Compiled Rapid Fire Presentations - Safer Healthcare Now!

Rapid Fire Presentations 

Fraser Health Region - BC 

Capital Health Region – AB 

Northern Health Region - BC 

Providence Health Care - BC 

Vancouver Coastal Health – BC 

BC Mental Health and Addiction Services – BC 

BREAK 

Interior Health Region - BC 

Vancouver Island Health Region - BC 

Winnipeg Regional Health - MB 

Calgary Health Region - AB 

Children’s and Woman’s - BC

Medication 

Reconciliation 

Janice Munroe 

Pharmacy Medication Safety Coordinator 

November 29, 2005

Where are we in Fraser Health 

‣ Executive level support 

‣ Senior level multidisciplinary Steering Committee 

‣ Identification of Pilot site 

‣ Peace Arch Hospital 

‣ Engagement of leaders at pilot site 

‣ Identification of Project Team leads and members 

‣ Co-leads 

‣ Multidisciplinary Team 

‣ Draft Project Charter

Pilot Team - Project Plan 

‣ Finalize Project Charter 

‣ Develop Project Timelines 

‣ Process flow mapping 

‣ Identify resources required to complete

Items for consideration…… 

‣ Initial pilot area – admission vs discharge 

‣ Site Project Team evolution as spread occurs 

‣ Spread to other FH sites – multiple vs single 

‣ Community involvement – phase I or II or

The Road Ahead….. 

‣ Impossible to envision all of the issues 

that will arise 

‣ Strong executive support 

‣ Goal of the dedicated multidisciplinary 

team is to improve patient care 

‣ Working together we will succeed!






Vancouver Coastal Health - BC 


BC Mental Health and Addiction Services - BC 





Safer Healthcare Now!- 

Medication Reconciliation 

Suburban/Rural Capital 

Health, AB

Who 

Primary/Secondary care sites 

• Westview Health Centre- Stony Plain 

• Redwater Health Centre- 

• Fort Saskatchewan Health Centre 

• Devon General Hospital 

• Leduc Community Hospital 

• Sturgeon Community Hospital 

September 2005 9

September 2005 10

Our Team 

Project Coordinator – 

Esther Nelles (0.4 FTE) 

Pharmacists - 

Maryann Chmilar (0.5 FTE) 

RN - 0.5 FTE 

Educator - 0.5 FTE 

Nurse Clinician- 

Sturgeon Community Hospital (1.0 FTE) 

September 2005 11

Next Steps 

• Hire the remaining members of the 

team. 

• December- informing the 

stakeholders of the plan and its 

implications 

September 2005 12












Others... 

13


in Northern BC 

Presenters: 

Cam Egli and Greg Atherton

Northern Health 

 

Safer Healthcare Now! 

– Multi-disciplinary teams established in each of three HSDA’s 

• Each team’s membership varies 

– Medication Reconciliation “team” is reporting to NI HSDA working 

Group 

• Members: 

– Greg Atherton (Rx) – Quesnel 

– Cam Egli (Rx) - Regional Director 

– Bruna Schnepf (RN and Admin) – Omineca Director of Nursing 

– RN and MD in Quesnel - TBA 

15


‣ NH Team is just forming 

‣ Initial meeting planned in December 

‣ Aim statement 

‣ Reduce the mean number of unintentional discrepancies at admission on 

the pilot unit by 50% within three months 

‣ Baseline data - yet to be compiled 

‣ Plan for the region 

‣ Start with pilot project in Quesnel (GR Baker Hospital) 

‣ Roll out to one site within each HSDA (Dawson Creek and 

Smithers) 

‣ NH-wide roll out coupled to new CIS 

16


‣ Complexities we face: 

‣ Many software programs in NH Rx 

‣ Geography 

‣ Human resources 

17













Medication 


Vancouver Coastal Health 

Providence Health Care

Providence Healthcare 

• St. Paul’s Hospital 

– 426 tertiary acute care beds 

• Mount St. Joseph Hospital 

– 128 community acute care beds 

– 100 residential care beds 

• Holy Family Hospital 


– 76 rehab beds 

• St. Vincent’s Hospitals 


• Youville 


September 2005 20

Medication Reconciliation at PHC 

• Team formed ~ 2 ½ years ago 

– Pharmacy, nursing, pharmacy IT 

– Acute and Residential care 

• Focusing on transitions at: 

