scaling up medrec measurement – experiences from alberta
DESCRIPTION
Purpose of the Call: •Speakers from AHS will share: •AHS’ approach to measurement for improvement (MedRec) •Lessons learned throughout our measurement journey •Their approach to using data to drive change at the frontlineTRANSCRIPT
![Page 1: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/1.jpg)
www.saferhealthcarenow.ca
Scaling up MedRec Measurement –
Experiences from Alberta
November 2014
![Page 2: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/2.jpg)
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
![Page 3: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/3.jpg)
www.saferhealthcarenow.ca
www.ismp-canada.org
Doc Mike Evans discusses the importance of
keeping a medication list
http://youtu.be/f2KCWMnXSt8
![Page 4: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/4.jpg)
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
![Page 5: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/5.jpg)
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
5
Click on the arrow icon
and then click on the appropriate location/response
on the slide
![Page 6: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/6.jpg)
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
![Page 7: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/7.jpg)
7
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
![Page 8: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/8.jpg)
8
Objectives
• Overview of MedRec Implementation in AHS
• Approach to Evaluation of Medrec in AHS
• Results so far…
• Lessons Learned
• Next Steps
![Page 9: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/9.jpg)
9
• Major Patient Safety Initiative
• Accreditation Canada Required
Organizational Practice (ROP)
• Varied Past:
– Multiple approaches
• Desired Future:
– Coordinated, integrated
approach
History of MedRec in AHS
![Page 10: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/10.jpg)
10
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
![Page 11: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/11.jpg)
11
Our Goal
• To have MedRec completed on all patients
(where appropriate) across the AHS continuum
by the end of 2015.
![Page 12: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/12.jpg)
12
“Seeing the Issue”
![Page 13: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/13.jpg)
13
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”
![Page 14: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/14.jpg)
14
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
![Page 15: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/15.jpg)
15
Acute Care – Measures
![Page 16: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/16.jpg)
16
Acute Care – Quality Elements
![Page 17: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/17.jpg)
17
Zone Acute Care – Measures
![Page 18: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/18.jpg)
18
Reporting & Learning System Data
![Page 19: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/19.jpg)
19
Reporting & Learning System Data
![Page 20: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/20.jpg)
20
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”
![Page 21: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/21.jpg)
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
![Page 22: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/22.jpg)
22
Calgary Zone Project Team
Project Manager
Project Coordinators
Physician Lead
Pharmacy consultant
Administrative Support
![Page 23: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/23.jpg)
23
Calgary Zone Map
![Page 24: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/24.jpg)
24
Our Approach in the Zone
Key Areas Of Focus
•Engagement Strategies
•Use of Objective Data
![Page 25: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/25.jpg)
25
Governance Committee Structure
![Page 26: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/26.jpg)
26
Early Adopters
![Page 27: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/27.jpg)
27
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
![Page 28: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/28.jpg)
28
Results so far...
![Page 29: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/29.jpg)
29
Progress Reports
![Page 30: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/30.jpg)
30
Site/Program Service Comparisons from
PSM
![Page 31: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/31.jpg)
31
Hospitalists Measurement
September - October
![Page 32: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/32.jpg)
32
Surgery
![Page 33: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/33.jpg)
33
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!!
![Page 34: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/34.jpg)
34
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.
![Page 35: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/35.jpg)
35
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
![Page 36: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/36.jpg)
36
Conclusion
![Page 37: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/37.jpg)
37
Thank You
![Page 38: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/38.jpg)
www.saferhealthcarenow.ca
Upcoming MedRec Webinars
38
Thank you for attending
Our next MedRec webinar will take
place in January 6th, 2015.
Topic: MedRec Quality Audit Month
Information call.
![Page 39: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/39.jpg)
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:
![Page 40: Scaling up MedRec Measurement – Experiences from Alberta](https://reader033.vdocument.in/reader033/viewer/2022052623/55984cec1a28ab376d8b470b/html5/thumbnails/40.jpg)
www.saferhealthcarenow.ca
www.ismp-canada.org
40
We encourage you to report
medication incidents
Practitioner Reporting https://www.ismp-canada.org/err_report.htm
Consumer Reporting www.safemedicationuse.ca/