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

www.saferhealthcarenow.ca

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

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:

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

Questions?

Contact Information

Arun Verma: arun.verma@ubc.ca

Judith Soon: judith.soon@ubc.ca

www.saferhealthcarenow.ca

Upcoming MedRec Webinars

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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

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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/

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 mssa@ismp-canada.org