safety, sleuthing and students: a novel collaborative medrec event
DESCRIPTION
Purpose of the Webinar 1.Describe the process of developing an undergraduate MedRec IPE Event involving > 480 senior Medicine, Pharmacy and Nursing students; 2.Explain the logistics of conducting the event in multiple venues and urban/remote locations; 3.Discuss the successes and challenges of communicating MedRec patient safety concepts through this process; and 4.Describe future opportunities for enhancing undergraduate MedRec training in an interprofessional environment. Watch the webinar recording: http://bit.ly/1fSqsqvTRANSCRIPT
www.saferhealthcarenow.ca
Safety, Sleuthing and Students: A
Novel Collaborative MedRec Event
Dr. Arun Verma, UBC Faculty of Pharmaceutical Sciences Faculty member
Dr. Judith Soon, UBC Faculty of Pharmaceutical Sciences Faculty member
Dr. Nick Petropolis, BC Fraser Health Authority physician
May 2014
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Safer Healthcare Now! MedRec
2014-2015 Year-at-a-glance
• 2nd MedRec Quality Audit Month (Fall-
Winter)
– 2 associated national call/webinars
• 6 national calls/webinars (webinars to
resume in Sept. 2014)
• Updates to Home Care Getting Started Kit
• Updates to MedRec Cross Canada
Check Up Map
• Developing MedRec FAQ documents
2
www.saferhealthcarenow.ca 3
ISMP Canada MedRec Projects
2014-2015
• Doc Mike Evans YouTube video- MedRec
• MyMedRec app- soon available for
Android and Blackberry devices
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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
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All Safer Healthcare Now! webinars are posted within the
week to the following locations:
Safety, Sleuthing and Students:
A Novel Collaborative MedRec Event
Arun Verma, B.Sc. Pharm, RPh, ACPR, PhD
Judith Soon, BSc Pharm, RPh, ACPR, PhD, FCSHP
Nick Petropolis, MD, BSc (Hon)
May 6, 2014
MedRec Team in Action!
Acknowledgements Pharmaceutical Sciences Medicine Nursing
Anita Lo Lesley Bainbridge Kathy O’Flynn-Magee
Wayne Riggs Linlea Armstrong Elsie Tan
Lynda Eccott Keri Closson Suzanne Campbell
Shelley Novak Fraser Black Tarnia Taverner
Allison Kirkwood Karen Joughin Noreen Frisch
Melissa Lo Jessica Hartley Martha MacLeod
Vivian Leung Deborah Phillips Lisa Viik
Dan Martinusen Anne Worthington Lela Zimmer
Aleisha Thornhill Remare Ettarh Maren Akyürek
Mark Collins Stan Bardai Diana Choi
Jamal Kurtu John Cheng Myitzu Shwe
Learning Objectives
1. Describe the process of developing an undergraduate MedRec Interprofessional (IP) Event involving > 480 senior Medicine, Pharmacy and Nursing students;
2. Explain the logistics of conducting the event in multiple venues and urban/remote locations;
3. Discuss the successes and challenges of communicating MedRec patient safety concepts through this process; and
4. Describe future opportunities for enhancing undergraduate MedRec training in an interprofessional environment.
Overview
Medication reconciliation ideally involves the healthcare team in the clinical practice setting
Opportunities for engaging interprofessional undergraduate interactions in meaningful problem-solving settings are rare
A novel approach was taken to explore patient safety issues in a 3rd year Pharmacy course that utilizes case studies to integrate scientific and clinical concepts
Background
During new case development for Pharmacy 498, this recently published paper was reviewed:
It was recognized that MedRec was not being taught in the undergrad healthcare curriculum at UBC
Only some students observed in clinical care rotations
Aim
To design and implement user-friendly interactive activities to teach senior undergraduate healthcare students about the importance of medication reconciliation at transition points of care
Acute Care Hospital Home Residential Care
Definition of Medication Reconciliation
Medication reconciliation is a formal process
in which healthcare providers work together
with patients, families and care providers
to ensure accurate and comprehensive
medication information is communicated
consistently across transitions of care.
http://www.ismp-canada.org/medrec/
Definition of Medication Reconciliation cont’d
Medication reconciliation requires a systematic
and comprehensive review of all the medications
a patient is taking (known as a BPMH) to ensure that
medications being added, changed or discontinued are
carefully evaluated.
http://www.ismp-canada.org/medrec/
Best Possible Medication History (BPMH)
The BPMH is a ‘snapshot’
of the patient’s actual medication use,
which may be different
from what is contained in their records.
This is why the patient/family involvement is vital.
http://www.ismp-canada.org/medrec/
Why Teach MedRec?
Common error1
Easily improved with systematic approach
Accreditation standard across Canada2
Standard of care in hospital2
Excellent opportunity to teach collaboration
1Kwan JL et al. Medication Reconciliation During Transitions of Care as a Patient Safety Strategy. Ann Intern Med. 2013;158(5.2):397-403 2 Mitchell JI et al. Medication Reconciliation: A Prescription for Safer Care. Healthcare Quarterly. 2013:16(4): 10 – 13.
Safety Issues
Different types of errors
Frequently non-Rx meds not accounted for
Patient confusion at discharge
Community care providers unaware of medication changes
Tam VC et al. Frequency, type and clinical importance of medication history errors at admission to hospital. CMAJ. 2005 Aug 30;173(5):510-5.
Why is Collaboration Important?
