•Understand the Accreditation Canada requirements for medication reconciliation at discharge •Learn from the experience of patients and receiving healthcare providers •Gain insight into practical strategies for communicating accurate medication information at discharge READ MORE: http://bit.ly/1ja1gxY

1. YOUR DISCHARGE IS SOMEONE’S
ADMISSION

2. Kim Streitenberger
Project Lead, ISMP Canada
Today’s Facilitator
2

3. Welcome
3
Mike Cass
Patient Safety Improvement Lead, CPSI

4. Welcome to our francophone
attendees
Bienvenue à nos participants
francophones
Hélène Riverin
Conseillère en sécurité et en amélioration
Safety Improvement Advisor
4

5. Pour nos participants francophones..
Pour accéder aux diapositives
français:
-Cliquez sur ​​l'onglet "FRENCH"
OU
-Envoyer un courriel à
helene.riverin@csssvc.qc.ca
Suivre la boîte «Chat» pour les
commentaires du
conférencière traduit en
français
5

6. 6
Audio Access Only
 WebEx does not support Windows XP
 If you have Windows XP
– Slides are available under “Medication
Reconciliation” on the ISMP Canada website
– Q&A – email questions to medrec@ismp-
canada.org

7. 7
Questions
ISMP Canada (Host)

8. Stay on after this call
MedRec Open Mike
- Need help with MedRec?…stay on the line
and join the discussion
- Meet and connect with others in MedRec
- Submit your questions to medrec@ismp-
canada.org or ask them live
8

9. By the end of this webinar you will:
 Understand the Accreditation Canada requirements
for medication reconciliation at discharge
 Learn from the experience of patients and
receiving healthcare providers
 Gain insight into practical strategies for
communicating accurate medication information at
discharge
Objectives
9

10. Please complete our poll
10

11. Today’s Speakers
Colleen Cameron
Clinical Pharmacist at Grand River
Hospital in Kitchener Ontario
Heather Howley
Accreditation Canada
Lynette Zielinski
Clinical Nurse Educator Home
Care Saskatoon Health Region,
Saskatchewan
Devin Elias
Community Pharmacist,
Saskatoon Health Region
Cynthia Berry
Lead Medication Reconciliation
Pharmacist for the Saskatoon Health
Region, Saskatchewan
Alice Watt
Medication Safety
Specialist, ISMP Canada
Michael Hamilton
Community and Long Term Care physician,
Newmarket Health Centre, Newmarket, Ontario
Physician Lead and Medication Safety
Specialist, ISMP Canada

12. Your Discharge is
Someone’s Admission:
How the Patient’s Truth
can be a MedWrecker
Colleen Cameron, RPh, Pharm.D.
Grand River Hospital, Kitchener ON
November 10, 2015

13. Hospital
Home
LTC
Retirement
Home
Primary
Care
Rehab

14. Ms. C is 72 years of age
Admitted to hospital for acute delirium, UTI, new onset diabetes, new onset
atrial fibrillation.
PMH – HTN, seizures, recurrent DVTs on warfarin
Social Hx: widowed, lives alone in home, Gr. 8 education, manages meds
& ADLs independently
Meds – phenobarbital, carbamazepine, telmisartan/HCTZ, warfarin
Warfarin history – on between 7-8 mg/day for > 15 years.
Has always had 5mg and 1mg tablets dispensed.
INRs pre-admission – consistently stable for years between 2.3-3.0

15. = 27mg
I put the 5mg vial behind my back and again asked her to
put 7mg in her hand using only 1mg tablets.
= 7mg
I confirmed with her “Is that 7mg?”  “Yes”
On discharge – delirium clearing and getting close to
baseline, I took the home warfarin bottles out of her bag.
“Can you please show me how you would take 7mg of
warfarin?”

16. Why the confusion?
COUNTING
MATHTaking 7mg using is
Taking 7mg using is

17. On the next admission for hematuria
pulmonary hemorrhage, GI bleed and
an INR > 10, when we ask her what
her warfarin dose is for her BPMH:
“I take 7 mg of warfarin every day.”
The Patient’s Truth

18. Outcome
Ms. C has been back in her home for 6
months.
She is independent with her ADLs and is
managing her medications using warfarin
1mg tablets
She is still my Aunt

19. Morals of the story…
1. What we tell the patient is often very
different than what their truth ends up
being.
2. A medication history or list is simply a hint
of what the patient may actually be doing.

