduced by Accreditation Canada

© Accreditation Canada/Agrément Canada

What is Med Rec?What is Med Rec?

Med Rec is a three-step process: COLLECT the Best Possible Medication

History

COMPARE what the client is actually taken with what is prescribed to identify discrepancies

COMMUNICATE and resolve medication discrepancies

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Page 5: Medication Reconciliation Recent changes introduced by Accreditation Canada

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History of MedRecHistory of MedRec

2006 = Med Rec ROP became part of the program

2008 = Med Rec ROP requirements scaled back due to challenges

2010 – 2012 = customization and clarity to the service level ROPs

Page 6: Medication Reconciliation Recent changes introduced by Accreditation Canada

© Accreditation Canada/Agrément Canada

Improved performance Improved performance

ROP Compliance (%)

2009 2010 2011

Medication reconciliation as an organizational priority ---- 61 77

Medication reconciliation at admission 46 47 60

Medication reconciliation at transfer/discharge 44 36 50

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Page 7: Medication Reconciliation Recent changes introduced by Accreditation Canada

© Accreditation Canada/Agrément Canada

Why Change MedRecWhy 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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Page 8: Medication Reconciliation Recent changes introduced by Accreditation Canada

© Accreditation Canada/Agrément Canada

Consultation and DevelopmentConsultation and Development

Extensive consultation during the development of MedRec revisions(Mar-Nov 2012)

Drafts of the revised ROPs sent out for national consultation (Nov – Dec 2012)

Changes were implemented as a result of excellent feedback

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Page 9: Medication Reconciliation Recent changes introduced by Accreditation Canada

© Accreditation Canada/Agrément Canada

Overview of changes:Overview of changes:

Increased expectations for implementation

Broader definition of “service”

A two-phased approach: Phase 1: 2014-2017, in one service area

Phase 2: 2018 and beyond, in all service area

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Page 10: Medication Reconciliation Recent changes introduced by Accreditation Canada

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Overview of changes - ROP StructureOverview of changes - ROP Structure

OLD REVISED

Med Rec as an organizationalpriority (Leadership Standards)

Med Rec as a strategic priority

2 ROPs: Med Rec at admission and Med Rec at transfer/discharge (service-based standards)

1 single ROP Med Rec at Care transitions

Page 11: Medication Reconciliation Recent changes introduced by Accreditation Canada

© Accreditation Canada/Agrément Canada

Medication Reconciliation as a Strategic PriorityMedication Reconciliation as a Strategic Priority

The organization has a strategy to partner with clients to collect accurate and complete information about client medications and utilize this information during transitions of care.

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Page 12: Medication Reconciliation Recent changes introduced by Accreditation Canada

© Accreditation Canada/Agrément Canada

Med Rec as a Strategic Priority: Tests for ComplianceMed Rec as a Strategic Priority: Tests for Compliance

1. The organization has a medication reconciliation policy and process to collect and utilize accurate and complete information about client medication at transitions of care. (Major)

2. The organization defines roles and responsibilities for completing medication reconciliation. (Minor)

3. The organization has a plan to implement and sustain medication reconciliation that specifies services/programs, locations and timelines. (Major)

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Page 13: Medication Reconciliation Recent changes introduced by Accreditation Canada

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Med Rec as a Strategic Priority: Tests for Compliance (continued)Med Rec as a Strategic Priority: Tests for Compliance (continued)

4. The organizational plan is led and sustained by an interdisciplinary coordination team. (Minor)

5. There is documented evidence that the organization educates staff and physicians responsible for medication reconciliation. (Major)

6. The organization monitors compliance with the medication reconciliation process, and makes improvements when required. (Minor)

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Page 14: Medication Reconciliation Recent changes introduced by Accreditation Canada

© Accreditation Canada/Agrément Canada

Medication Reconciliation at Care TransitionsMedication Reconciliation at Care Transitions

With the involvement of the client, family, or caregiver (as appropriate), the team generates a Best Possible Medication History (BPMH) and uses it to reconcile client medications .... Five versions:

Acute care Ambulatory care Home and Community care Long-term care Substance misuse (unchanged)

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Page 15: Medication Reconciliation Recent changes introduced by Accreditation Canada

© Accreditation Canada/Agrément Canada

STANDARDS SET VersionAboriginal Integrated Primary Care Services AmbulatoryAboriginal Substance Misuse Services Standards Substance MisuseAcquired Brain Injury Services AcuteAmbulatory Care AmbulatoryAmbulatory Systemic Cancer Therapy Services AmbulatoryCancer Care and Oncology Services AcuteCase Management Services Home and CommunityCommunity-Based Mental Health Services and Supports Standards Home and CommunityCorrectional Service of Canada Health Services Standards AcuteCritical Care AcuteEmergency Department AcuteHome Care Services Home and CommunityHospice, Palliative, and End-of-Life Services AcuteLong Term Care Services Long-term careMedicine Services AcuteMental Health Services AcuteObstetrics Services AcuteProvincial Correctional Health Services Standards AcuteRehabilitation Services AcuteResidential Homes for Seniors Long-term careSpinal Cord Injury Acute Services AcuteSpinal Cord Injury Rehabilitation Services AcuteSubstance Abuse and Problem Gambling Services Substance MisuseSurgical Care Services Acute

