Successfully reported this slideshow.
Optimizing Medications: time to bring the pieces together
January 16 2014

Medication Reconciliation (MedRec):
Accreditati...
Outline





Overview of MedRec
Review expectations for implementation
Review changes to ROPs
Explore sector-specific ...
Required Organizational Practices
(ROPs) in Qmentum

© Accreditation Canada/Agrément Canada

3
What is Med Rec?
MedRec is a three-step process:

 COLLECT the Best Possible Medication
History

 COMPARE what the clien...
What is NOT MedRec
 MedRec is about identifying discrepancies to
prevent adverse drug events


It is needed at transitio...
History of MedRec






2006 MedRec ROP introduced (service-based)
2008 MedRec ROP requirements scaled back
2010 MedR...
Improved performance
ROP

Compliance (%)
2009

2010

2011

2012

Medication reconciliation as an organizational
priority

...
Why Change MedRec






Performance has improved
More support and resources available
Broader scope
Higher expectatio...
Increased Expectations for
Implementation
 Broaden definition of “Service”




Includes all teams that use a given set ...
Changes to ROP Structure
OLD ROP

REVISED ROP

MedRec as an organizational priority
• 1 + 1 + a plan

MedRec as a strategi...
Leadership for MedRec

© Accreditation Canada/Agrément Canada
© Accreditation Canada/Agrément Canada

11
Medication Reconciliation
as a Strategic Priority







Policy and process
Define roles and responsibilities
Plan t...
MedRec Leadership:
What does it look like?
 Documented policies, processes, and plans
 Engaged leadership, including phy...
MedRec Process

© Accreditation Canada/Agrément Canada
© Accreditation Canada/Agrément Canada

14
Medication Reconciliation
at Care Transitions
 Five versions customized to different settings


Acute Care



Ambulator...
Version
Acute Care

Ambulatory Care

Home and Community Care

Long-term Care
Substance Misuse
© Accreditation Canada/Agrém...
MedRec in Acute Care

© Accreditation Canada/Agrément Canada
© Accreditation Canada/Agrément Canada

17
Overview of Tests for Compliance
(Acute Care)





Generate a BPMH upon admission
Reconcile medications at admission
R...
Evidence of a good MedRec process
(Acute Care)
 A complete BPMH (not just a primary medications list)




Home medicat...
Key Questions/Challenges
(Acute Care)








Quality MedRec vs. just a form in a chart
Internal transfers that req...
MedRec in Ambulatory Care
and Home and Community Care

© Accreditation Canada/Agrément Canada
© Accreditation Canada/Agrém...
Tests for Compliance
(Ambulatory Care)
 Documented rationale for targeting MedRec
and frequency of MedRec

 BMPH at or p...
Tests for Compliance
(Home and Community Care)






Documented rationale for targeting MedRec
BPMH at the beginning ...
Evidence of a good MedRec process
(Ambulatory & Home and Community)
 Targeting is standardized and appropriate


Clients...
Key Questions/Challenges
(Ambulatory & Home and Community)
 Where to start - how to identify targets for
MedRec


Engage...
MedRec in Long-term Care

© Accreditation Canada/Agrément Canada
© Accreditation Canada/Agrément Canada

26
Tests for Compliance
(Long-term Care)
 BPMH upon admission
 Compare BPMH and admission orders to
identify and resolve di...
Evidence of a good MedRec Process
(Long-Term Care)
 BPMH (not just admission orders or the MAR)




Home medications, ...
Key Questions/Challenges
(Long-Term Care)
 Once generated, BPMH „disappears‟


Becomes complete list of medications



...
MedRec Resources

© Accreditation Canada/Agrément Canada
© Accreditation Canada/Agrément Canada

30
MedRec Resources
 Accreditation Canada


2014 ROP Handbook (updated)



Backgrounder



FAQ (updated)



Webcast



...
Thank you!

© Accreditation Canada/Agrément Canada
© Accreditation Canada/Agrément Canada

32
Proud to be a
Top 25 Employer
in 2010, 2011, and 2012.

Fier de faire partie des
25 meilleurs employeurs
en 2010, 2011 et ...
Upcoming SlideShare
Loading in …5
×