– Admitting 

– Transfer 

•Acute Acute 

•Acute Residential 

– Discharge 

September 2005 21

Regionalization of Pharmacy Services 

VCH/PHC Beds by Site and Type 

800 

600 

Beds 

400 

Acute - Tertiary 

Acute - Community 

Residential 

Rehab 

200 

0 

0 1 2 3 4 5 6 

Site 

September 2005 22

Opportunities for Reconciliation 

Opportunities for Reconciliation 

800 

Contracted 

Facilities 

Community 

600 

Beds 

400 

Acute - Tertiary 

Acute - Community 

Residential 

Rehab 

200 

0 

0 1 2 3 4 5 6 

Site 

September 2005 23

Regional Medication 

Reconciliation Initiatives 

• Report to Regional Medicine Council 

• Teams at 

– Richmond 

– Vancouver Acute 

–PHC 

– Lions Gate 

– Sunshine Coast/Garibaldi 

September 2005 24

Pharmacy Startup Meeting 

• Availability of data 

• Extraction of data 

• User access 

• Current processes 

• Pilot 

• Membership 

• Resources 

• Evaluation 

September 2005 25

Pharmacy Startup Meeting 

• Decisions 

– VA, NS and PHC to focus on the discharge process 

– RGH under discussion 

– Sunshine coast to focus on admission process 

• Tasks 

– Define membership at local level 

–Structure 

– Start-up meeting 

– Discharge prescription feasibility and 

implementation cost 

September 2005 26

Regional Medication 

Reconciliation Initiatives 

September 2005 27












Others...

Lions Gate Hospital 

North Shore Coast Garibaldi 

VCH 

Team: 

Romilda Ang: Director Professional Practice 

Derek Andrews: Pharmacy Computer Coordinator 

Mark Collins: Pharmacy Clinical Coordinator

Baseline Survey 

Emergency Department 

• October 2005 

• ER pharmacist 

• 18 admitted patients over 6 days. 

• N = 121 Rx’s 

• Average = 7 Rx’s per patient (n = 2-17) 

• 35 min. per patient

Baseline discrepancy rate 

Mean Discrepancy Rate 

Number/ Patient 

Undocumented Intentional 

(Documentation Accuracy) 

0.6 

Unintentional 

(Rate of error) 

0.7 

Incidence of Intended Therapy: 

None AND Intentional = 80% 

(MRSI)

Patients with discrepancy 

Discrepancy 

Number 

Patients (N=18) 

Percent 

Intentional 14 78 % 

Unintentional 4 22% 

Undocumented 7 39% 

Undocum. OR Uninten. 9 50 %

Information Systems: 

Testing McKesson Computer Upgrade 

• Home Medication Reports 

• Medication Reconciliation Report 

• Medication Discharge Reconciliation Report 

• Discharge Planning Report












Others...

MEDICATION 

RECONCILIATION 

Nov. 29, 2005

B.C. Mental Health and Addiction 

Services 

Medication Reconciliation Committee 

Riverview Hospital 

Forensic Psychiatric Institute 

Forensic Clinics 

Representation from 

Nursing, Pharmacy, Medicine 

September 2005 

36

Admission Reconciliation 

Staff education/awareness 

Collect baseline data 

• Getting started kit 

• Retrospective analysis of patient charts in 3 

different areas: Riverview Hospital (Forensic 

Psychiatric Institute, and Forensic Clinics) 

Intentional discrepancy 

Undocumented intentional/unintentional 

• Pharmacy, nursing, medicine 


37

Admission Reconciliation 

Meet to discuss 

• Results of baseline data 

Plan next steps 

• Staffing requirements 

• Do we need to modify the forms for AR 

• Team make-up 

• Barriers/ Challenges 


38

NEXT…. 


39

BREAK 


40












Others...

Interior Health 


Norma Malanowich 

Regional Director, Pharmacy

43 

Very Early Stages of 

Planning & Definition 

Pharmacy Lead Medication Reconciliation 

1. Specific populations of patients admitted from 

Emergency 

– Pilots at Kelowna General Hospital and Royal 

Inland Hospital 

2. Medication Reconciliation incorporated into 

pharmacy anticoagulation service and 

medication consultation process. 

– Pilot locations to be determined: Vernon 

Jubilee Hospital + 

3. Admission to Residential Care

44 

Nursing Lead Medication Reconciliation 

1. Patient Discharge 

– Pilot facilities and units tbd

45 

Team Composition 

• Sponsored by Quality, Pharmacy, and site 

Medication Safety and Advisory Committees 

• Multi-disciplinary teams created for each pilot

46 

How to get started and avoid the 

pitfalls: 

We’re here to learn from you!













