Webinar - The Stepping Stones to MedRec Success

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Webinar - The Stepping Stones to MedRec Success

  1. 1. The Stepping Stones to Med Rec Success Sandy Jansen, Director of Pharmacy Nadia Facca, Pharmacy Practice Leader Pam Andress, Clinical Informatics Specialist London Health Sciences Centre (LHSC) •Multi-site acute care teaching hospital in London, Ontario •Over 900 beds •15, 000 staff •Regional academic programs including renal, cancer, neonatology and pediatrics, transplant, emergency, medicine, surgery, cardiology, CNS, mental health 11 1/22/2013 Sharing Our Success @ LHSC • Successful Corporate Implementation of Medication Reconciliation at Admission, Transfer, Post-op and Discharge achieved by June 2012 • Acknowledged by ISMP to have achieved “All Star” Status for Medication Reconciliation Cross Country MedRec Check-up 2 1/22/20132 1/22/2013
  2. 2. The Stepping Stones to Med Rec Success @ LHSC 3 1/22/20133 1/22/2013 “It’s very important that you find something that you care about, that you have a deep passion for, because you’re going to have to devote a lot of your life to it.” – George Lucas COMMITMENT 4 1/22/20134 1/22/2013 Commitment • Lessons learned from three failed previous attempts • A number of factors prevented successful adoption including: • No formal policy, procedures • Not an Required Organization Practice for Accreditation • Pharmacy owned the process…no Multidisciplinary Focus • No Corporate Wide Sponsors • Lack of Physician Engagement 5 1/22/20135 1/22/2013
  3. 3. Commitment • New CEO: October 2010 • New Director of Pharmacy: Spring 2011 • Interdisciplinary Champions Appointed • Support from other Influential Leaders 6 1/22/20136 1/22/2013 Commitment ‘Key Messages’ shared with all… Key Messages’ all… •Medication Reconciliation is not an option and will be done on every inpatient at LHSC •It is an interdisciplinary process including physicians, nurses, pharmacists •It is a combined paper/electronic process •It is a Required Organizational Practice for Accreditation Canada It is Mandatory!! 77 1/22/2013 ”Life is not a dress rehearsal. Stop practicing what you’re going to do and just go do it. In one bold stroke you can transform today". - Marilyn Grey CHALLENGES 8 1/22/20138 1/22/2013
  4. 4. Challenges • No additional funding to support process • Lack of engagement • Pervasive perception that med rec involves more work and no benefit • “Why do this on paper when it would be so much easier to do this electronic?” • Education of all involved in process • Evaluation 9 1/22/20139 1/22/2013 Challenges “Its not so much that were afraid of change or so in love with the old ways, but its that place in between that we fear . . . . Its like being between trapezes. Its Linus when his blanket to” is in the dryer. Theres nothing to hold on to”. - Marilyn Ferguson 10 1/22/201310 1/22/2013 Challenges • “Admission, Transfer AND Discharge???” • Challenging Patient Populations • Surgery • Areas with existing pre-printed (paper) orders • Mental Health • Transfer from one hospital to the other (within LHSC) • Obstetrics 11 1/22/201311 1/22/2013
  5. 5. “If everyone is moving forward together, then success takes care of itself”. - Henry Ford COLLABORATION 12 1/22/201312 1/22/2013 Collaboration Board of Directors Medication Reconciliation Steering Committee MAC Medication Reconciliation DTC Project Team Drug & Therapeutics Committee Medication Reconciliation Project Structure Unit Working Teams13 1/22/2013 Collaboration Project Team Members: • Project Leader • Frontline Nurses • Project Manager • Clinical Informatics • Pharmacy Leadership • Decision Support • Pharmacists • Medical Affairs • Pharmacy Student • Risk Management • Physicians and Residents • Forms Management • Nursing Leadership • Communications • Nursing Educators 1/22/201314 1/22/2013
  6. 6. Collaboration Unit Specific Working Teams • Consisted of Unit Leadership, Nursing Educators, Frontline Nursing Staff, Physicians, Unit Clerks, Pharmacists • Met with members of the Project Team to learn about new forms and new process • Project Team provided Units with various standardized educational materials • Discussed how Med Rec would be implemented in their clinical area with current resources 15 1/22/201315 1/22/2013 Audience Poll #1 Please take the next 30 seconds to respond to the following poll question (found on the right hand side of your screen). 16 1/22/201316 1/22/2013 FORMS… FORMS… 17 1/22/201317 1/22/2013
  7. 7. 18 1/22/201318 1/22/2013 19 1/22/201319 1/22/2013 “The real art of conversation is not only to say the right thing at the right place but to leave unsaid the wrong thing at the tempting moment”. – Dorothy Nevill CONVERSATIONS 20 1/22/201320 1/22/2013
