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CMH Medication Reconciliation Journey 2011
- 1. CITIZENS MEMORIAL HEALTHCARE MEDICATION RECONCILIATION JOURNEY 1
- 3. MIB (make it better) initiated
- 4. Team established by action plan owner, to include clinical leaders from all disciplines
- 5. Acute Care
- 7. Clinics
- 9. Pharmacy
- 10. Physicians2
- 12. Clinical staff
- 13. Information Specialists or Technicians
- 15. A process flow diagram was drawn for each discipline
- 16. Informal FMEA (failure modes effects analysis) was applied to each process, to identify weak steps or steps lending to failure3
- 18. The first step included buy in by nurses and physicians to stop using and accepting: โresume all medsโ.
- 19. IS focused on designing improvements in the listing of medications, and methods for electronic med rec for transfers within the system.4
- 21. To Acute care and physicians
- 22. An admission/discharge nurse was hired, med.rec. was part of this roleโs responsibility
- 23. Clinics with each visit
- 24. Home Care โ learning to work with a new software program
- 25. LTC is in initial process of rolling out for admission from home 5
- 28. Annual one/one competency for nurses
- 29. Interactive Healthstream courses for nurses
- 30. One/one education with physicians
- 31. Monthly news letters with bits of med rec education 7
- 33. Printable med list on website
- 34. Articles in CMH quarterly magazine
- 35. Brief articles in newspaper or on radio
- 36. Access to med list from electronic portals
- 37. possibly from Patient Friendly registration card8
- 38. ED view accessing Reconcile Meds
- 39. ED and Inpatient Nursing view of Reconcile Meds
- 40. โReconcile Medsโ with Patient
- 41. View of Reconciled Medications
- 42. Inpatient side of Accessing Reconcile Meds
- 43. Nurses View of being in the process of Med Reconciliation
- 45. Medication Reconciliation Required Questions
- 47. Transferable or Non Transferable Meds
- 48. Physician View of Discharge Med Reconciliation
- 50. List is printed and faxed to Physician
- 51. Nurse enters the orders for the Resident
- 53. Medication List
- 55. Automatically Reconciles the Patients Medication List
- 59. We can measure completion of med rec but it is very difficult to find the resources to track accuracy
- 60. Staff becomes dependent on the system to guide the process
- 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.29
- 62. For More Information or Clarification Aileen Kelley RN,BC CMH Quality Coordinator akelle@citizensmemorial.com Michelle Cahow CMH IS Specialist michelle.cahow@citizensmemorial.com 30
Editor's Notes
- 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 โ 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