MEDICATION RECONCILIATION 

Richard Bachand Pharm D 

Department of Pharmacy 

November 29 th , 2005 

September 2005 48

Team 

Newly formed 

Team Leader 

Nurse Manager 

Clinical Nurse Leader 

Clinical Nurse Educator 

Pharmacy Resident 

Surgeon 

One of our “Big dot” projects with an executive sponsor 

September 2005 49

Focus 

Medication reconciliation “ on admission” 

Where 

1 to 2 Surgical Units 

Planning on involving the pre-admission clinics (PAC) 

Baseline data 

In progress 

Developed 

• Pharmacist consult – medication reconciliation form (BPMH) 

• Home Medication Reconciliation and Order Form 

September 2005 50

CHALLENGES 

‣ Manpower resources 

‣ Culture 

‣ Complex systems 

September 2005 51












Others...


Current Status within the 

Winnipeg Regional Health Authority

Regional Approach 

• Proposal & Budget 

• Leadership buy-in 

• Role of the Project Management Office 

(PMO) 

• Standardized form and process 

• Site Selection 

• Recruitment of unionized staff 

September 2005 54

GOAL 

To develop & implement a regional 

MedRec process throughout the 

continuum of care including: 

admission to an acute care unit 

referral to home care 

primary care 

September 2005 55

Objectives 

the mean # undocumented intentional 

discrepancies by 75% by December 31, 2006. 

the mean # unintentional discrepancies 

by 50% by December 31, 2006. 

the MedRec Success Index by 50% by 

December 31, 2006. 

Spread the MedRec Process to 100% of 

Medicine/Family medicine acute care units 

by December 31, 2006. 

The MedRec Process is completed within 24 

hours in 90% of patients upon admission. 

September 2005 56

Pilot units 

Framework 

Acute care - General/Family Medicine - 6 

Home care - 2 

Primary Care - 2 

Initial focus admission process 

standardized form and process 

include allergies 

September 2005 57

Framework 

Spread to other units 

Pilot units start testing/development of 

the transfer/discharge process 

Project Team Staffing 

frontline staff 

12 - 0.4 EFT nurses 

2 pharmacists (1.6 EFT total) 

September 2005 58

Pre-Planning 

Planning 

Education for project team 

Oct 4 workshop 

Overview of med reconciliation, model for 

improvement 

Oct 24, 25 

focus on process improvement 

“hands on” PDSA cycles 

Ongoing as needed 

Site visits 

September 2005 59

Pre-Planning 

Planning 

Regional Project Team Meetings 

Pre-PDSA PDSA work 

networking with other teams 

baseline audit 

develop draft med reconciliation form 

flow charting 

template for how to perform med history 

criteria for pharmacist involvement 

develop local teams 

communication plan 

September 2005 60

Challenges 

Multi-site pilot units 

Baseline audit 

Communication 

Spread 

Unions 

Forms Committee(s) 

Scheduling of project team 

September 2005 61

Baseline Audit 

240 mg MD changed 

Diltiazem CD 120 mg OD 

Ramipril 10 mg OD 

Amiodarone 100 mg OD 

Clopidogrel (HOLD) 

Ranitidine 150 mg OD 

Prednisone 5 mg OD 

Acetazolamide 250 mg OD 

Atorvastatin 10 mg OD 

Glyburide 5 mg BID 

Salbutamol 2 puffs BID 

QID 

Pilocarpine 2% 1 drop to BOTH eyes QID 

10 mg MD changed 

RIGHT eye 

September 2005 62

Challenges 

Multi-site pilot units 

Baseline audit 

Communication 

Spread 

Unions 

Forms Committee(s) 

Scheduling of project team 

September 2005 63

Questions














Calgary Health Region, Alberta 

Presented by: 

Jamie Stroud, QI Consultant, Internal Medicine, Unit 74 RGH 

and 

Debbie Friesen, Clinical Pharmacist, Unit 32 FMC 

Who’s on What – Vancouver, BC. November 29, 2005

Team Make-up 

• Unit 74 RGH 

• 1 physician 

• 2 clinical pharmacists 

• 2 clinical nurse educators 

•1 unit manager 

• 1 QI consultant 

• 1 transition coordinator 

•0 RNs 


Initial Flow Map 


Unit 74 Baseline Measures 

(n=20) 

