presentation on implementing medrec in non-inpatient settings

22
Medication Reconciliation Networking Session Steve Rough, MS., RPh. Director of Pharmacy University of Wisconsin Hospital and Clinics

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Page 1: Presentation on Implementing MedRec in Non-Inpatient Settings

Medication Reconciliation Networking Session

Steve Rough, MS., RPh.Director of Pharmacy

University of Wisconsin Hospital and Clinics

Page 2: Presentation on Implementing MedRec in Non-Inpatient Settings

Objectives

Provide a return on investment (ROI) framework for cost-justifying additional pharmacist resources for medication reconciliation

Review a strategy for implementing medication reconciliation in non-inpatient care areas (clinics, procedure areas, emergency department, etc)

Page 3: Presentation on Implementing MedRec in Non-Inpatient Settings

ROI Framework

Page 4: Presentation on Implementing MedRec in Non-Inpatient Settings

ROI Framework

Page 5: Presentation on Implementing MedRec in Non-Inpatient Settings

ROI Framework

Page 6: Presentation on Implementing MedRec in Non-Inpatient Settings

Approach for implementing medication reconciliation in

non-inpatient areas

Page 7: Presentation on Implementing MedRec in Non-Inpatient Settings

Key stakeholders identified– Medical staff, pharmacists, nurses, and representation from

the OR, radiology, cath lab, medical records, quality, risk management, public affairs, and IT

Establishment of Medication Reconciliation Steering Committee– Charged with leading the implementation process– Pharmacy and Nurse Managers serve as co-chairs– Membership from each key stakeholder group

Resident major project

Step 1: Prepare

Page 8: Presentation on Implementing MedRec in Non-Inpatient Settings

Step 1: Prepare

Charge of the Medication Reconciliation Steering Committee – Developing standardized medication reconciliation

processes and workflows– Developing training materials, tools and resources– Outlining specific accountabilities for staff training

and implementation– Develop auditing mechanisms to ensure

compliance and measure sustained compliance

Page 9: Presentation on Implementing MedRec in Non-Inpatient Settings

Step 2: Assess the current system

Identify all impacted areas and the manager of each area (91 areas)

Gap analysis to determine levels of performance in clinics, procedure areas, emergency department– Identify all access points for patients within the

organization– For each element of performance, determine

areas where not fully compliant with standards

Essentially 100% non-compliance!

Page 10: Presentation on Implementing MedRec in Non-Inpatient Settings

Example of Accountabilities

Page 11: Presentation on Implementing MedRec in Non-Inpatient Settings

Step 3: Analyze

Meet with leaders/managers from four major areas– Clinics (2 nursing directors over all 80 clinics)– Procedure areas (Radiology, Cath Lab, Infusion

Center, Peds Sedation, GI, etc, etc)– Perioperative areas (Inpatient and ambulatory

surgery, recovery)– Emergency Department

Educate them on the required elements of NPSG 8a & 8b

Page 12: Presentation on Implementing MedRec in Non-Inpatient Settings

Step 3: Analyze

Workflows documented for each area to fit with patient flow– Four workflows established:

• Paper• Traditional electronic medical record (WISCR/ADS)• Health Link (Epic) – new electronic health record• Transplant database

Page 13: Presentation on Implementing MedRec in Non-Inpatient Settings

Example of workflow diagram

Workflow for WISCR/ADS Clinics

Dis

char

ge P

lann

erM

DM

A or

Aut

horiz

ed P

erso

nnel

Patie

nt

DP prints medication list with

changes and provides to patient

MD gives visit data form to patient to

take to Disch. Planner

Print a master problem list and visit data sheet

Patient stops at discharge planner

desk

MD documents changes on visit data form and

writes new prescriptions

DP transcribes changes into ADS

Medication changes?

Patient education on medication

changes

Patient arrives in clinic

Patient leaves clinic

Verifies patient allergies

NoMA takes patient to exam room

Yes MD conducts patient visit

Allergy changes?

MA notifies MD that patient is ready for visit

Medication changes?

MA opens ADS in the exam room and completes

standard question list

DP obtains visit data form and

reviews changes to medication list

No

Yes

MD reviews patient medication list and problem

list

Visit Data Form is returned for filing

in the Medical Record

MA verifies current medication list with

patient

Updates patient allergies in ADS

Patient schedules appointment and is given

reminder to bring in medication list

No

MA updates ADS med list

Yes

DP schedules return appt or diagnostics &

gives medication list to patient

Page 14: Presentation on Implementing MedRec in Non-Inpatient Settings

Step 4: Plan

Identify responsible person for implementation in each clinic site– Documentation of medication history,

reconciliation, updates, providing list to patient and next provider of care

Quantify resources needed by area– Computers– Access to information– Education– Personnel

Page 15: Presentation on Implementing MedRec in Non-Inpatient Settings

Step 4: Plan

Develop education materials– Include the case for medication reconciliation- it’s

the right thing to do for our patients!– Steps for obtaining a complete medication list

• Include name, dose, route, frequency, last dose taken, indication

– How to perform reconciliation– Policy expectations

• documentation of history and allergies on every patient• providing every patient with discharge medication list• send list to next provider if medication changes

Page 16: Presentation on Implementing MedRec in Non-Inpatient Settings

Step 4: Plan

Development of documentation tools– Paper documentation form for areas without

electronic documentation – Modifications to electronic tools already available

to include patient friendly terms, easier to read information

• provider-entered information prints out in patient-friendly format

Page 17: Presentation on Implementing MedRec in Non-Inpatient Settings

Example of Paper Documentation

Page 18: Presentation on Implementing MedRec in Non-Inpatient Settings

Step 4: Plan

Development of auditing tools that are sustainable– Include questions on all five elements of

performance on Joint Commission tracer• History documented• Reconciliation• Clarification of discrepancies• List to patient• List to next provider of care

Page 19: Presentation on Implementing MedRec in Non-Inpatient Settings

Step 5 & 6: Execute and Measure

Educational road shows and web casts for managers and front line staff

Rolling implementation, not pilots– Start with high risk area: ED, Radiology, Cath lab, surgery

clinics

Pharmacy resident and students audit compliance for 6 months

Implement changes and improvements on the fly as needed

Page 20: Presentation on Implementing MedRec in Non-Inpatient Settings

Step 7&8: Communicate & Replicate

Communicate audit results to key stakeholders

Big bang go-live in all remaining areas over 2 month timeframe

Poster showcase for Joint Commission surveyors

Optimize processes in Health Link

Page 21: Presentation on Implementing MedRec in Non-Inpatient Settings

Tools Available on ASHP Website

Policy and Procedure Workflows Forms Training materials ROI spreadsheet

http://www.ashp.org/s_ashp/cat1c.asp?CID=489&DID=7607

Page 22: Presentation on Implementing MedRec in Non-Inpatient Settings

Questions