Medication Reconciliation and Accreditation

661 views

Published on

Presented at the Optimizing Medications Workshop in Vancouver by Heather Howley

Published in: Health & Medicine, Business
  • Be the first to comment

  • Be the first to like this

Medication Reconciliation and Accreditation

  1. 1. Optimizing Medications: time to bring the pieces together January 16 2014 Medication Reconciliation (MedRec): Accreditation Canada Requirements Heather Howley, MS Accreditation Canada Accredited by Agréé par © Accreditation Canada/Agrément Canada
  2. 2. Outline     Overview of MedRec Review expectations for implementation Review changes to ROPs Explore sector-specific customization  Highlight test for compliance  What to look for on-site  FAQs and Key Challenges © Accreditation Canada/Agrément Canada 2
  3. 3. Required Organizational Practices (ROPs) in Qmentum © Accreditation Canada/Agrément Canada 3
  4. 4. What is Med Rec? MedRec is a three-step process:  COLLECT the Best Possible Medication History  COMPARE what the client is actually taking with what is prescribed to identify discrepancies  CORRECT any medication discrepancies © Accreditation Canada/Agrément Canada 4
  5. 5. What is NOT MedRec  MedRec is about identifying discrepancies to prevent adverse drug events  It is needed at transitions where clients are at-risk  It is NOT about appropriateness  Medication review  It is NOT needed at all transitions  Bed relocation  Hand-offs © Accreditation Canada/Agrément Canada 5
  6. 6. History of MedRec      2006 MedRec ROP introduced (service-based) 2008 MedRec ROP requirements scaled back 2010 MedRec ROP introduced (Leadership) 2010 – 2012 customization and clarity 2014 strengthen requirements change structure to improve applicability © Accreditation Canada/Agrément Canada 6
  7. 7. Improved performance ROP Compliance (%) 2009 2010 2011 2012 Medication reconciliation as an organizational priority ---- 61 77 82 Medication reconciliation at admission 46 47 60 71 Medication reconciliation at transfer/discharge 44 36 50 62 © Accreditation Canada/Agrément Canada 7
  8. 8. Why Change MedRec      Performance has improved More support and resources available Broader scope Higher expectations = patient safety Clarification and realignment of expectations © Accreditation Canada/Agrément Canada 8
  9. 9. Increased Expectations for Implementation  Broaden definition of “Service”   Includes all teams that use a given set of standards across all locations For standards that contain a MedRec ROP  Move beyond „1 + 1 + a plan‟ to full implementation within two cycles:  Phase 1: 2014-2017, in one service  Phase 2: 2018-2022, in all services © Accreditation Canada/Agrément Canada 9
  10. 10. Changes to ROP Structure OLD ROP REVISED ROP MedRec as an organizational priority • 1 + 1 + a plan MedRec as a strategic priority • What is needed to implement and sustain MedRec 2 ROPs: MedRec at Admission 1 ROP: MedRec at Care Transitions MedRec at Transfer/Discharge • Removes artificial separation • Improves customization © Accreditation Canada/Agrément Canada 10
  11. 11. Leadership for MedRec © Accreditation Canada/Agrément Canada © Accreditation Canada/Agrément Canada 11
  12. 12. Medication Reconciliation as a Strategic Priority       Policy and process Define roles and responsibilities Plan to implement and sustain MedRec Led by an interdisciplinary coordination team Education for staff and physicians Monitor and make improvements © Accreditation Canada/Agrément Canada 12
  13. 13. MedRec Leadership: What does it look like?  Documented policies, processes, and plans  Engaged leadership, including physicians  Common understanding at all levels     What it is (three-step process) When it is needed (transitions, targets) Who is responsible for each MedRec step How it is done (model used, forms/tools)  Monitoring compliance  Adherence and quality  Addressing lessons learned © Accreditation Canada/Agrément Canada 13
  14. 14. MedRec Process © Accreditation Canada/Agrément Canada © Accreditation Canada/Agrément Canada 14
  15. 15. Medication Reconciliation at Care Transitions  Five versions customized to different settings  Acute Care  Ambulatory Care  Home and Community Care  Long-term Care  Substance Misuse (unchanged) © Accreditation Canada/Agrément Canada 15
  16. 16. Version Acute Care Ambulatory Care Home and Community Care Long-term Care Substance Misuse © Accreditation Canada/Agrément Canada STANDARDS SET Acquired Brain Injury Services Cancer Care and Oncology Services Correctional Service of Canada Health Services Standards Critical Care Emergency Department Hospice, Palliative, and End-of-Life Services Medicine Services Mental Health Services Obstetrics Services Provincial Correctional Health Services Standards Rehabilitation Services Spinal Cord Injury Acute Services Spinal Cord Injury Rehabilitation Services Surgical Care Services Aboriginal Integrated Primary Care Services Ambulatory Care Ambulatory Systemic Cancer Therapy Services Case Management Services Community-Based Mental Health Services and Supports Standards Home Care Services Long Term Care Services Residential Homes for Seniors Aboriginal Substance Misuse Services Standards Substance Abuse and Problem Gambling Services 16
