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Canadian MedRec Quality Audit Month: Results and Future Direction

Canadian MedRec Quality Audit Month: Results and Future Direction



Purpose of the Call: ...

Purpose of the Call:
•Review the results of the Canadian MedRec Audit Month
•Discuss lessons learned from the audit month – strengths and areas for improvement
•Suggest future value of audits and audit tools for your organization
•Gather ideas about how to improve the quality of MedRec at admission

Watch the recorded webinar: http://bit.ly/19aUYbU



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    Canadian MedRec Quality Audit Month: Results and Future Direction Canadian MedRec Quality Audit Month: Results and Future Direction Presentation Transcript

    • Canadian MedRec Quality Audit Month: Results and Future Direction Marg Colquhoun, Virginia Flintoft and Alex Titeu December 2013 www.saferhealthcarenow.ca
    • Where to find our webinars… www.ismp-canada.org/medrec See “Education and Training” http://www.saferhealthcare now.ca/EN/events/National Calls/Pages/default.aspx www.saferhealthcarenow.ca
    • Outline • • • • Background Audit Month results Interactive discussion Accessing your results in the Patient Safety Metrics System www.saferhealthcarenow.ca
    • Background MedRec Quality Audit Tool • Launched in June 2013 • Collects data on the quality completion of admission MedRec in acute and long term care settings • Completed through chart audit post-completion of admission MedRec processes • Organization specific tools are generated through Patient Safety Metrics System (PSMS) • Completed tools are faxed, and data is presented in PSMS www.saferhealthcarenow.ca
    • Background Canadian MedRec Quality Audit Month • Across Canada, there are ongoing challenges related to the effective and reliable completion of MedRec processes. • Measurement of MedRec processes can help to identify areas of excellence and areas for improvements MedRec Quality Audit Month – October 2013 5 www.saferhealthcarenow.ca
    • Background Audit Month Methodology • Call to action national call/webinar on October 1st, 2013. • Sites registered to participate – Central Measurement Team (CMT) facilitated the creation of audit/data collection forms • MedRec Audit Month Workbook published • Sites submitted data to the Patient Metrics System throughout the month of October – CMT corrected any data submission error reports and resubmitted • Preliminary results (e.g. numbers of participating sites) were presented October 30th, during Canada’s Virtual Forum on Patient Safety and Quality Improvement 6 www.saferhealthcarenow.ca
    • Audit Month Results www.saferhealthcarenow.ca
    • Audit Month Results • Audit participation • Results by column • Calculated results • Relationships between variables 8 www.saferhealthcarenow.ca
    • Audit “Participants” Sites = 103 Patient/Resident Charts = 2,340 9 www.saferhealthcarenow.ca
    • “Participants” by Province/Territory 103 sites 2,340 patients Number of Patients Provinces/Territories 10 www.saferhealthcarenow.ca
    • “Participants” by Sector 2,340 patients 103 sites 15% N=348 23% N=24 LTC LTC Acute Care Acute Care 85% N=1,992 11 77% N=79 www.saferhealthcarenow.ca
    • • Audit participation • Results by column • Calculated results • Relationships between variables 12 www.saferhealthcarenow.ca
    • 0 13 www.saferhealthcarenow.ca
    • A. ‘Admission via’ N=2,298 57% 50% 14 www.saferhealthcarenow.ca
    • = 15 www.saferhealthcarenow.ca
    • B. ‘Med Rec Performed’ N = 2,328 95% 75% 16 www.saferhealthcarenow.ca
    • 17 www.saferhealthcarenow.ca
    • Literature suggests….. • A review of published articles found that 10-67% of patients had at least 1 prescription medication history error – when non-prescription medications were included the frequency of errors was 25-83% • Authors suggest: “should be a comprehensive medication history that includes an interview, inspection of medication vials or lists, or both and contact with community pharmacies, or family physicians.” CMAJ, 2005 http://www.cmaj.ca/content/173/5/510.full.pdf+html www.saferhealthcarenow.ca
    • C. ‘BPMH -greater than one source’ N=2,040 74% 60% 19 www.saferhealthcarenow.ca
    • 20 www.saferhealthcarenow.ca
