medication reconciliation in long-term care: where do i begin?
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Medication reconciliation in long-term care: where do I begin?. November 15 th , 2011 0900 to 1000 pst. November 4, 2011. Clinical Care Management (CCM). Ministry of Health chose nine quality improvement areas to support through the CCM initiative - PowerPoint PPT PresentationTRANSCRIPT
MEDICATION RECONCILIATION IN LONG-TERM CARE: WHERE DO I BEGIN?NOVEMBER 15TH, 20110900 TO 1000 PST
November 4, 2011
Clinical Care Management (CCM)
• Ministry of Health chose nine quality improvement areas to support through the CCM initiative
• BC Patient Safety & Quality Council providing a supportive role to the Health Authorities
• Resources and information on website• http://www.bcpsqc.ca/quality/medrec.html
• Med Rec in Long-term Care• Quality Lead – Mary Lou Lester• Clinical Lead – Dr. Keith White
December Virtual Learning Opportunity
Tuesday, December 13th from 0900 to 1000 PSTMedication Reconciliation in Long-term Care: How do we measure up?Guest speakers:
• PH/VCH med rec team • Jill Veenendall, BCPSQC Measurement Quality Lead
Safer Healthcare Now! and
Medication Reconciliationin the Long-Term Care Setting
Jennifer TurpleMedication Safety Specialist- MedRec
ISMP Canada
Tools and Resources
• How- to Guide• Quick Reference• Provides:
– Graphics, diagrams, posters and forms
– Tips– Definitions– Information on
measurement, and QI methodologies
Tools and Resources• MedRec Community of Practice
– A website where registered users can:• Share tools such as MedRec forms, educational
materials, presentations, business cases, etc.• Post and/or respond to questions • Receive alerts on newly posted contents, upcoming
webinars, and general announcements.
Community of Practice
• Uses Sharepoint software• Free!• Simple registration process• Set up alerts to automatically send
updates (of your choice) to your email
Community of Practice Demo
Education• National Calls/Webinars via Webex
December 6th
– MedRec Success Stories from across the Continuum (Acute Care, Home Care, Ambulatory and Long-Term Care)
January 10th
– Medication Reconciliation in Long Term Care – A Fully Integrated Electronic Solution
Education
• Virtual Action Series- MedRec to Go!
– An online “course” that gives guidance to acute care facilities on creating a reliable MedRec on discharge process.
– Consists of 5 x 1.5 hour virtual sessions over 5 months.
– Next series will begin in February 2012.
MedRec to Go!
• This series:– Encourages developing a multidisciplinary team of
care providers including representation from LTC facilities.
– Shares experiences of many acute care- LTC collaborations that have resulted in improved transfer of medication information.
MedRec to Go!
Information SessionNovember 24th and January 17th
Registration DeadlineJanuary 17th
Looking for Practice Leaders in LTC!
To acknowledge the broad diversity of healthcare systems in Canada, we now want to broaden this definition to include MedRec reliably implemented across all transitions of care for:
• An entire program or targeted patient group such as a region wide Home Care program or province wide renal program
or• > 50% of all applicable patients/clients served by
your organization
Cross Canada Checkin
• Map link and Demo
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Facilitating Med Rec in Residential Care and
Assisted LivingAnita Lo BSc (Pharm) Pharm D
Fraser Health Med Rec Facilitator November, 2011
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Learning Objectives
The role of a Med Rec Facilitator Strategies used to facilitate Medication Reconciliation in
residential care
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Fraserhealth (FH) Med Rec Facilitator
FH hired 3 facilitators (2Rx and 1 RN) FH is moving forward with Program Management and
residential care is one of the programs that concerns 12 FH acute sites
As Med Rec Facilitators, we have a critical mission : We must successfully meet the rising challenges (ensuring
safety at each transition point of care ) and complexities of the Healthcare environment
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Role of a Med Rec Facilitator
Learn more about the current and future state Build processes Develop tools Implement practice change Remove or alleviate barriers to sustain practice change
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Bringing Med Rec to FH RCAL Create a realistic Timeline
Short term opportunities (0-2 month) Establish team, set realistic goals, connect and bond
Medium term opportunities (2-4months) Process mapping, introduce tools, PDSA cycles, work with a
work plan Marketing and promoting Med Rec
Long term opportunities (4-6 months) Discuss sustainability
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Bringing Med Rec to FH RCALShort term opportunities (0-2month)
Establish teams (Stakeholders/key players) Steering committee memberships –Regional Directors
(Pharmacy and Nursing), Physician lead, QI, PPI, & Med Rec Expert Leaders -responsible for goals and objectives
Working group memberships- Local nursing staff, Unit clerks, Res Care Coordinators, Pharmacists, & Clinical Nurse Educators, Access coordinators.-work with tools and flow of work.
