admission medication reconciliation at lions gate hospital
DESCRIPTION
Admission Medication Reconciliation at Lions Gate Hospital. Lean Transformation Services Laarnie St-Laurent, Lean Coordinator Lorelei Grosser, Lean Coordinator Carissa Looman, Lean Educator. Objectives: What is MedRec ? Why do MedRec ? How was MedRec implemented? - PowerPoint PPT PresentationTRANSCRIPT
AdmissionMedication Reconciliation
at Lions Gate HospitalLean Transformation Services
Laarnie St-Laurent, Lean CoordinatorLorelei Grosser, Lean Coordinator
Carissa Looman, Lean Educator
Admission MedRec at Lions Gate Hospital
Objectives:
• What is MedRec?• Why do MedRec?• How was MedRec implemented?
Brief overview of Lean Methodology How Lean was used for implementation
• How are we doing now? Audit Results
• What are key “lessons learned?” Impacts of MedRec
Ever wondered…
• Right medication?• Right dose?
• Right time?
Admission MedRec at Lions Gate Hospital
What is MedRec?
Admission MedRec at Lions Gate Hospital
What is MedRec?
“Best Possible”
Medication History
Reconciliation (Orders)
Pharmanet(Prescribed
Drugs)
Admission MedRec at Lions Gate Hospital
Why do MedRec?
Did you know…• “40-50% of patients on admission” are at risk of
unintentional medication discrepancies? Medication errors may harm patients Of these, 6% are at risk of harm serious enough to
increase length of stay from 2-8 days2.
Admission MedRec at Lions Gate Hospital
Why do MedRec?
Some Local Data
• At Lions Gate: About 38.8 daily admissions 12.5 patients at risk of unintentional discrepancies
0.75 patients daily at risk of staying 2 to 8 days longer About $246K additional costs per year
(based on average cost of $450/patient/night)
Admission MedRec at Lions Gate Hospital
Steps to Achieving Continuous Improvement– sequence to approach the tools
Observe and Collect Data
Standard Work
Unit Layout/ Cell Design (Flow)
Mistake ProofingVisual Controls
Other tools to improve flow and implement pull
See for yourself & collect objective data that becomes the starting point for
discussions
-”Without Standards, there can
be no improvement“ Taiichi
Ohno
Adapted from Virginia Mason Lean Leader Certification
Materials
Continuous
Improvement
First:
Understand the Current
State
Then:
Improve the Process
Rather than thinking specific tools do not apply, consider if their concept can provide
benefit.
And Then:
Repeat!
VCH Improvement SystemLean Tollgate
LTS_VCH Improvement System_V1
Project Definition
Current State Analysis
Future State Development
Implementation/Go-Live
Audit/Refine
Sustainment
Observations: Data Collection
How was MedRec implemented?
Admission MedRec at Lions Gate Hospital
Future State Value Stream Map
Triage Emerg Nurse Emerg Doctor Admission
MRO printed
for certain areas in Emerg
• BPMH documented
by RN or Pharmacist
on • MRP
reconciles home
medications• MedRec Order (MRO)
form processed
How was MedRec implemented?
Admission MedRec at Lions Gate Hospital
Standard Operating Procedures:
How was MedRec implemented?
Who
WhyWhen
How
Admission MedRec at Lions Gate Hospital
What
How was MedRec implemented?
Admission MedRec at Lions Gate Hospital
How was MedRec implemented?Auditing and Breakthrough Lanes:
Met MedRec criteria
Did not meet
MedRec criteria
Admission MedRec at Lions Gate Hospital
How was MedRec implemented?Auditing and Breakthrough Lanes:
Why did not meet
MedRec criteria?
Admission MedRec at Lions Gate Hospital
How was MedRec implemented?Auditing and Breakthrough Lanes:
Did not meet MedRec?
Now what????
Admission MedRec at Lions Gate Hospital
How are we doing now?
Organizational TargetsCompletion Rate 75%
BPMH Completion 75%
Reduction in unintentional discrepancies 75%
Reduction in undocumented intentional discrepancies 75%
Admission MedRec at Lions Gate Hospital
How are we doing now?
Area Quantitative ResultsElective Surgery: • Implemented on November 2011
•100% have complete, accurate medication histories•100% receive post-op medication orders• 75% reduction in unintentional discrepancies• 85% reduction in undocumented intentional discrepancies
Admission MedRec at Lions Gate Hospital
How are we doing now?
Area Quantitative ResultsEmergent/Direct Admissions• Implemented on May 23, 2012
•77.5% to 80% reconciliation rate (exceeded target of 75%)•47.5% “best possible medication history” completion rate•50% reduction in unintentional medication discrepancies•55% reduction in undocumented intentional medication discrepancies
Admission MedRec at Lions Gate Hospital
Comparison: Vancouver CoastalSite Average Completion Rate
• Since Implementation
Richmond Hospital 60%
Vancouver General 78%
Coastal
Squamish General 60%
St. Mary’s Hospital 65%
Powell River General TBA
Lions Gate Hospital 78%
How are we doing now? Examples of “good saves” and Qualitative Results…
Admission MedRec at Lions Gate Hospital
MedRec Success Stories
Unit Good saves…Emergency MD ordered only one of patient’s home meds at half the dose the patient was
taking. When med history was taken by RN, MD ordered the rest of home meds (5 pages were missed).
Pediatrics Patient’s Pharmanet only showed one medication. When BPMH was taken, patient was taking medication at a different dose than on Pharmanet and was also taking a number of other medications NOT on the Pharmanet.
Daycare Surgical patient was seen in PSSU 2 weeks prior to surgery, but had filled other prescriptions since then. Daycare RN picked up on new meds when BPMH was done prior to surgery.
Admission MedRec at Lions Gate Hospital
Reference List:
1 Canada. Accreditation Canada. Required Organization Practice. Ottawa: Accrediation Canada, 2012. Print.
2 Canada. Optimizing Medication Safety at Care Transitions – Creating a National Challenge. Toronto: 2011. Print.
Admission MedRec at Lions Gate Hospital
Questions???Thank you for listening!
Admission MedRec at Lions Gate Hospital
February 27, 2013
What is MedRec?
SystematicPartnership
Conversation
Admission MedRec at Lions Gate Hospital
February 27, 2013
How was MedRec implemented?
2 Map the
Value Stream
3Establish
Flow
4Implement
Pull
5Work to
Perfection
1Specify Value
2 Map the
Value Stream
3Establish
Flow
4Implement
Pull
5Work to
Perfection
1Specify Value
Source: James P. Womack. Lean Thinking.
5 Steps to Lean Thinking
Admission MedRec at Lions Gate Hospital
February 27, 2013
Audit & Refine
Paper flow
Implement
Medication Management
Admission MedRec at Lions Gate Hospital