20. Morals of the story…
3. The only hope we have of finding out the
patient’s truth
– Talk and listen
– Dialogue
– Demonstrate (us and them)
– Keep sleuthing…
4. The patient’s truth is often cause for
someone else’s admission.

21. Thank you for listening to my story!

22. Medication Reconciliation at Discharge
Accreditation Canada Requirements
Heather Howley
Accreditation Canada
November 10, 2015

23. Qmentum:
A quality improvement framework
23
A process for organizations to regularly and
consistently examine and improve their
services
A tool to identify areas for improvement
A measure of an organization’s services
comparedagainststandards

24. Required Organizational Practices
(ROPs) in Qmentum
24

25. History of Medication
Reconciliation ROPs
25
2006:
At admission &
discharge
(Service standards)
2010:
As an organizational
priority
(Leadership standards)
2014:
Improved
customization
Expanded
requirements

26. MedRec at care transitions:
Discharge requirements
• Unique to inpatient acute care
• Two medication lists need to be reconciled:
– BPMH generated at admission
– Current medication list (e.g., MAR)
• The result is a single list (updated BPMH) of all
medications the client should be taking
26

27. MedRec at Care Transitions ROP
(acute care version)
2015 ROP Handbook
27

28. MedRec at Care Transitions ROP
(discharge requirements)
Major The prescriber uses the Best Possible Medication History
(BPMH) and the current medication orders to generate
transfer or discharge medication orders.
Major The team provides the client, community-based health
care provider, and community pharmacy (as appropriate)
with a complete list of medications the client should be
taking following discharge.
2015 ROP Handbook
28

29. Care transitions that benefit from
MedRec
• Admission
• Discharge (external transfer)
• Internal transfers where there is the potential
to introduce medication discrepancies, e.g.:
– Medications are re-ordered or re-written
– Change in service environments where the most
responsible prescriber changes
29

30. The On-site Survey:
Discharge requirements for MedRec
30
REVIEW
TALK and
LISTEN
RECORD
OBSERVE

31. Thank you!
31
Proud to be a Top 25 employer for five consecutive years
Fier de faire partie des 25 meilleurs employeurs
depuis 5 années consécutives
Thank you!
Merci!
Accredited by
Agréé par

32. Cynthia Berry
Lead Medication Reconciliation Pharmacist for the
Saskatoon Health Region, Saskatchewan

33. Discharge Medication
Reconciliation

34. 2011 Call to Action!
• Accreditation!
• SK MoH
Provincial
Strategic and
Operational
Directive
• Recognition of
a flawed
system

35. Discharge/Transfer MedRec Timeline
2011-present
Autumn 2011: Interdisciplinary working group struck
to develop and implement MedRec for patients
discharged from acute care and newly admitted to
LTC
• PDSA cycles
• Role definition
• Rural versus urban
• Form
• Education and communication
• Measuring

36. Discharge/Transfer MedRec Timeline
2011-present
Autumn 2013: Interdisciplinary working group struck
to develop and implement MedRec for ALL patients
discharged from acute care to “home”.
• Baseline audit – discrepancies, practices
• Role definition
• Process exploration
• Form revision

37. Discharge/Transfer MedRec Timeline
2011-present
Winter – Spring 2014
• Buy in from Cardiologists and Clinical Nurse
Specialists = revised pre-printed discharge order
set
• Hesitation from our next targeted groups
• HURDLE: time to complete form well

38. Discharge/Transfer MedRec Timeline
2011-present
Spring 2014 onward:
• Exploration form generated from in-patient
pharmacy software
• Pilot with CTU Team Silver
• PDSA cycles with Silver, Red, Blue
• Evaluation of workload
• Fully implemented for all patients discharged from
RUH CTU (medicine)

39. Discharge/Transfer MedRec Timeline
2011-present
Spring 2014 onward:
• Creation of a form generated from in-patient
pharmacy software
• Pilot with CTU Team Silver
• PDSA cycles with Silver, Red, Blue
• Evaluation of workload
• Fully implemented for all patients discharged from
RUH CTU (medicine)