Schedule meetings – q2weeks for WG and monthly for SC.
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Bringing Med Rec to FH RCALShort term opportunities (0-2month)
Set realistic goals Establish a Charter (Goals and objectives) to catch VPs/Exec Dir/Medical Directors’ attention An agreement on what’s possible, and what’s not (eg.
measurements) Connect and bond
Review past pilot experience and lessons learned Start with small group discussions prior to bigger group
discussion to secure “buy-ins”.
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Bringing Med Rec to FH RCALMedium term opportunities (2-4 month)
Process mapping Identify current state and seek opportunities of
improvement in the future state Introduce tools
Consider Electronic vs manual tools Internal transfers (within FH)
From Acute Care to Residential Care From one FH site to another
External transfers (Direct admit) From Assisted Living Facilities
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Making the tools accessible
Work with local IT/IS Assess what is available Assess what is currently useful Modify and refine current tools with Med Rec in mind Assess who needs access Get physicians to test+input+refine tools
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Bringing Med Rec to FH RCALMedium term opportunities (2-4 month)
PDSA (Plan-Do-Study-Act) cycles Identify things that can be tested (can be process or tools) Eg. redundancy of a residential care fax covering sheet During our tests period (Sept 20-October 17, 2011)
12 admits (3 deceased, 1 transferred out to Geriatric care, 1 was a recurring res where the form was not applied)
7 of the remaining has 100% compliance in having the form on the chart, prescribers orders indicated, and signatures complete
28% put a date, 57% put college ID 57% initialed and indicated they have reviewed meds on
admission.
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Bringing Med Rec to FH RCALMedium term opportunities (2-4 month)
Create and follow a step by step work plan A lot of work but rewarding at the end Preparation, Planning, Education, Go-live, Evaluation, Sustainment What is the task in the above? Who’s responsible for the task? When is the time to finish this? How are we doing- What is the status of this task?
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Marketing and Promoting Med Recis a continuous process
Clarify what is Medication Reconciliation Med Rec versus Med Review
Internal resources Clinical Nurse Educator (CNE) is a “huge” component It’s better from a RNs perspective as the Audience is largely
Nursing (RNs, Unit Clerks, LPNs and nursing managers) Rx is your next best friend
External resources Build an ongoing Communication Plan (Manager to staff, physician to
physician, Pharmacy staff meetings, attend RCC meetings, use FAQs for go-live)
Physicians connections (use what works right now….eg. How to roll out preprinted orders)
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Bringing Med Rec to FH RCAL Long Term Opportunities (4-6 month)
Empowering and sustaining Leaders are people who find the possibilities in others
Empower and work with the frontline staff by Discussing the possibility of increased patient safety Highlight shaping best practice possibilities Reassuring ongoing support is at local sites
Build infrastructures (see diagram next)
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Sustaining the practice
Clinical Integration Executive Committee Sponsors
Clinical Operations
Clinical Program Leadership/Program
ED & MDand
Program Quality Performance Committees
Regional Medication Reconciliation Advisory Committee(Regional Steering)
· Representative Clinical / Operational Leaders
· Quality Improvement · Pharmacy Information Systems· Senior Consultant Health
Informatics· Professional Practice & Integration
Representative· MedRec Facilitators· Site Director· Patient Advocate
Local/Program Steering & Working Groups
Proposed Medication Reconciliation Initiative Charter Organization Chart
Med-Rec Faculty· Representative Program Clinical /
Operational Leaders· Med Rec Facilitators· QIPS Managing consultant· PPI· Physician (Ad hoc)
Site Directors
HAMAC
Multidisciplinary Healthcare
Coordinating Committee
PHYSICIAN SPONSORSHIP
ACCOUNTABILITYTO IMPLEMENT
AND SUSTAIN MED-REC
LEADERSHIP/COORDINATION OF REGIONAL EFFORTS
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MilestonesTimeline 2011 2012
Developments April May June July Aug Sept Oct Nov Dec Jan
1. Met with Exec
2. Identify membership
3. one page charter
4. Process Mapping
S. Introduce tools
6. Review tools
7. Set up work plan
8. Discuss PDSA cycles
9. Test PDSA
10. Plan Education needs
11. Discuss Go-live
12. Next site?
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RCAL Med Rec Pearls Realistic timeline Connect- Build a team (find a physician who’s interested) Assess tools- Keep it simple Learn from each others – encourage and empower the
staff