  17. 17. MedRec in Acute Care © Accreditation Canada/Agrément Canada © Accreditation Canada/Agrément Canada 17
  18. 18. Overview of Tests for Compliance (Acute Care)     Generate a BPMH upon admission Reconcile medications at admission Retain a current medications list Use the BPMH to generate transfer/discharge orders  Provide a complete list of medications upon discharge *Special consideration in emergency departments © Accreditation Canada/Agrément Canada 18
  19. 19. Evidence of a good MedRec process (Acute Care)  A complete BPMH (not just a primary medications list)    Home medications, including OTC Source(s) of medication information identified Actual medication use (not just as prescribed)  Method and tools to identify and resolve discrepancies  Use BPMH (not just MAR) to generate transfer/discharge orders  Transitions where discrepancies may be introduced (e.g., orders are re-written)  Accurate understanding of medications upon discharge  Client, family, next care provider © Accreditation Canada/Agrément Canada 19
  20. 20. Key Questions/Challenges (Acute Care)        Quality MedRec vs. just a form in a chart Internal transfers that require MedRec What is a „service‟ The MAR is probably not sufficient Physicians reluctant to reconcile medications Access to pharmacy Client arrives with BPMH - no need to repeat © Accreditation Canada/Agrément Canada 20
  21. 21. MedRec in Ambulatory Care and Home and Community Care © Accreditation Canada/Agrément Canada © Accreditation Canada/Agrément Canada 21
  22. 22. Tests for Compliance (Ambulatory Care)  Documented rationale for targeting MedRec and frequency of MedRec  BMPH at or prior to the first visit  Identify and document discrepancies  At or prior to the first visit  Subsequent visits, as per the policy  Work with client to resolve discrepancies  Retain current medications list in client record © Accreditation Canada/Agrément Canada 22
  23. 23. Tests for Compliance (Home and Community Care)      Documented rationale for targeting MedRec BPMH at the beginning of service Work with client to resolve discrepancies Update current medications list Educate client and family to share complete medications list © Accreditation Canada/Agrément Canada 23
  24. 24. Evidence of a good MedRec process (Ambulatory & Home and Community)  Targeting is standardized and appropriate  Clients at-risk of medication discrepancies  Complete BPMH (not a primary meds list)  Method to identify discrepancies  Comparing prescriptions, not orders  Understand everything a client is taking  Efforts to resolve discrepancies (with client)  Client empowered to maintain and share list © Accreditation Canada/Agrément Canada 24
  25. 25. Key Questions/Challenges (Ambulatory & Home and Community)  Where to start - how to identify targets for MedRec  Engage front-line  Organizations may start small with a plan for spread  How often to repeat MedRec in ambulatory care  Appropriate for risk  Access to prescriber  Prescribers reluctant to resolve discrepancies © Accreditation Canada/Agrément Canada 25
  26. 26. MedRec in Long-term Care © Accreditation Canada/Agrément Canada © Accreditation Canada/Agrément Canada 26
  27. 27. Tests for Compliance (Long-term Care)  BPMH upon admission  Compare BPMH and admission orders to identify and resolve discrepancies  Retain a complete meds list in client record  Identify and resolve discrepancies at readmission  Provide a complete list of client medications upon transfer out © Accreditation Canada/Agrément Canada 27
  28. 28. Evidence of a good MedRec Process (Long-Term Care)  BPMH (not just admission orders or the MAR)    Home medications, including OTC Source(s) of medication information identified Actual medication use (not just as prescribed)  Method to identify and resolve discrepancies  Repeat MedRec at re-admission  Use the complete meds list to generate transfer/discharge orders (MAR may not be enough)  Accurate understanding of medications upon discharge  Client, family, next care provider © Accreditation Canada/Agrément Canada 28
  29. 29. Key Questions/Challenges (Long-Term Care)  Once generated, BPMH „disappears‟  Becomes complete list of medications  May be different from the MAR  Resident arrives with BPMH - no need to repeat  The MAR may not be sufficient  Need to reconcile against BPMH (admission) or complete meds list (re-admimssion)  Internal transfers requiring MedRec are rare © Accreditation Canada/Agrément Canada 29
  30. 30. MedRec Resources © Accreditation Canada/Agrément Canada © Accreditation Canada/Agrément Canada 30
  31. 31. MedRec Resources  Accreditation Canada  2014 ROP Handbook (updated)  Backgrounder  FAQ (updated)  Webcast  Webinar Series  Accreditation Specialist  MedRec@accreditation.ca  Safer Healthcare Now! Getting Started kits © Accreditation Canada/Agrément Canada 31
  32. 32. Thank you! © Accreditation Canada/Agrément Canada © Accreditation Canada/Agrément Canada 32
  33. 33. Proud to be a Top 25 Employer in 2010, 2011, and 2012. Fier de faire partie des 25 meilleurs employeurs en 2010, 2011 et 2012. © Accreditation Canada/Agrément Canada © Accreditation Canada/Agrément Canada 33

×