Success Index – 68.9% 

Mean # of Undocumented 

Intentional Discrepancies – 

3.05 

Mean # of Unintentional 

Discrepancies – 0.50 


Unit 74 – Next Steps 

• Refine team 

• Understand variability 

• Brainstorm ideas for change 

•Set goals 

• Complete Improvement 

charter 

• Select area for improvement 

• Prepare for PDSA cycle #1 


• Unit 32 FMC 

Team Make-up 

• 1 QI physician 

• 2 Hospitalist physicians 

• 2 clinical pharmacists 

• 1 APC nurse manager 

• 1 QI consultant 

• 1 staff nurse 

• 1 hospitalist nurse liaison 

• 1 program manager family 

medicine 


Improving the Process (Unit 32) 

CALGARY HEALTH REGION 

FAMILY PHYSICIAN: ____________________________________ 

COMMUNITY PHARMACY: _______________________________ 

Medication Allergies/Intolerances (include specific patient reaction if known): 

PRE-ADMISSION MEDICATION LIST 

PRESCRIPTION MEDICATIONS 

(pills, eye drops, patches, inhalers, etc.) 

Medication Name & Dose Route Dosing 

Interval 

Continue 

Change 

ON ADMISSION 

Reason for Change/ Hold/ 

Discontinuation 

Hold 

or D/C 

NON-PRESCRIPTION MEDICATIONS 

(OTC’s, herbals, etc.) 

Source of Medication List (check all used): 

Review of medication vials Family Physician list 

Review of patient medication list EMS record 

Patient recall Wellnet list 

Family Recall Medication Administration Record from another facility 

Pharmacy list Other (specify): 


Measures for Unit 32 (FMC) 

Success Index: Baseline - 56.9% 

(Improvement over time) 

Goal: 85% (increase by 50%); Stretch Goal: 100% (increase by 75%) 

Mean # of undocumented intentional 

discrepancies: Baseline - 1.2 

(Documentation accuracy) 

Goal: 0.3 (decrease by 75%); Stretch Goal: 0.2 (decrease by 80%) 

Mean # of unintentional discrepancies: 

Baseline - 1.7 

(Rate of error) 

Goal: 1.275 (decrease by 25%); Stretch Goal: 0.42 (decrease by 75%) 


Success Index 

100 

Percent 

80 

60 

40 

Baseline 

(n=24) 

PDSA 1: Form 

Version 1 

(n=7) 

PDSA 2: Form 

Version 2 

(n=5) 

PDSA 3: Form 

Version 3 

(n=11) 

20 

0 

Aug.-Sep., 2005 Oct. 12, 2005 Oct. 25, 2005 Nov. 16/17, 2005 


Mean # of Undocumented Discrepancies 

Mean # of Discrepancies 

1.8 

1.6 

1.4 

1.2 

1 

0.8 

0.6 

0.4 

0.2 

0 

Baseline 

(n=24) 

PDSA 1: Form 

Version 1 

(n=7) 

PDSA 2: Form 

Version 2 

(n=5) 

PDSA 3: Form 

Version 3 

(n=11) 



Mean # of Unintentional Discrepancies 

Mean # of Discrepancies 

2 

1.8 

1.6 

1.4 

1.2 

1 

0.8 

0.6 

0.4 

0.2 

0 

Baseline 

(n=24) 

PDSA 1: Form 

Version 1 

(n=7) 

PDSA 2: Form 

Version 2 

(n=5) 

PDSA 3: Form 

Version 3 

(n=11) 



Next Steps 

• Additional PDSA Cycles 

• Further explore Nursing role 

• Explore use of form by multiple 

health care professionals 

• Pilot screening tool 

• Monitor progress 











Saskatoon Health Region - SK 



Medication 


BCCH Emergency Department

The Team 

Dr. Jeffrey Hung – Medicine, ED 

Denise Hudson – Quality Initiatives, ED 

Norma Donovan – CNC, ED 

Faye Kingdon – Programme Manager, ED 

Judy Komori – Leader, Quality Safety & 

Risk Management 

Kim Shearer – Sr. Practice Leader, Nursing 

Projects 

Ian Sheppard – Director, Pharmacy 


80

Current & Future Plans 

Start in the Children’s Emergency 

Department 

Collect baseline data 

Refine data collection and analysis tools; 

implement fully in Emergency 

Develop a “roll out” plan for the rest of 

C&W – paediatrics and maternity 


81

Baseline Data 

To be collected in December 2005 

Chart Audit (retrospective) 

• seen in the Emergency department, and 

• admitted to an inpatient unit, and 

• taking 5 for more medications 


82

Challenges 

Resource challenges 

• Time for staff who have been assigned - 

to do the work, and 

• Staff with IT skills needed to search and/or 

write custom reports to find the required 

information in electronic databases 

Finding the patients who meet the 

criteria 


83

Charter 


84

AIM Statements 


85

Lunch Time! 

Thank you very much…

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