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The Puzzle Gets Bigger

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Presented at the Optimizing Medications Workshop in Vancouver by Marg Colquhoun

Presented at the Optimizing Medications Workshop in Vancouver by Marg Colquhoun

Published in Health & Medicine , Business
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  • 1. Optimizing Medications Time to Bring the Pieces Together MedRec Update 2014 Margaret Colquhoun Project Lead ISMP Canada National MedRec Co-Lead © ISMP Canada and Safer Healthcare Now! 2014
  • 2. Outline • Leadership • Quality Measurement • Technology • National Resources © ISMP Canada and Safer Healthcare Now! 2014
  • 3. David Denison © ISMP Canada and Safer Healthcare Now! 2014
  • 4. 2010- National MedRec Summit Healthcare CEOs, senior leaders, representatives from national organizations, provincial quality councils, physicians, nurses and pharmacists identified themes that would accelerate and optimize MedRec across the continuum of care © ISMP Canada and Safer Healthcare Now! 2014
  • 5. LEADERSHIP ACCOUNTABILITY “Senior leadership commitment is critical to ensuring MedRec is implemented successfully across an organization. It is essential to dedicate resources to support the achievement of an ambitious plan of action, and include MedRec as a strategic priority with goals, timelines, accountability for implementation, evaluation and progress reporting. Accountability must rest with the CEO with clear reporting expectations at the board level.” © ISMP Canada and Safer Healthcare Now! 2014
  • 6. Got Med Wreck? Targeted Repairs from the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) Jeffrey L. Schnipper, MD, MPH, FHM Director of Clinical Research, BWH Hospitalist Service Associate Physician, Division of General Medicine, Brigham and Women’s Hospital Associate Professor, Harvard Medical School
  • 7. Leadership • MARQUIS Study • To discuss lessons learned from sites that have implemented the MARQUIS program and how they might be applied to Canadian hospitals • To make the case for provinces, health systems, and hospitals to invest in medication reconciliation quality improvement efforts, and why physicians need to play a major role in these efforts Find it at: http://www.ismp-canada.org/medrec/ 7 © ISMP Canada and Safer Healthcare Now! 2014
  • 8. Quality Measurement October was National MedRec Quality Audit Month © ISMP Canada and Safer Healthcare Now! 2014
  • 9. Need to critically evaluate admission processes to ensure quality of processes at other transitions MedRec Quality Audit Tool © ISMP Canada and Safer Healthcare Now! 2014
  • 10. “Participants” by Province/Territory 103 sites 2,340 patients Number of Patients 10 Provinces/Territories © ISMP Canada and Safer Healthcare Now! 2014
  • 11. “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 © ISMP Canada and Safer Healthcare Now! 2014 77% N=79
  • 12. Design of the Tool – the Literature • 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 © ISMP Canada and Safer Healthcare Now! 2014
  • 13. © ISMP Canada and Safer Healthcare Now! 2014
  • 14. Column C Results (‘BPMH -greater than one source) N=2,040 74% 60% 14 © ISMP Canada and Safer Healthcare Now! 2014
  • 15. Literature suggests… • 66% of Canadians have sometimes used nonprescription medication in the past six months. 2004 Survey of Canadians’ Use of OTC Medications http://www.bemedwise.ca/english/usagesurvey.html • 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 © ISMP Canada and Safer Healthcare Now! 2014
  • 16. Column D – Actual Med Use Verified by Pt./Caregiver 16 © ISMP Canada and Safer Healthcare Now! 2014
  • 17. D Results: Med Use Verified by Pt/Caregiver N=2,044 63% 57% 17 © ISMP Canada and Safer Healthcare Now! 2014
  • 18. Literature suggests…. Column F • 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 © ISMP Canada and Safer Healthcare Now! 2014
  • 19. 19 © ISMP Canada and Safer Healthcare Now! 2014
  • 20. Results F.‘Meds on BPMH+Admin Order’ N=2,006 87% 73% 20 © ISMP Canada and Safer Healthcare Now! 2014