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Page 16: Medication Reconciliation Recent changes introduced by Accreditation Canada

© Accreditation Canada/Agrément Canada

Acute care version:Tests for ComplianceAcute care version:Tests for Compliance

1. Upon or prior to admission, the team generates and documents a Best Possible Medication History (BPMH), with the involvement of the client, family, or caregiver (and others, as appropriate). (Major)

2. The team uses the BPMH to generate admission medication orders OR compares the Best Possible Medication History (BPMH) with current medication orders and identifies, resolves, and documents any medication discrepancies. (Major)

3. A current medication list is retained in the client record. (Major)4. The prescriber uses the Best Possible Medication History (BPMH) and the

current medication orders to generate transfer or discharge medication orders. (Major)

5. The team provides the client, community-based health care provider, and community pharmacy (as appropriate) with a complete list of medications the client should be taking following discharge. (Major)

*Special consideration in emergency departments

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Page 17: Medication Reconciliation Recent changes introduced by Accreditation Canada

© Accreditation Canada/Agrément Canada

Ambulatory care version:Tests for ComplianceAmbulatory care version:Tests for Compliance

1. The organization identifies and documents the type of ambulatory care visits where medication reconciliation is required. (Major)

2. For ambulatory care visits where medication reconciliation is required, the organization identifies and documents how frequently medication reconciliation should occur. (Major)

3. During or prior to the initial ambulatory care visit, the team generates and documents the Best Possible Medication History (BPMH), with the involvement of the client, family, caregiver (as appropriate). (Major)

4. During or prior to subsequent ambulatory care visits, the team compares the Best Possible Medication History (BPMH) with the current medication list and identifies and documents any medication discrepancies. This is done as per the frequency documented by the organization. (Major)

5. The team works with the client to resolve medication discrepancies OR communicates medication discrepancies to the client’s most responsible prescriber and documents actions taken to resolve medication discrepancies. (Major)

6. When medication discrepancies are resolved, the team updates the current medication list and retains it in the client record. (Major)

7. The team provides the client and the next care provider (e.g., primary care provider, community pharmacist, home care services) with a complete list of medications the client should be taking following the end of service. (Major)

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Page 18: Medication Reconciliation Recent changes introduced by Accreditation Canada

© Accreditation Canada/Agrément Canada

Home and community care version:Tests for ComplianceHome and community care version:Tests for Compliance

1. The organization identifies and documents the types of clients who require medication reconciliation. (Major)

2. At the beginning of service the team generates and documents a Best Possible Medication History (BPMH), with the involvement of the client, family, health care providers, and caregivers (as appropriate). (Major)

3. The team works with the client to resolve medication discrepancies OR communicates medication discrepancies to the client’s most responsible prescriber and documents actions taken to resolve medication discrepancies. (Major)

4. When medication discrepancies are resolved, the team updates the current medication list and provides this to the client or family (or primary care provider, as appropriate) along with clear information about the changes. (Minor)

5. The team educates the client and family to share the complete medication list when encountering health care providers within the client’s circle of care. (Major)

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Page 19: Medication Reconciliation Recent changes introduced by Accreditation Canada

© Accreditation Canada/Agrément Canada

Long-term care version:Tests for complianceLong-term care version:Tests for compliance

1. Upon or prior to admission, the team generates and documents a Best Possible Medication History (BPMH), in consultation with the resident, family, health care providers, and caregivers (as appropriate).

2. The team compares the Best Possible Medication History (BPMH) with the admission orders and identifies, resolves, and documents any medication discrepancies.

3. The team uses the reconciled admission orders to generate a current medication list that is kept in the resident record.

4. Upon or prior to re-admission from another service environment (e.g., acute care), the team compares the discharge medication orders with the current medication list and identifies, resolves, and documents any medication discrepancies.

5. Upon transfer out of long-term care, the team provides the resident and next care provider (e.g., another long-term care facility or community-based health care provider), as appropriate, with a complete list of medications the resident should be taking.

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Page 20: Medication Reconciliation Recent changes introduced by Accreditation Canada

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ImplementationImplementation

Revised ROPs apply to on-site surveys beginning in 2014 Implementation in one service (broadly defined) is

expected for on-site surveys between 2014 and 2017. For services that use standards that contain an

applicable MedRec ROP

Implementation in all services is expected for on-site surveys in 2018 and beyond For services that use standards that contain an

applicable MedRec ROP

Page 21: Medication Reconciliation Recent changes introduced by Accreditation Canada

© Accreditation Canada/Agrément Canada

ResourcesResources

Accreditation Canada Backgrounder

FAQ

Webcast

Webinar Series

Accreditation Specialist

[email protected]

Safer Healthcare Now! Getting Started kits

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