Medication Reconciliation – Providence Health Care.pdf - Safer ...

Western Node CollaborativeProvidence Health CareMedication ReconciliationResidential TeamPam Kelly, Residential Section Head, PharmacyCamille Ciarniello, Leader, Risk Management & Patient SafetyPharmacy ServicesProvidence Health Care - ResidentialFive Residential care sites• Holy Family Hospital ECU• Langara• Mount Saint Joseph Hospital ECU• Brock Fahrni Pavillion• Youville ResidenceHome to 697 residentsAdmissions to Residential Care via Priority Access• 40% of PHC residential admissions came from PHC acute sites• Other 60% from:– Other acute care facilities– Other residential care facilities– Direct from the community– ReadmissionsPharmacy Services1

Residential Team Members• Lynette Best (Sponsor)• Pam Kelly, Residential Section Head, Pharmacy Services(Team Lead)• Fruzsina Pataky, Regional Medication Safety Coordinator• Sue Higginbotham, Clinical Nurse Leader, Holy Family• Julia Duda, QI Specialist• Jody Burrell, Pharmacist Youville• Lisa James, Pharmacist Brock Fahrni• Barb Laurillard, Pharmacist Langara• Ron Wall, Coordinator, Pharmacy IS• Nick Groves, Project Leader - Primary Health CareTransition FundPharmacy ServicesAim Statements1. Reduce the mean number of undocumentedintentional discrepancies on residents moving intoResidential Neighbourhoods by 75% by October20062. Reduce the mean number of unintentionaldiscrepancies on residents moving into ResidentialNeighbourhoods by 75% by October 20063. Increase our Medication Reconciliation SuccessIndex (MRSI) by 75% by October 2006Pharmacy Services2

Moving In Medication Orders - MIMOPharmacy ServicesChanges TestedP DA SPDSA 1Jan-Feb 06ImplementedMIMO atHoly FamilyECUP DA SPDSA 2Mar 06Evaluation ofHFH MIMOImplementationPDSA 3 NurseSatisfactionPDSA 4 PostedRN InstructionsP DA SPDSA 5Apr 06Developed Rxspreadsheet totrack MIMOsPDSA 6ImplementedMIMO atLangaraResidenceP DA SPDSA 7May 06ImplementedMIMO at MSJECUPDSA 8Implementedreview ofstoppedordersP DA SPDSA 9Aug 06ImplementedMIMO at BrockFahrniPharmacy Services3

Medication Reconciliation IndicatorsPHC Residential Care Admissions1.60100%Rate (per patient)1.401.201.000.800.60MIMOImplementedat 1 SiteHoly FamilyMIMOImplementedat 2nd SiteLangaraOne outliern = 9MIMOImplementedat 3rd SiteMount St.JosephMIMOImplementedat 4th SiteBrock Fahrni90%80%70%60%50%40%Success Index30%0.4020%0.2010%0.00Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06Undocumented IntentionalTarget (0.35 per patient)Unintentional DiscrepanciesDiscrepancies(per patient)(per patient)Target (0.21 per patient)Pharmacy Medication Reconciliation ServicesSuccess IndexTarget (96%)0%One Resident’s Story• TW, 75 year old femaleHomeVGHUBCHLangaraMay 8May 19June 13• 5 drugs omitted on initial admission from home• At least 3 opportunities for medicationreconciliation• Undetected until admitted to LangaraPharmacy Services4

Leadership Support• In 2001, Providence Health Care engaged in the Institutefor Healthcare Improvement Collaborative: “QuantumLeaps in Patient Safety.”– Senior Leadership Involvement• Chief of Professional Practice – Lynette Best• Pharmacy Leader - Robin Ensom• Patient Safety Leader Position• Patient Safety Officer Training – IHI• Organizational commitment to best practice and evidencebased care• Safer Healthcare Now!Pharmacy ServicesKeys to Success• Team Accelerators– Team Leader - Early Adopter– Physician advocate– Resources allocated to do the work– Quality Support– Small Tests of Change– Nurse and Physician Buy In – What’s in it for me?• Rolling out – implementing across program– Involving key stakeholders – CNL, UC, Rx– Education– Timely follow-up - communicationPharmacy Services5

Questions ???For more information contact:Pam Kelly, Team LeaderPhone: (604) 322-2601Email: pkelly@providencehealth.bc.caPharmacy Services6