  • 21. Overall National MedRec Quality Audit Results 2340 patients 103 29% Organizations (acute care) • 1906 Acute Care • 329 Long Term Care • Met all 5 quality criteria 55% • Met all 5 quality (Long Term Care) criteria © ISMP Canada and Safer Healthcare Now! 2014
  • 22. Comments • Audit tool results demonstrate need for ongoing and specific improvements • Future audits to measure improvement are critical • Many people believe they are doing MedRec but they may not be doing it well – The foundation of the process – the BPMH needs work © ISMP Canada and Safer Healthcare Now! 2014
  • 23. Comments • Need to critically evaluate admission processes to ensure quality of MedRec processes at other transitions • Sites will need to train people to use the audit tool – materials are available to support this process 23 © ISMP Canada and Safer Healthcare Now! 2014
  • 24. Pennsylvania Patient Safety Advisory 2013 • 501 reports involving MedRec breakdowns in 1 year • 69% at admission • Events most often at prescribing (40%) • Drug omission most frequent (26.7%) © ISMP Canada and Safer Healthcare Now! 2014
  • 25. eMedRec in Canada Paper to Electronic Project Online survey 212 people responded © ISMP Canada and Safer Healthcare Now! 2014
  • 26. Available Soon To support organizations migrate from a paperbased system to an electronic system for MedRec © ISMP Canada and Safer Healthcare Now! 2014
  • 27. Motivation for Moving to eMedRec • Integrates electronic data from multiple sources ( electronic and non-electronic) • Provides electronic tools and user interfaces for comparing medication lists • Facilitate discharge MedRec with multiple sources of information © ISMP Canada and Safer Healthcare Now! 2014
  • 28. Advantages of eMedRec • Improved standardization, legibility, communication, accessibility • Potentially improved compliance through soft stops (i.e., reminders that eMedRec needs to be completed and/or hard stops (orders cannot be placed until eMedRec is completed) • Decision support tools to assist in comparing medication lists/identifying discrepancies integrated to generate warnings • Integration with CPOE to facilitate improved ordering processes • Improved efficiency of many medication-related processes in healthcare organizations (Poon et al., 2006). © ISMP Canada and Safer Healthcare Now! 2014
  • 29. Tools/Checklists Soon to be Available • Organizational Readiness • Steps to support the safe transition to eMedRec • Ideal features of eMedRec, • Evaluation of eMedRec © ISMP Canada and Safer Healthcare Now! 2014
  • 30. Judy Colquhoun © ISMP Canada and Safer Healthcare Now! 2014
  • 31. © ISMP Canada and Safer Healthcare Now! 2014
  • 32. Having a look at MedRec Nationally © ISMP Canada and Safer Healthcare Now! 2014
  • 33. © ISMP Canada and Safer Healthcare Now! 2014
  • 34. INTER-PROFESSIONAL ENGAGEMENT LEADERSHIP ACCOUNTABILITY PUBLIC/CONSUMER/CAREGIVER ENGAGEMENT PHYSICIAN ROLES © ISMP Canada and Safer Healthcare Now! 2014 Identified Themes 2010 National MedRec Summit
  • 35. INTER-PROFESSIONAL ENGAGEMENT Role of the pharmacy technician © ISMP Canada and Safer Healthcare Now! 2014
  • 36. LEADERSHIP ACCOUNTABILITY National Health Leadership Conference © ISMP Canada and Safer Healthcare Now! 2014
  • 37. PUBLIC/CONSUMER/CAREGIVER ENGAGEMENT Free iPhone app for patients to track medications. Android version coming mid- 2014. Sunrise Health Region (SK)’s PR campaign “Be a Champion of Your Health” PR Campaign from North Bay Regional Health Centre (ON) © ISMP Canada and Safer Healthcare Now! 2014
  • 38. PUBLIC/CONSUMER/CAREGIVER ENGAGEMENT www.SafeMedicationUse.ca © ISMP Canada and Safer Healthcare Now! 2014
  • 39. PUBLIC/CONSUMER/CAREGIVER ENGAGEMENT Toronto Zoomer Show, November 2013 35,000 consumers in attendance © ISMP Canada and Safer Healthcare Now! 2014
  • 40. © ISMP Canada and Safer Healthcare Now! 2014
  • 41. Healthcare Practitioner Education © ISMP Canada and Safer Healthcare Now! 2014
  • 42. www.Rxbreifcase.com © ISMP Canada and Safer Healthcare Now! 2014
  • 43. BPMH Training Pharmacy Technicians © ISMP Canada and Safer Healthcare Now! 2014 Clinicians
  • 44. Primary Care – 2 Page Information Sheet © ISMP Canada and Safer Healthcare Now! 2014
  • 45. Home Care © ISMP Canada and Safer Healthcare Now! 2014