Picture 1043                                Medication Reconciliation                                It’s about the conver...
Overview • Implementing MedRec on admission across a   large complex health organization that spreads   across rural and c...
Picture 17                                      VCH-PHC at a Glance                                      • 22,000 staff   ...
Synergy for Success            imgPreview                                                                         Picture ...
Synergy for Success • ……paradox of a living system… Each organism   maintains a clear sense of its individual identity   w...
Picture 4
Picture 3
Picture 3
Leadership Support • Vancouver Coastal Health (VCH) and Providence   Health Care (PHC) senior leadership team “walk   the ...
Project Structure • Regional Steering Committee • Executive Steering Committees (VCH & PHC) • TOR and Regional Project Cha...
Project Structure            Picture 6                                                                    Picture 9Picture...
Team Leads Committee • The primary goal of the team leads has been to   work together to create a regional approach to   s...
Team Leads Committee            Picture 5                                                                         Picture ...
Implementation Scope            Picture 9                                                                         Picture ...
Regional Supports • Implementation plan template • PharmaNet populated forms • Manual forms for all Communities of Care   ...
Learnings • The process for implementing MedRec   forces us to connect in ways we haven’t   before • We’re getting to know...
Measures of Success • Progress • Performance • Outcome                                                             Picture...
Progress Measures –            Picture 4                          Residential Care                                        ...
Progress Measures – Acute Care            Picture 4                                                                    Pic...
Performance            Picture 4                                                                     Picture 9Picture 8   ...
Outcome MeasuresPicture 12                                                                 Picture 9      Picture 8       ...
Medication Reconciliation Team Leads 2011-2012 •          Lindsay Bendickson - Clinical Resource Nurse, Professional Pract...
Picture 1043                              Medication Reconciliation                              It’s about the conversati...
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A7 Rapid Fire: Implementing Medication Reconciliation Across the Continuum - K. Trapnell and F. Pataky

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  • There are approx 220 opportunities for Med Rec every day in VCH on admission alone
  • You can ’t walk this path alone -
  • For a new world view of the organization - Margaret Wheatley wrote of large organizations as living systems-
  • VCH –PHC comprised of many layers and “parts” that contribute to the whole To maintain health across the organization we have to ensure all the parts are healthy too- this is important when implementing MedRec –looking down the road we have come to realize that success in one sector is dependant on success in another sector
  • Similarly in the Vancouver Community of Care
  • Leadership is key ingredient
  • Regional MedRec Team Leads are the real stars – began in June 2010 with 3 nurses and 2 pharmacists. In the past twelve months this group has grown to embrace 21 “leaders” from all sectors including acute, residential, community, mental health, home care, information technology, professional practice, etc.
  • We have everyone at the table
  • What happens in one sector impacts all others.
  • The development of these standardized tools and processes has been instrumental in allowing the leads to expend energy where needed most, namely, connecting and communicating with local teams and their leaders while guiding them through the implementation process.
  • how do we measure success? What do we measure?
  • For progress we measure the degree to which medication reconciliation has been rolled out at VCH-PHC acute care and residential sites For acute we use the number of “discharges” across the organization For residential care- the number of admissions Residential care – 21 sites Jan 2011 – 5 sites Jan 2012 - 16 sites (remainder are in final phases) Community –
  • By the end of April/May all lines will converge at the top (100%)and our focus will be on improving and sustaining performance ( 75%- 100%) And implementing in other sectors (community etc) Acute – 9 sites Jan 2011 – 1 site implemented for admissions Jan 2012 – 6 sites – remaining 3 (also the largest) over the next few months
  • To measure performance we look at the % of patients for whom medication reconciliation was performed on admission- by site and by program core measure for CCM (MoH) Accreditation Canada (on hold) Safer Healthcare Now!
  • making a difference: core measures for Safer Healthcare Now! mean number of unintentional discrepancies identified per patient (greatest risk) mean number of undocumented intentional discrepancies identified per patient - an indicator of efficiency; change is intentional but reason is not evident from chart documentation causing potential confusion and unnecessary attempts at clarification  phone calls+++, etc Baseline studies within VCH indicate the range of unintended medication discrepancies at admission to be 0.7 - 1.6 / patient (2006) Pilot Studies across VCH have demonstrated a reduction of discrepancies by at least 75% in targeted areas here- Unintentional discrepancies – 69%
  • A7 Rapid Fire: Implementing Medication Reconciliation Across the Continuum - K. Trapnell and F. Pataky

