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A2 Laarnie St-Laurent - Admission Med Reconciliation at Lions Gate Hospital

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A2 Laarnie St-Laurent - Admission Med Reconciliation at Lions Gate Hospital

  1. 1. AdmissionMedication Reconciliation at Lions Gate Hospital Lean Transformation Services Laarnie St-Laurent, Lean Coordinator Lorelei Grosser, Lean Coordinator Carissa Looman, Lean Educator
  2. 2. Admission MedRec at Lions Gate HospitalObjectives:•What is MedRec?• Why do MedRec?•How was MedRec implemented?  Brief overview of Lean Methodology  How Lean was used for implementation•How are we doing now?  Audit Results•What are key “lessons learned?”  Impacts of MedRec
  3. 3. Admission MedRec at Lions Gate HospitalEver wondered…• Right medication? • Right dose? • Right time?
  4. 4. Admission MedRec at Lions Gate HospitalWhat is MedRec?
  5. 5. Admission MedRec at Lions Gate Hospital What is MedRec? “Best Possible” Reconciliation Medication (Orders) History Pharmanet(Prescribed Drugs)
  6. 6. Admission MedRec at Lions Gate HospitalWhy do MedRec?Did you know…• “40-50% of patients on admission” are at risk of unintentional medication discrepancies?  Medication errors may harm patients  Of these, 6% are at risk of harm serious enough to increase length of stay from 2-8 days2.
  7. 7. Admission MedRec at Lions Gate HospitalWhy do MedRec?Some Local Data• At Lions Gate:  About 38.8 daily admissions 12.5 patients at risk of unintentional discrepancies  0.75 patients daily at risk of staying 2 to 8 days longer  About $246K additional costs per year (based on average cost of $450/patient/night)
  8. 8. Steps to Achieving Continuous Improvement– sequence to approach the tools Other tools to And Then: improve flow and implement pull Repeat! Mistake Proofing Visual Controls Unit Layout/ Cell Design (Flow) Rather than thinking specific tools do not apply, consider Standard Work if their concept can provide benefit.Observe andCollect Data See for yourself & collect objective data that becomes the starting point for discussions Adapted from Virginia Mason Lean Leader Certification Materials
  9. 9. VCH Improvement System Lean Tollgate Sustainment Audit/Refine Implementation/ Go-Live Future State Development Current State Analysis ProjectDefinition LTS_VCH Improvement System_V1
  10. 10. Admission MedRec at Lions Gate HospitalHow was MedRec implemented?Observations: Data Collection
  11. 11. Admission MedRec at Lions Gate HospitalHow was MedRec implemented?Future State Value Stream Map Triage Emerg Nurse Emerg Admission Doctor MRO •BPMH printed documented by for RN or certain Pharmacist on areas in •MRP Emerg reconciles home medications •MedRec Order (MRO) form processed
  12. 12. Admission MedRec at Lions Gate HospitalHow was MedRec implemented?Standard Operating Procedures: Who What How When Why
  13. 13. Admission MedRec at Lions Gate HospitalHow was MedRec implemented?
  14. 14. Admission MedRec at Lions Gate HospitalHow was MedRec implemented? Auditing and Breakthrough Lanes: Did not meet MedRec criteriaMet MedRec criteria
  15. 15. Admission MedRec at Lions Gate HospitalHow was MedRec implemented?Auditing and Breakthrough Lanes:Why did not meet MedRec criteria?
  16. 16. Admission MedRec at Lions Gate HospitalHow was MedRec implemented?Auditing and Breakthrough Lanes: Did not meet MedRec? Now what????
  17. 17. Admission MedRec at Lions Gate HospitalHow are we doing now? Organizational TargetsCompletion Rate 75%BPMH Completion 75%Reduction in unintentional discrepancies 75%Reduction in undocumented intentional discrepancies 75%
  18. 18. Admission MedRec at Lions Gate HospitalHow are we doing now? Area Quantitative ResultsElective Surgery: •100% have complete, accurate• Implemented on November 2011 medication histories •100% receive post-op medication orders • 75% reduction in unintentional discrepancies • 85% reduction in undocumented intentional discrepancies
  19. 19. Admission MedRec at Lions Gate HospitalHow are we doing now? Area Quantitative ResultsEmergent/Direct Admissions •77.5% to 80% reconciliation rate• Implemented on May 23, 2012 (exceeded target of 75%) •47.5% “best possible medication history” completion rate •50% reduction in unintentional medication discrepancies •55% reduction in undocumented intentional medication discrepancies
  20. 20. Comparison: Vancouver Coastal Site Average Completion Rate • Since ImplementationRichmond Hospital 60%Vancouver General 78%Coastal Squamish General 60% St. Mary’s Hospital 65% Powell River General TBA Lions Gate Hospital 78%
  21. 21. Admission MedRec at Lions Gate HospitalHow are we doing now?Examples of “good saves” and QualitativeResults…
  22. 22. MedRec Success Stories Unit Good saves…Emergency MD ordered only one of patient’s home meds at half the dose the patient was taking. When med history was taken by RN, MD ordered the rest of home meds (5 pages were missed).Pediatrics Patient’s Pharmanet only showed one medication. When BPMH was taken, patient was taking medication at a different dose than on Pharmanet and was also taking a number of other medications NOT on the Pharmanet.Daycare Surgical patient was seen in PSSU 2 weeks prior to surgery, but had filled other prescriptions since then. Daycare RN picked up on new meds when BPMH was done prior to surgery.
  23. 23. Admission MedRec at Lions Gate Hospital
  24. 24. Admission MedRec at Lions Gate HospitalReference List:1 Canada. Accreditation Canada. Required Organization Practice. Ottawa: Accrediation Canada, 2012. Print.2 Canada. Optimizing Medication Safety at Care Transitions – Creating a National Challenge. Toronto: 2011. Print.
  25. 25. Admission MedRec at Lions Gate Hospital Thank you for listening! Questions???
  26. 26. Admission MedRec at Lions Gate HospitalWhat is MedRec? Systematic Partnership Conversation February 27, 2013
  27. 27. Admission MedRec at Lions Gate HospitalHow was MedRec implemented? 25 Steps to Lean Map theThinking 1 Value Stream Specify Value 3 5 Establish Work to Flow Perfection 4 Implement Pull Source: James P. Womack. Lean Thinking. February 27, 2013
  28. 28. Admission MedRec at Lions Gate Hospital Medication Management Paper flow Audit & Refine Implement February 27, 2013

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