  8. 8. Conversations • Implementation Phases vs. Pilot Areas • Entire Hospital vs. Key Areas • Clear Communication for Implementation Phases: • Phase 1 (Oct 2011): Sub Acute Medicine Unit/Palliative Care at Victoria Hospital • Phase 2 (Nov 28, 2011): Orthopaedics Surgery at University Hospital • Phase 3a (Feb 29, 2012): All of University Hospital • Phase 3b (May 30, 2012): All of Victoria Hospital 21 1/22/201321 1/22/2013 Conversations • Crucial Conversations® • Timing is everything… • Educational sessions • Medical Leaders, Staff Physicians, Residents, Students • Pharmacists, Pharmacy Technicians • Nurses, Unit Clerks • Quality & Patient Safety Council 22 1/22/201322 1/22/2013 Conversations • Various communication strategies were used • E-casts, articles, weekly tips via email, newsletters • Kickoff sessions at each hospital prior to implementation • Visible, active support during implementation by project team members • Risk Management Involvement (AEMS) • Support via email, phone, pager • Follow-up with unit leadership and staff post- implementation • Wrap up meetings post-implementation at both hospitals 23 1/22/201323 1/22/2013
  9. 9. "Success is not final, failure is not fatal: it is the courage to continue that counts”. - Winston Churchill COURAGE 24 1/22/201324 1/22/2013 Courage • Courage to ask the question “Why will this not work on your unit/with your patient(s)?” • To be able to respond appropriately • May have to say “No…we are doing it this way” • Resist the urge to allow customization of forms/process unless absolutely necessary • “Don’t give up” • Being truthful and manage expectations • “Med rec will add work to your day…but it’s about patient safety and we will be electronic in less than 2 years” 25 1/22/201325 1/22/2013 Summary of the Stepping Stones to Med Rec Success at LHSC • Commitment • Challenges • Collaboration • Conversations • Courage 26 1/22/201326 1/22/2013
  10. 10. “Learn from yesterday, live for today, hope for tomorrow. The important thing is not to stop questioning”. -Albert Einstein WHERE ARE WE AT TODAY? 27 1/22/201327 1/22/2013 LHSC Med Rec Sustainability Team • Involves a subset of Members from the Corporate Project Team and Steering Committee • Meet regularly to discuss issues/concerns • Creation of mandatory online training (iLEARN modules) • Dissemination of stats to clinical areas and staff • Preparing for conversion to electronic platform 28 1/22/201328 1/22/2013 Audience Poll #2 Please take the next 30 seconds to respond to the following poll question (found on the right hand side of your screen) What does evaluation of MedRec in your institution consist of? 29 1/22/201329 1/22/2013
  11. 11. far… Feedback thus far… • One area in chart to look for most accurate BPMH; plan for home medications on admission is clearly documented • ICU transfers are not so complex now • “Just print off the form and check the boxes…it’s so easy” • “…the residents will all agree that med rec went from tedious and annoying to extremely beneficial and time-saving…” 30 1/22/201330 1/22/2013 far… Feedback thus far… • CCAC case managers have commented • the discharge forms are a “huge improvement” • patient care has been “greatly streamlined” • have seen an elimination of redundant communication, confusion and adverse events • Elimination of illegible handwriting of medications and signatures….need we say more! 31 1/22/201331 1/22/2013 Our Unique Evaluation • Health Records Data Abstraction • Coding every Patient chart according to predefined criteria* • Will “code” a Med Rec form as • Complete • Partially Complete • Missing Form • Not Applicable • Blank *Caveat: Revision to criteria was made in July – August 2012 (post-implementation) 32 1/22/201332 1/22/2013
  12. 12. Admission Data – University Hospital 33 1/22/201333 1/22/2013 Verification of BPMH Data - University Hospital 34 1/22/201334 1/22/2013 Admission Data – Victoria Hospital 35 1/22/201335 1/22/2013
  13. 13. Verification of BPMH Data – Victoria Hospital 36 1/22/201336 1/22/2013 Discharge Data – University Hospital 37 1/22/201337 1/22/2013 Discharge Data – Victoria Hospital 38 1/22/201338 1/22/2013
  14. 14. Additional Evaluation • Outcome Evaluation • Retrospective chart review • Pharmacy Student Involvement • Comparison of medication discrepancies at discharge pre-implementation to post-implementation 39 1/22/201339 1/22/2013 Audience Poll #3 Please take the next 30 seconds to respond to the following poll question (found on the right hand side of your screen). Has your institution successfully implemented MedRec in ambulatory care/outpatient areas? 40 1/22/201340 1/22/2013 Thank You ! nadia.facca@lhsc.on.ca sandy.jansen@lhsc.on.ca pam.andress@lhsc.on.ca QUESTIONS??? 41 1/22/201341 1/22/2013
  15. 15. Kindly take a few minutes to reply to the poll! www.saferhealthcarenow.ca 42

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