CMH Medication Reconciliation Journey 2011

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  • 74 bed hospital, 20 clinics, 5 LTC, 1 Res Care, 5 sets of independent living units, HCS/Hospice, HME, cardiac rehab, oncology/radiologyAll facilities are integrated electronically throughout the continuum of care.
  • MIB is the process improvement model designed and used by CMH, closely follows the PDCA model.Recognized the need to formally address NPSG – Medication Reconciliation
  • Education through Healthstream an electronic educational system, which allows access by staff at anytime including from home. Provides the ability to track completion and test for understanding.
  • Exploring methods for tracking and sharing med errrors and/or near miss events secondary to poor completion of med rec
  • Focus on carrying a current list of all meds, show it to physicians and pharmacists, ask for help keeping it updated. Possibly scan card for updated list.Michelle will share some of the electronic designs employed by CMH to accomplish MR
  • CMH Medication Reconciliation Journey 2011

    1. 1. CITIZENS MEMORIAL HEALTHCARE <br />MEDICATION RECONCILIATION JOURNEY<br />1<br />
    2. 2. Designing the Process<br /><ul><li>2008 Strategic Plan identified Med Rec as a critical process requiring an action plan.
    3. 3. MIB (make it better) initiated
    4. 4. Team established by action plan owner, to include clinical leaders from all disciplines
    5. 5. Acute Care
    6. 6. Home Care/Hospice
    7. 7. Clinics
    8. 8. Long Term Care
    9. 9. Pharmacy
    10. 10. Physicians</li></ul>2<br />
    11. 11. <ul><li>Each discipline/business unit identified a leader and a team of peers
    12. 12. Clinical staff
    13. 13. Information Specialists or Technicians
    14. 14. Quality/Performance Improvement staff
    15. 15. A process flow diagram was drawn for each discipline
    16. 16. Informal FMEA (failure modes effects analysis) was applied to each process, to identify weak steps or steps lending to failure</li></ul>3<br />
    17. 17. <ul><li>Basic med. rec. education was developed and provided to all clinical staff.
    18. 18. The first step included buy in by nurses and physicians to stop using and accepting: “resume all meds”.
    19. 19. IS focused on designing improvements in the listing of medications, and methods for electronic med rec for transfers within the system.</li></ul>4<br />
    20. 20. Roll Out<br /><ul><li>Initial process rolled out in Emergency Dept.
    21. 21. To Acute care and physicians
    22. 22. An admission/discharge nurse was hired, med.rec. was part of this role’s responsibility
    23. 23. Clinics with each visit
    24. 24. Home Care – learning to work with a new software program
    25. 25. LTC is in initial process of rolling out for admission from home </li></ul>5<br />
    26. 26. Summer of 2010 joined the national collaboration with Primaris<br />Outlined processes again- new issues identified<br />Staff had designed “work arounds”<br />Staff focused on admission and discharge, ignoring med rec at transfer<br /><ul><li>New focus on education of nurses, physicians, community:</li></ul>6<br />
    27. 27. Education in process or for consideration:<br /><ul><li> New employee orientation
    28. 28. Annual one/one competency for nurses
    29. 29. Interactive Healthstream courses for nurses
    30. 30. One/one education with physicians
    31. 31. Monthly news letters with bits of </li></ul> med rec education<br />7<br />
    32. 32. Community Education:<br /><ul><li>Website paragraphs
    33. 33. Printable med list on website
    34. 34. Articles in CMH quarterly magazine
    35. 35. Brief articles in newspaper or on radio
    36. 36. Access to med list from electronic portals
    37. 37. possibly from Patient Friendly registration card</li></ul>8<br />
    38. 38. ED view accessing Reconcile Meds<br />
    39. 39. ED and Inpatient Nursing view of Reconcile Meds<br />
    40. 40. “Reconcile Meds” with Patient<br />
    41. 41. View of Reconciled Medications<br />
    42. 42. Inpatient side of Accessing Reconcile Meds <br />
    43. 43. Nurses View of being in the process of Med Reconciliation<br />
    44. 44. Nursing Reconciled Meds<br />
    45. 45. Medication Reconciliation Required Questions<br />
    46. 46. Continue From Ambulatory<br />
    47. 47. Transferable or Non Transferable Meds<br />
    48. 48. Physician View of Discharge Med Reconciliation<br />
    49. 49. LTCAdmission Medication process<br />
    50. 50. List is printed and faxed to Physician<br />
    51. 51. Nurse enters the orders for the Resident<br />
    52. 52. Discharged Medication List<br />
    53. 53. Medication List <br />
    54. 54. Clinics Medication Reconciliation<br />
    55. 55. Automatically Reconciles the Patients Medication List<br />
    56. 56. Medications Reconciled<br />
    57. 57. Medication Summary List<br />
    58. 58. Lessons Learned<br /><ul><li>Staff from all business units must know where to find the “source of truth”
    59. 59. We can measure completion of med rec but it is very difficult to find the resources to track accuracy
    60. 60. Staff becomes dependent on the system to guide the process
    61. 61. Biggest Lesson Learned: We have a process now but if one person does not do their part completely the entire process is impacted and it is hard to identify errors.</li></ul>29<br />
    62. 62. For More Information or Clarification<br />Aileen Kelley RN,BC CMH Quality Coordinator<br />akelle@citizensmemorial.com<br />Michelle Cahow CMH IS Specialist<br />michelle.cahow@citizensmemorial.com<br />30<br />

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