Diverse sources of medication profile
Various opportunities to do reconciliation
Input from multiple disciplines
Timeline for Curriculum Development
Process of Developing MedRec IP Event
Need to establish links to other professions
Need to identify by healthcare profession:
Level and number of students
Appropriate course to host activity
*** DATE *** of the activity
Participation - mandatory or volunteer
Assignment - individual or team
Technology – Faculty-specific or University-wide platform
Budget - e.g. facilitators, supplies
Participant Considerations
Need to identify by healthcare profession:
Which other course coordinators need to be consulted
Responsibility for communication to students
Consequences for the student if they do not participate
Class list to be shared to develop IP group & room list
Urban/Remote Location Logistics
Need to identify for each of the three academic sites:
Number of IP participants
Number, size and location of rooms required
Faculty individual responsible for room bookings
Availability of rooms on potential date and times
IT technology to support the simultaneous activities
Facilitators: Regional Health Authority MedRec Coordinators
4 UBC site; 1 UNBC site; 1 UVIC site
Technology Specifications
Need to identify by healthcare profession:
Technology manager and support personnel
On call individual prior to and during event
Early booking for technology link between sites
Preferred online platform and “shell” for courses
Platform login for participants to be set-up prior to event
Implications of high volume usage
Clinical Case Development
Collaboration with acute care MedRec Coordinator
Case: acute care geriatric patient with complex medications and multiple errors identified during routine MedRec
Patient identifiers removed
Lab values, medical and social history generated
Clinical Case Setting and Resources
MedRec activity situated in a multidisciplinary discharge planning meeting
Patient, nurse, social worker, pharmacist, attending physician
PharmaNet pre-admission form developed:
diagnosis, age, medication history
Acute care MedRec admission form
Acute care Discharge form
Pre-Reading Materials
Learning Objectives
Background reference articles
MedRec clinical case
SBAR form
Situation, Background, Assessment, Recommendation
Map of the venues
Request bring laptop or tablet
Pack a lunch
Room Preparation
Directional signage
Sign-in sheets
White boards
Online connectivity
Doors to rooms unlocked
Communications
Need to identify by healthcare profession:
Individual responsible for coordinating consistent messaging
Press release – by individual profession or collaborative
Signage – paper and/or digital
Media – academic, professional and/or community
Curriculum Intervention 2013
Life Sciences Centre
Pharmaceutical Sciences
Lecture theatre 308 students
Seminar rooms 44 groups x 7 students
Small group session Undergrads on the move
Debriefing session
Student Evaluation 2013
“The interprofessional collaboration was most valuable. It provided a platform to talk about the challenges of medication reconciliation and the different expectations and different roles”. Pharmacy Student
“I felt that setting up the groups with pharmacy and medical students was an excellent idea. It was great to meet new people in such an environment and to work with them. It helped to establish to us what role pharmacists play in the community and hospital.” Medical Student
“The case in the module was fantastic! It was very complex, and brought together many topics that we’ve covered in a single patient. Having a case for us to work up collaboratively in small groups was an excellent idea.” Pharmacy Student
Curriculum Intervention 2014
January 6, 2013 Pre-reading posted online – MedRec video and references
January 13, 2014
10:00 am–11:15 am UBC: 52 groups of 8 students (4 MD/4Rx +/-1 RN) UNBC: 5 groups of 7 students (5 MD/1Rx/1RN) UVIC: 4 groups of 8 students (6 MD/1Rx/1RN)
Review case, identify discrepancies, draft recommendations, submit group assignment online
11:30 am–12:00 pm Debriefing on IP concepts and reviewed recommendations
Student Evaluation 2014
“It was a complex case and realistic in terms of what occurs in the hospital. Interesting to see perspectives of the different groups of students with regards to medications.” Medical Student
“I think having a variety of forms which we haven’t been exposed to is helpful, and to shift our thinking to a more hospital discharge based setting is new and contributed to a lot of great ideas.” Pharmacy student
“Excellent opportunity to meet pharmacy students and collaborate in a collegial environment. The pharmacy students were knowledgeable, helpful, and pleasant to work with. Nursing opinions were also appreciated, as they spend by far the most time with patients, and are involved in medication administration, monitoring for adverse effects, receiving patient questions and complaints, etc.” Medical Student
MedRec Successes
Executed event involving 480 senior Medical, Pharmacy, and Nursing students
Involved 3 sites (Vancouver, Victoria, and Prince George)
Valuable learning experience for students
Worked with IPE leadership from other healthcare academic units
Blended learning model
MedRec Challenges
Logistics in developing, implementing, and evaluating this event
Overall coordination between academic units
Lack of resources
Online MedRec course shell in Blackboard
Timing of the event
Future Opportunities
Expanding involvement of nursing and nurse practitioner students
Involve more pharmacists at the external sites
Enhance initial introduction of MedRec by a knowledgeable representative of each profession
More time for students to collaborate on the cases
Explore incorporation of facilitators with small groups
www.saferhealthcarenow.ca
Upcoming MedRec Webinars
38
Thank you for attending
Our next MedRec webinar will take
place in September/October 2014.
Details to follow.
www.saferhealthcarenow.ca
www.ismp-canada.org
39
We encourage you to report
medication incidents
Practitioner Reporting https://www.ismp-canada.org/err_report.htm
Consumer Reporting www.safemedicationuse.ca/
www.saferhealthcarenow.ca
www.ismp-canada.org
Medication Safety Self-Assessment®
• Hospitals (acute care)(2006) – free for Ontario*
• Long-term care (2012) – free for Ontario*
• Complex Continuing Care and Rehabilitation (2008) – free for Ontario*
• Community and Ambulatory Pharmacy (2007) – free for Ontario*
• Operating Room Medication Safety Checklist (2009) – free for Ontario*
• Oncology (2012)
• Anticoagulant Safety (VTE) – free for Ontario*
• HYDROmorphone Safety Self-Assessment (2014) - $50
* Supported by the Ontario MOHLTC
For more information visit www.ismp-canada.org/MSSA or email [email protected]