    • Literature suggests… • 66% of Canadians have sometimes used non-prescription medication in the past six months. • 57% sometimes took vitamins and minerals, while 34% sometimes took herbal and natural products. 2004 Survey of Canadians’ Use of OTC Medications http://www.bemedwise.ca/english/usagesurvey.html • Adherence- “the extent to which a person’s behavior [in] taking medication…corresponds with agreed recommendations from a health care provider” (World Health Organization, 2003). • 12% of patients don’t fill their prescription at all. • 12% of patients don’t take medication at all after they fill the prescription. • 22% of patients take less of the medication than is prescribed on the label. Adult Meducation http://www.adultmeducation.com/OverviewofMedicationAdherence_2.html www.saferhealthcarenow.ca
    • D.‘Med Use Verified by Pt/Caregiver’ N=2,044 63% 57% 22 www.saferhealthcarenow.ca
    • www.saferhealthcarenow.ca
    • 24 www.saferhealthcarenow.ca
    • E.‘Each med w/ name dose, route, etc.’ N=1982 77% 92% 25 www.saferhealthcarenow.ca
    • 26 www.saferhealthcarenow.ca
    • Literature suggests…. • Medication discrepancy was defined as a difference between the medication use history (BPMH) and the admission medication orders. • In the sample of patients admitted to general medicine unit: – 54% of patients had at least one unintentional discrepancy identified (most common type was omission of a regularly used medication) – 38% of these discrepancies were judged to have the potential to cause moderate to severe discomfort or clinical deterioration www.saferhealthcarenow.ca
    • F.‘Meds on BPMH+Admin Order’ N=2,006 87% 73% 28 www.saferhealthcarenow.ca
    • 29 www.saferhealthcarenow.ca
    • G.‘Prescriber documented rationale’ N=1,946 84% 64% 30 www.saferhealthcarenow.ca
    • Audit Month Results • Audit participation • Results by column • Calculated results • Relationships between variable 31 www.saferhealthcarenow.ca
    • To calculate a MedRec Quality Score, each “Yes” (or “Unable to Perform”) is assigned 1 point for each of the highlighted columns 32 www.saferhealthcarenow.ca
    • Percentage of Patients by Score N=1,937 55% 29% 33 Scores www.saferhealthcarenow.ca
    • Audit Month Results • Audit participation • Results by column • Calculated results • Relationships between variables 34 www.saferhealthcarenow.ca
    • 35 www.saferhealthcarenow.ca
    • % Med Rec Performed by Score 55% 29% 7% 36 0% www.saferhealthcarenow.ca
    • 37 www.saferhealthcarenow.ca
    • Compliance w/ 1st 3 elements by “Admit via” 38 www.saferhealthcarenow.ca
    • Results Summary Comments • Because this is the first audit using these criteria, we do not have historical data to compare our progress it is likely that we have collectively improved • However, audit tool results demonstrate need for ongoing and specific improvements • Many people believe they are doing MedRec but they may not be doing it well – The foundation of the process – the BPMH needs work • Validity of the BPMH –results are disappointing – It will be useful to use the scores and correlations in future audits to measure improvement www.saferhealthcarenow.ca
    • Results Summary Comments • Need to critically evaluate admission processes to ensure quality of MedRec processes at other transitions • Sites will need to understand the need for training people to use the audit tool – materials are available to support this process 40 www.saferhealthcarenow.ca
    • Discussion www.saferhealthcarenow.ca
    • Accessing Your Data in the Patient Safety Metrics System Virginia Flintoft & Alex Titeu 42 www.saferhealthcarenow.ca
    • 43 www.saferhealthcarenow.ca
    • 44 www.saferhealthcarenow.ca
    • 45 www.saferhealthcarenow.ca
    • Data Collection (Audit) Form 46 www.saferhealthcarenow.ca
    • 47 www.saferhealthcarenow.ca
    • 48 www.saferhealthcarenow.ca
    • 49 www.saferhealthcarenow.ca
    • 50 www.saferhealthcarenow.ca
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    • 54 www.saferhealthcarenow.ca
    • Contact Patient Safety Metrics team at: metrics@saferhealthcarenow.ca Contact ISMP Canada MedRec team at: medrec@ismp-canada.org 55 www.saferhealthcarenow.ca
    • Upcoming MedRec Webinars Jan 14, 2014 The MARQUIS Project Dr. Jeffrey Schnipper Feb 11, 2014 Engaging Patients in MedRec March 25, 2014 MedRec in Home Care 56 www.saferhealthcarenow.ca
    • On behalf of the ISMP Canada MedRec Team, CPSI and the Patient Safety Metrics Team All the best in 2014! www.saferhealthcarenow.ca