    1. 1. Picture 1043 Medication Reconciliation It’s about the conversation. Synergy for Success: Implementing Medication Reconciliation at VCH-PHC BC Patient Safety & Quality Council Quality Forum March 2012 Karin Trapnell Fruzsina Pataky Picture 1031Picture 1030
    2. 2. Overview • Implementing MedRec on admission across a large complex health organization that spreads across rural and city centres presents with significant challenges • To be successful requires a new world view of the organization and a strong leadership model in which leaders empower leaders with the support and the freedom to create a new path for change Picture 9Picture 8 Picture 24 Medication Reconciliation It’s about the conversation.
    3. 3. Picture 17 VCH-PHC at a Glance • 22,000 staff • 556 locationsPicture 16 • 13 acute care hospitals • 15 community health centres • 3+million patient days of care • Primary, secondary, tertiaryPicture 12 and quaternary services • Care, teaching, research • Affiliation with universities andPicture 18 colleges • ≈80,000 admissions /yr Picture 9 Picture 8 Picture 24 Medication Reconciliation It’s about the conversation. 3
    4. 4. Synergy for Success imgPreview Picture 9Picture 8 Picture 24 Medication Reconciliation It’s about the conversation.
    5. 5. Synergy for Success • ……paradox of a living system… Each organism maintains a clear sense of its individual identity within a larger network of relationships that helps shape its identity. Each being is noticeable as a separate entity, yet it is simultaneously part of the whole system Wheatley, M. (2006). Leadership and the New Science: Discovering Order in a Chaotic World Picture 9Picture 8 Picture 24 Medication Reconciliation It’s about the conversation.
    6. 6. Picture 4
    7. 7. Picture 3
    8. 8. Picture 3
    9. 9. Leadership Support • Vancouver Coastal Health (VCH) and Providence Health Care (PHC) senior leadership team “walk the talk” • Medication Reconciliation is an organizational strategic directive. “1.3 – To provide the best quality of care -Build a regional medication reconciliation system across the continuum.” Picture 9Picture 8 Picture 24 Medication Reconciliation It’s about the conversation.
    10. 10. Project Structure • Regional Steering Committee • Executive Steering Committees (VCH & PHC) • TOR and Regional Project Charter ↓ Regional MedRec Leads Committee Picture 9Picture 8 Picture 24 Medication Reconciliation It’s about the conversation.
    11. 11. Project Structure Picture 6 Picture 9Picture 8 Picture 24 Medication Reconciliation It’s about the conversation.
    12. 12. Team Leads Committee • The primary goal of the team leads has been to work together to create a regional approach to successfully implement MedRec • The MedRec team leads created standardized tools and processes for implementation, education, communication, and evaluation to be utilized and adapted at local levels Picture 9Picture 8 Picture 24 Medication Reconciliation It’s about the conversation.
    13. 13. Team Leads Committee Picture 5 Picture 9Picture 8 Picture 24 Medication Reconciliation It’s about the conversation.
    14. 14. Implementation Scope Picture 9 Picture 9Picture 8 Picture 24 Medication Reconciliation It’s about the conversation.
    15. 15. Regional Supports • Implementation plan template • PharmaNet populated forms • Manual forms for all Communities of Care (CoCs) • Forms for ambulatory care, residential care • Policy • Training module (ppt) • E module on CCRS • Webpage created • Medication safety pamphlet • Data coordination and reporting Picture 9Picture 8 Picture 24 Medication Reconciliation It’s about the conversation.
    16. 16. Learnings • The process for implementing MedRec forces us to connect in ways we haven’t before • We’re getting to know and appreciate each other’s importance as part of a greater system • We’ve come to understand the necessity of strengthening our relationships • We realize to be successful - we need each other! Picture 9Picture 8 Picture 24 Medication Reconciliation It’s about the conversation.
    17. 17. Measures of Success • Progress • Performance • Outcome Picture 9Picture 8 Picture 24 Medication Reconciliation It’s about the conversation.
    18. 18. Progress Measures – Picture 4 Residential Care Picture 9Picture 8 Picture 24 Medication Reconciliation It’s about the conversation.
    19. 19. Progress Measures – Acute Care Picture 4 Picture 9Picture 8 Picture 24 Medication Reconciliation It’s about the conversation.
    20. 20. Performance Picture 4 Picture 9Picture 8 Picture 24 Medication Reconciliation It’s about the conversation.
    21. 21. Outcome MeasuresPicture 12 Picture 9 Picture 8 Picture 24 Medication Reconciliation It’s about the conversation.
    22. 22. Medication Reconciliation Team Leads 2011-2012 • Lindsay Bendickson - Clinical Resource Nurse, Professional Practice, Van Community • Renee Bjarnson – Pharmacist, Burnaby Centre for Mental Health & Addiction • Val Cartmel – Team Lead, Coastal Community of Care (to Jan 2012) • Jo Chang - Coordinator of Residential Pharmacy, UBCH - Koerner Pavilion • Chris Foley - Manager, Cambie Older Adult Mental Health Team. • Maylene Fong - Manager - AOA & PC, Evergreen CHC • Debra Halket - GNE, Pharmacy/Nursing PHC • Zoe Krickan - Supervisor - Patient Care Coordinator, Magnolia House • Nadine Lambert - Medication Safety Pharmacist and Medication Reconciliation Coordinator • Melissa Lo - VCH/PHC Regional Medication Safety Coordinator • Mary Marlow - Professional Practice Lead, Addiction Services • Grant McCullough - Practice Consultant, Professional Practice and Nursing • Naomi Monaster - AOA Clinical Applications Support Educator, IMITS - Community Applications • Shelley Novak - Medication Safety Pharmacist, Vancouver • Fruzsina Pataky - Regional Medication Safety Coordinator (to Nov. 11) • Nicola Piggott - Practice Initiatives Coordinator, Richmond MH & A, • Lisa Ramage - Manager - Mental Health & Addiction, Acute, Richmond • Mary Shyng - Medication Safety Pharmacist - Coastal • Jamie Simpson - Team Lead (Clinical) for IMITIS - Primary and Community Care • Karin Trapnell- Regional MedRec Project Manager-Professional Practice-Nursing • Harjender Walia - Clinical Educator Nursing, VA • Heather Wright - AOA Manager, Three Bridges CHC Picture 9Picture 8 Picture 24 Medication Reconciliation It’s about the conversation.
    23. 23. Picture 1043 Medication Reconciliation It’s about the conversation. Questions? Picture 1031Picture 1030

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