42. Current Discharge/Transfer Med Rec Form

43. Current Discharge/Transfer Med Rec Form

44. Current Discharge/Transfer Med Rec Form

45. • An accurate BPMH is VITAL to Discharge Med
Rec.
• Electronic tools are helpful in many ways
(reduction of transcription error), but come with
their own set of challenges (resources).
• Most discrepancies occur when the physician is
rushed. (Patient flow!)
• Physician champions and rapid PDSAs are keys
to success.
• Involve a community pharmacist!
Critical Learning Moments

46. Lynette Zielinski, RN
Clinical Nurse Educator Home Care, Saskatoon
Health Region, Saskatchewan

50. 50
Devin Elias
Community Pharmacist
Willow Grove Pharmacy, Saskatoon, SK

51. 51

52. 52
Michael Hamilton
Community and Long Term Care physician, Newmarket Health
Centre, Newmarket, Ontario
Physician Lead and Medication Safety Specialist, ISMP Canada

54. Alice Watt
Medication Safety Specialist, ISMP Canada

55. A Toolkit and Checklist for Healthcare Providers
Hospital to Home - Facilitating Safe
Medications at Transitions

56. “A superb, comprehensive guide to implementing effective medication
reconciliation, which is a key component of high quality healthcare transitions.”
Dr. Kenneth Boockvar
"... was really helpful for getting discharge medication lists to the service providers,
like myself in a timely manner. Not having a discharge medication list can be
troublesome especially if there are cognitive challenges and/or poor patient support
in the home, or no family doctor.“
CCAC Rapid Response Nurse
"... one of the most rewarding parts of my job is improving the patient's
understanding of their medications and to help them feel more confident about
taking their medications when they go home. The checklist prompts me to
systematically go through each step so that the medication information we send with
the patient and to their healthcare providers is accurate and complete. It's about
passing the baton to ensure the patient can succeed at home.“
Clinical Pharmacist
Testimonials

57. 57
Questions
ISMP Canada (Host)

58. Upcoming MedRec Webinars
February 9, 2015 BOOMR: Care Coordinated Cross
Sectional Medication Reconciliation
Initiative for LTC residents
58
58

59.  How can I access a previous Safer Healthcare
Now! MedRec webinar/national call?
 How do I access the Safer Healthcare Now!
MedRec Quality Audit Tool?
 Where can I find information about MedRec in the
home care setting?
 Where can I find patient and family resources for
medication reconciliation?
 Where can I find videos, eLearning modules or
onsite training on how to create a Best Possible
Medication History (BPMH)?
 Where can I find discharge MedRec resources?
 What is the purpose of the MedRec Quality Audit?
 How do I prepare for the MedRec Quality Audit?
 How do I complete the MedRec Quality Audit and
submit the results?
New Frequently Asked Questions
59
Visit http://www.ismp-canada.org/medrec/#tab7
http://www.patientsafetyinstitute.ca/en/Topic/Pages/medication
-reconciliation-%28med-rec%29.aspx

60. MedRec Communities of
Practice
 Post your questions
 Respond to questions
 Share tools and
resources
http://tools.patientsafetyinstitute.ca/Co
mmunities/MedRec/default.aspx
Online Community Dedicated to MedRec
60

61. We are here to help!
61
 For MedRec Content (MedRec Intervention Lead)
Institute for Safe Medication Practices Canada (ISMP Canada)
medrec@ismp-canada.org
 CPSI Patient Safety Intervention Lead
Mike Cass MCass@cpsi-icsp.ca

62. Stay on after this call
MedRec Open Mike
- Need help with MedRec?…stay on the line
and join the discussion.
- Submit your questions to medrec@ismp-
canada.org or ask them live
62

63. Please complete our poll
63

64. MedRec Open Mike
64

65. Your opportunity to:
 Ask MedRec related questions to the
ISMP Canada MedRec Team
 Pose questions to teams on the line to
get their input
 Share stories and tools/resources
 Exchange ideas about are doing and
what you have learned
What is Open Mike?
65

66. How to ask questions?
66

67. 67
Lets start the discussion