the puzzle gets bigger
DESCRIPTION
Presented at the Optimizing Medications Workshop in Vancouver by Marg ColquhounTRANSCRIPT
© ISMP Canada and Safer Healthcare Now! 2014
Optimizing Medications Time to Bring the Pieces Together
MedRec Update 2014
Margaret Colquhoun Project Lead ISMP Canada
National MedRec Co-Lead
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
Outline
• Leadership
• Quality Measurement
• Technology
• National Resources
© ISMP Canada and Safer Healthcare Now! 2014
David
Denison
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
2010- National MedRec Summit
Healthcare CEOs, senior leaders, representatives from national organizations,
provincial quality councils, physicians, nurses and pharmacists identified themes that
would accelerate and optimize MedRec across the continuum of care
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
“Senior leadership commitment is critical to
ensuring MedRec is implemented successfully
across an organization. It is essential to dedicate
resources to support the achievement of an
ambitious plan of action, and include MedRec as
a strategic priority with goals, timelines,
accountability for implementation, evaluation and
progress reporting. Accountability must rest with
the CEO with clear reporting expectations at the
board level.”
LEADERSHIP ACCOUNTABILITY
Got Med Wreck? Targeted Repairs from the Multi-Center
Medication Reconciliation Quality Improvement Study (MARQUIS)
Jeffrey L. Schnipper, MD, MPH, FHM
Director of Clinical Research, BWH Hospitalist Service Associate Physician, Division of General Medicine,
Brigham and Women’s Hospital Associate Professor, Harvard Medical School
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
• MARQUIS Study
• To discuss lessons learned from sites that have implemented the MARQUIS program and how they might be applied to Canadian hospitals
• To make the case for provinces, health systems, and hospitals to invest in medication reconciliation quality improvement efforts, and why physicians need to play a major role in these efforts
Find it at: http://www.ismp-canada.org/medrec/
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Leadership
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
Quality Measurement
October was National MedRec Quality Audit Month
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
Need to critically evaluate admission processes
to ensure quality of processes at other transitions
MedRec
Quality
Audit
Tool
© ISMP Canada and Safer Healthcare Now! 2014
“Participants” by Province/Territory
10
103 sites
2,340 patients
Number of Patients
Provinces/Territories
© ISMP Canada and Safer Healthcare Now! 2014
“Participants” by Sector
11
103 sites
85%
N=1,992
15%
N=348
Acute Care
LTC
Acute Care
LTC
77%
N=79
23%
N=24
2,340 patients
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
Design of the Tool – the Literature • A review of published articles found that 10-67% of patients
had at least 1 prescription medication history error – when non-prescription medications were included the
frequency of errors was 25-83% • Authors suggest: “should be a comprehensive medication
history that includes an interview, inspection of medication vials or lists, or both and contact with community pharmacies, or family physicians.”
CMAJ, 2005 http://www.cmaj.ca/content/173/5/510.full.pdf+html
© ISMP Canada and Safer Healthcare Now! 2014
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
Column C Results (‘BPMH -greater than one source)
14
60%
N=2,040
74%
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
Literature suggests…
• 66% of Canadians have sometimes used non-prescription medication in the past six months.
2004 Survey of Canadians’ Use of OTC Medications http://www.bemedwise.ca/english/usagesurvey.html
• 12% of patients don’t fill their prescription at all.
• 12% of patients don’t take medication at all after they fill the prescription.
• 22% of patients take less of the medication than is prescribed on the label.
Adult Meducation http://www.adultmeducation.com/OverviewofMedicationAdherence_2.html
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
Column D – Actual Med Use Verified by Pt./Caregiver
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D Results: Med Use Verified by Pt/Caregiver
17
57%
N=2,044
63%
© ISMP Canada and Safer Healthcare Now! 2014
Literature suggests…. Column F
• Medication discrepancy was defined as a difference between the medication use history (BPMH) and the admission medication orders.
