Presentation on Implementing MedRec in Non-Inpatient Settings


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Presentation on Implementing MedRec in Non-Inpatient Settings

  1. 1. Medication Reconciliation Networking Session Steve Rough, MS., RPh. Director of Pharmacy University of Wisconsin Hospital and Clinics
  2. 2. Objectives  Provide a return on investment (ROI) framework for cost-justifying additional pharmacist resources for medication reconciliation  Review a strategy for implementing medication reconciliation in non- inpatient care areas (clinics, procedure areas, emergency department, etc)
  3. 3. ROI Framework
  4. 4. ROI Framework
  5. 5. ROI Framework
  6. 6. Approach for implementing medication reconciliation in non-inpatient areas
  7. 7.  Key stakeholders identified – Medical staff, pharmacists, nurses, and representation from the OR, radiology, cath lab, medical records, quality, risk management, public affairs, and IT  Establishment of Medication Reconciliation Steering Committee – Charged with leading the implementation process – Pharmacy and Nurse Managers serve as co-chairs – Membership from each key stakeholder group  Resident major project Step 1: Prepare
  8. 8. Step 1: Prepare  Charge of the Medication Reconciliation Steering Committee – Developing standardized medication reconciliation processes and workflows – Developing training materials, tools and resources – Outlining specific accountabilities for staff training and implementation – Develop auditing mechanisms to ensure compliance and measure sustained compliance
  9. 9. Step 2: Assess the current system  Identify all impacted areas and the manager of each area (91 areas)  Gap analysis to determine levels of performance in clinics, procedure areas, emergency department – Identify all access points for patients within the organization – For each element of performance, determine areas where not fully compliant with standards Essentially 100% non-compliance!
  10. 10. Example of Accountabilities
  11. 11. Step 3: Analyze  Meet with leaders/managers from four major areas – Clinics (2 nursing directors over all 80 clinics) – Procedure areas (Radiology, Cath Lab, Infusion Center, Peds Sedation, GI, etc, etc) – Perioperative areas (Inpatient and ambulatory surgery, recovery) – Emergency Department  Educate them on the required elements of NPSG 8a & 8b
  12. 12. Step 3: Analyze  Workflows documented for each area to fit with patient flow – Four workflows established: • Paper • Traditional electronic medical record (WISCR/ADS) • Health Link (Epic) – new electronic health record • Transplant database
  13. 13. Example of workflow diagram
  14. 14. Step 4: Plan  Identify responsible person for implementation in each clinic site – Documentation of medication history, reconciliation, updates, providing list to patient and next provider of care  Quantify resources needed by area – Computers – Access to information – Education – Personnel
  15. 15. Step 4: Plan  Develop education materials – Include the case for medication reconciliation- it’s the right thing to do for our patients! – Steps for obtaining a complete medication list • Include name, dose, route, frequency, last dose taken, indication – How to perform reconciliation – Policy expectations • documentation of history and allergies on every patient • providing every patient with discharge medication list • send list to next provider if medication changes
  16. 16. Step 4: Plan  Development of documentation tools – Paper documentation form for areas without electronic documentation – Modifications to electronic tools already available to include patient friendly terms, easier to read information • provider-entered information prints out in patient-friendly format
  17. 17. Example of Paper Documentation
  18. 18. Step 4: Plan  Development of auditing tools that are sustainable – Include questions on all five elements of performance on Joint Commission tracer • History documented • Reconciliation • Clarification of discrepancies • List to patient • List to next provider of care
  19. 19. Step 5 & 6: Execute and Measure  Educational road shows and web casts for managers and front line staff  Rolling implementation, not pilots – Start with high risk area: ED, Radiology, Cath lab, surgery clinics  Pharmacy resident and students audit compliance for 6 months  Implement changes and improvements on the fly as needed
  20. 20. Step 7&8: Communicate & Replicate  Communicate audit results to key stakeholders  Big bang go-live in all remaining areas over 2 month timeframe  Poster showcase for Joint Commission surveyors  Optimize processes in Health Link
  21. 21. Tools Available on ASHP Website  Policy and Procedure  Workflows  Forms  Training materials  ROI spreadsheet
  22. 22. Questions