To start, I’ll tell you a bit about VCH. We service a large catchment area that houses 25% of BC’s population stretching from Bella Coola down to Richmond. Our MedRec implementation was only for Vancouver Acute, that includes Vancouver General, UBC Hospital and GF Strong Rehab.In 2011/2012, our Emergency departments saw one hundred thousand visits and nineteen thousand of those clients were admitted. We also had thirteen thousand direct admissions from our pre-op area.
Medication Reconciliation is a more structured process to ensure that we know a client’s medications any time we are prescribing or administering them. We make sure that we know what the client is actually taking as opposed to what we think they are taking or just what they were prescribed – as those can be very different.
Snapshot of post-implementation at VGH.Shows audit data from Health Records. Shaded is when meds are reconciled and white is when form was present but not completed. Currently our compliance is around 80%.Detailed audits also:
Planning:sharing learning's at the regional levelCareful/deliberate implementation timing (e.g. go-live on a Tuesday)Pre-admission clinic, PCU, Surgery, Psychiatry and then Emergency deptMemo’s at a higher level, Newsletters, posters
Education: provided separately to the physician group and unit staff (nurses and unit clerks)including weekend, nights, and roaming on unitsshort 20 minute sessions brought directly to the units
Posters displayed in ALL patient care areasMedRec team stationed in ED and roaming to all areas Chart audits conducted immediately post go-live to monitor and resolve issues in a timely mannerBed meetings were utilized to connect with all frontline leaders on a daily basis to answers any questions address concernsMedRec Team huddles to support each other
Sustainment:Toolkits (include LP, FAQs,PP, posters)to unit educators and/or Patient Care CoordinatorsIncluded in all new hires orientation packageOngoing monthly audits – posted to Intranet site;Unit specific in depth chart audits shared with staff and physicians for opportunities in improvmentLooking at incorporating ‘My Med Card’ as a resource for patients
As with any change in practice, we had a few challenges. We don’t yet have an electronic solution to reconcile medications. This is a change to our previous documentation practices for medications and because of that there’s a perception of extra work. Our team also faced resource limitations, because both our practice teams and pharmacy teams are involved in many initiatives. Medication Reconciliation is also a philosophy change from our traditional ways of gathering medication info from clients.
For admission, we are going to continue to work off of our successes and strengthen the process. In November, VCH scored a 98% on accreditation, and that was a great incentive to continue improving MedRec.For Transfer, we are defining and mapping out internal and external transfers as well as discharges.We also have a discharge pilot that’s currently going on, so we are set to expand that into other areas soon.And in the outpatient areas we are implementing and polishing our ambulatory care clinic admissions and community program work – like home health and mental health.
A2 Harjender Walia - Med Rec: VCH - Vancouver Acute Improves Patient Safety
Medication Reconciliation: VCH –Vancouver Acute Improves Patient Safety Harjender Walia, Clinical Educator, Professional Practice Lori Campbell, Clinical Resource Nurse, Professional Practice
Vancouver Coastal HealthVCH serves 25% of BC’s population, thats over 1 million people including the residents of Vancouver, Richmond, the North Shore and Coast Garibaldi, Sea-to-Sky, Sunshine Coast, Powell River, Bella Bella and Bella CoolaVancouver Acute (VA) includes Vancouver General Hospital, UBC Hospital, and G.F. Strong Rehabilitation CentreIn 2011/12, Vancouver Acute (VGH, UBC, and G.F.S) had:• 100 000 ED Visits• 19 000 admissions from ED• 13 000 direct admissions or from peri-operative services
What is Medication Reconciliation? (MedRec)…a formal, systematic process in which health care professionals partner with patients to ensure accurate and complete medication information transfer at Interfaces of care. 3
Why Reconcile?Over half of medication errors occur at the interfaces of care. Rozich JD, Reser RK. Medication Safety: One Organization’s Approach to the Challenge. J Clin Outcomes Manage. 2001;8(10): 27-34An example:Mr Smith comes to hospital for a planned surgery, his anti- depressant medication isn’t ordered on admission.On post-op day 5 the omission is discovered after he is feeling ill and not motivated to ambulate.
MedRec at VA• Collaboration between Pharmacy and Professional Practice – Nursing• Focus on MedRec at admission• Phased implementation 2009 to 2012
% Medication Reconciliation at Admission: VGH Acute Care (All Programs) 100% 90% 80%Medication Reconciliation Documentation % of Patient Health Records Containing 70% 60% 50% 40% 30% 20% 10% 0% 13-03 13-04 13-05 13-06 Discharge Fiscal Period Medications Reconciled on Admission Form Available but Incomplete Target ( 75 %)
Keys to SuccessPlanning:• Having senior and frontline leadership support and involvement• Regional MedRec leads group• A phased approach• Ensure consistent and clear communication
Keys to SuccessEducation:• Tailored education• Planned/intense 6 weeks of education• Short 20 min sessions
Keys to SuccessImplementation:• Build up to go live• MedRec team’s presence/availability – 8 am to 10 pm roaming• Comprehensive and timely chart audits/feedback• Attended daily bed meetings• Daily team huddles to review issues/problem solve
Keys to SuccessSustainment:• Toolkits provided• Online E-module for new hires• Information posted to the Intranet site• Audit results communicated to physicians, staff and leadership groups• “My Medication Card” – BC Patient Safety and Quality Council
Challenges– No electronic solution– Change in medication documentation practices– Perception of extra work– Resource limitations– Culture change
Current work and Future plans• Admission – Continue improvements• Transfer – implement inter-site & intra-site transfer processes• Discharge – expand discharge pilot• Ambulatory Care Clinic admission implementation• Continue Community work (admission completed)