• In the sample of patients admitted to general medicine unit:
– 54% of patients had at least one unintentional discrepancy identified (most common type was omission of a regularly used medication)
– 38% of these discrepancies were judged to have the potential to cause moderate to severe discomfort or clinical deterioration
© ISMP Canada and Safer Healthcare Now! 2014 19
© ISMP Canada and Safer Healthcare Now! 2014
Results F.‘Meds on BPMH+Admin Order’
20
73%
N=2,006
87%
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
Overall National MedRec Quality Audit Results
2340 patients
29% (acute care)
55% (Long Term Care)
• 1906 Acute Care
• 329 Long Term Care
• Met all 5 quality criteria
• Met all 5 quality criteria
103 Organizations
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
Comments
• Audit tool results demonstrate need for ongoing and specific improvements
• Future audits to measure improvement are critical
• Many people believe they are doing MedRec but they may not be doing it well
– The foundation of the process – the BPMH needs work
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
Comments
• Need to critically evaluate admission processes to ensure quality of MedRec processes at other transitions
• Sites will need to train people to use the audit tool – materials are available to support this process
23
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
Pennsylvania Patient Safety Advisory -2013
• 501 reports involving MedRec breakdowns in 1 year
• 69% at admission
• Events most often at prescribing (40%)
• Drug omission most frequent (26.7%)
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
eMedRec in Canada Paper to Electronic Project
Online survey 212 people responded
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
Available Soon
To support organizations
migrate from a paper-
based system to an
electronic system for
MedRec
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
Motivation for Moving to eMedRec
• Integrates electronic data from multiple sources ( electronic and non-electronic)
• Provides electronic tools and user interfaces for comparing medication lists
• Facilitate discharge MedRec with multiple sources of information
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
Advantages of eMedRec
• Improved standardization, legibility, communication, accessibility
• Potentially improved compliance through soft stops (i.e., reminders that eMedRec needs to be completed and/or hard stops (orders cannot be placed until eMedRec is completed)
• Decision support tools to assist in comparing medication lists/identifying discrepancies integrated to generate warnings
• Integration with CPOE to facilitate improved ordering processes
• Improved efficiency of many medication-related processes in healthcare organizations (Poon et al., 2006).
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
Tools/Checklists Soon to be Available
• Organizational Readiness
• Steps to support the safe transition to eMedRec
• Ideal features of eMedRec,
• Evaluation of eMedRec
© ISMP Canada and Safer Healthcare Now! 2014
Judy
Colquhoun
© ISMP Canada and Safer Healthcare Now! 2014
© ISMP Canada and Safer Healthcare Now! 2014
Having a look at MedRec Nationally
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
Identified Themes -
2010 National MedRec Summit
INTER-PROFESSIONAL ENGAGEMENT
LEADERSHIP ACCOUNTABILITY
PUBLIC/CONSUMER/CAREGIVER ENGAGEMENT
PHYSICIAN ROLES
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INTER-PROFESSIONAL ENGAGEMENT
Role of the pharmacy technician
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National Health Leadership Conference
LEADERSHIP ACCOUNTABILITY
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Free iPhone app for
patients to
track medications.
Android version
coming mid- 2014.
PR Campaign from North Bay
Regional Health Centre (ON)
Sunrise Health
Region (SK)’s PR
campaign “Be a
Champion of Your
Health”
PUBLIC/CONSUMER/CAREGIVER ENGAGEMENT
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
www.SafeMedicationUse.ca
PUBLIC/CONSUMER/CAREGIVER ENGAGEMENT
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
Toronto Zoomer Show, November 2013 35,000 consumers in attendance
PUBLIC/CONSUMER/CAREGIVER ENGAGEMENT
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014
Healthcare Practitioner Education
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www.Rxbreifcase.com
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BPMH Training
Pharmacy Technicians Clinicians
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Primary Care – 2 Page Information Sheet
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Home Care