Purpose of the Call: •Recap of aggregated MedRec audit month data that identifies potential opportunities for improvement •Review quality improvement concepts as it relates to measuring for quality improvement •Hear how Horizon Health team (NB) is using their data to improve MedRec processes •Receive a tutorial on how to access your MedRec Quality Score run charts in Patient Safety Metrics. WATCH: http://bit.ly/1EVcREL

1. BEYOND THE AUDIT:
MEASURING FOR
IMPROVEMENT
Kim Streitenberger, Project Leader, ISMP Canada
Maryanne D’Arpino, Patient Safety Improvement Lead, CPSI
Paula Pickard, Patient Safety Consultant – Horizon - Fredericton & Upper River Valley Area
John Thomas Glidden, Patient Safety Consultant, Horizon - Miramichi Area
Diane Beaulieu, Patient Safety Consultant, Horizon - Saint John Area
Alex Titeu, Project Coordinator, Central Measurement Team, Safer Healthcare Now!

2. Lynn Riley
Medication Safety Specialist and Educator, ISMP
Canada
Today’s Facilitator
2

3. Welcome to our francophone
attendees
Bienvenue à nos participants
francophones
Hélène Riverin
Conseillère en sécurité et en amélioration
Safety Improvement Advisor
3

4. Pour nos participants francophones..
Pour accéder aux diapositives
français:
-Cliquez sur l'onglet "FRENCH"
OU
-Envoyer un courriel à
helene.riverin@csssvc.qc.ca
Suivre la boîte «Chat» pour les
commentaires du
conférencière traduit en
français
4

5. 5
Where to find our webinars…

6. 1. Recap of 2015 MedRec audit month data that identify
potential opportunities for improvement – ISMP
Canada
2. Review QI principles as it relates to measuring for
quality improvement – Maryanne
3. Hear from local teams of how they use measurement
for MedRec quality improvement.- John, Paula, Diane
4. Review how to enter data into the Patient Safety
Metrics System and create run charts – CMT
Objectives
6

7. 7
Please complete our poll
7

8. 8
Today’s Speakers
Kim Streitenberger Maryanne D’Arpino Diane Beaulieu
John Thomas Glidden Paula Pickard Alex Titeu

9. KIM STREITENBERGER
ISMP Canada

10. 10
Outline
 Provide brief summary of 2015 audit
month results
– March 31st presentation handouts available at
http://ismp-canada.org/medrec/#webinars
 Discuss opportunities for Improvement

11. 11
Oct. 2013 Feb. 2015
Sites 103 173
Patients /
Residents
2340 5201
Audit Participation

12. Performance of MedRec
80% 98%
n = 4745+443
12

13. Quality of MedRec Performed
13
Element Acute Care
(% of patients)
LTC
(% of residents)
BPMH based on > 1 source 69% 70%
Med use verified by patient/caregiver 66% 54%
Each med w/name, dose, route, etc. 88% 83%
Meds on BPMH are accounted for 80% 81%
Prescriber documented rationale 69% 76%
QUALITY BPMH
QUALITY
RECONCILIATION

14. 35%
n=4825
30%
Percentage of Patients by Quality
Score
14

15. Average MedRec Quality Score
2013 vs. 2015 by Sector
2013 (n) = 1945
2015 (n) = 4825
15

16. Percentage of MedRec Performed x Score
30%
40%
n=4210
16

17. Compliance w/ BPMH elements by
“Admit via”
n=2393
17

18. Measurement for Continuous
Improvement
18
1-9 Data
Submissions
53%
10-17 Data
Submissions
47%
Data Submissions since MRQA
Month 2013*
• 88% of sites who participated in the 2013
MedRec Quality Audit Month continued to
submit data to Patient Safety Metrics

19.  Measure your MedRec processes
consistently over time and submit your data
to Patient Safety Metrics
 Use your own organizational data to drive
your quality improvement efforts.
– Improve the performance of MedRec for all patients
– Improve the quality of MedRec performed
Summary of Opportunities for
Improvement
19

20. How Are You Using Your Data for
Improvement
We Are Actively Making
Changes
Based On Our Data
We Are Planning
Improvements
Based On Our
Data
We Haven’t Started
to Use Our Data Yet
20

21. MARYANNE D’ARPINO
Canadian Patient Safety Institute (CPSI)
QI Principles: Measurement for Improvement

22.  Knowing why you need to improve
 Having a way to get feedback to let you know if
improvement is happening
 Developing an effective change that will result in
improvement
 Testing a change before attempting to implement
 Implementing a change
Langley, G. (2009). The improvement guide: A practical approach to enhancing organizational
performance (2nd ed., p. 490). San Francisco, California: Jossey-Bass.
5 Fundamental Principles of Improvement
22

23. QI Measurement is Different Than
Accountability or Research
Improvement Accountability Research
WHO?
Audience
Internal External Science
community
WHY?
Purpose
Process knowledge,
change monitoring
Comparison New knowledge
WHAT?
Scope
Measures
Time Period
Confounders
Local
Few, easy
Short, current
Rarely
Local & other
Few, complex
Long, past
Try to measure
Universal
Complex
Long, past
Measure
HOW?
Measures
Sample Size
Collection
Internal
Small
Simple
External
Large
Complex
External
Large
Complex
Source: Solberg, et al. (1997). The Three Faces of Performance Measurement. Jt Comm J Qual Improv.;23(3):135-47
23

24. Why IS Measurement Important?
 What does "better" look
like?
 How will we recognize
better when we see it?
 How do we know if a
change is an improvement
24

25. How Can We Depict Data?
STATIC VIEW
Descriptive Statistics
Bar graphs/Pie charts
DYNAMIC VIEW
Run Chart
Control Chart
(plot data over time)
Source: Lloyd, R. & Scoville, R. (2010). Simplifying the Selection & Use of Shewart Charts. Institute for Healthcare
Improvement [IHI] Forum.
8
3
0
1
2
3
4
5
6
7
8
WEEK 4 WEEK 11
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26. Measuring over time – the value of a
run chart
To understand baseline
performance and identify
opportunities for
improvement
To determine if a change
resulted in improvement
To determine if we are
holding the gains made by
our change
26

27.  Use audit results as your baseline
 Identify where there is opportunity for
improvement
 Identify the measures you will use to
monitor your improvement efforts over
time
 Measure consistently over time
Beyond the Audit: Measuring for
Improvement
27

28.  Leadership Support
 Aligns with organizational strategy
 QI Lead & Team
 QI Culture
QI Implementation Fundamentals
28

29. JOHN THOMAS GLIDDEN
PAULA PICKARD DIANE BEAULIEU
Horizon’s Approach to Using Med Rec
Measurement for Improvement

30. A little about us…
“Areas”
 Moncton*
 Saint John
 Fredericton/Upper River
 Miramichi
(12 Hospital Facilities)
30

31. Accountability breeds
“response-ability”.
Stephen R. Covey, Beyond the 7 Habits
Measurement for Improvement –
Accountability
31

32.  Quantity
Horizon Med Rec Dashboard
• % of patients receiving MedRec on Admission
• % of patients receiving MedRec at Discharge
Measurement
• Quarterly Data
• Clinical Network, Facility, & Unit-Level Data
• Trend Analysis
32

33.  Quality
SHN! Patient Safety Metrics
• % MedRec performed
• Quality Bundle
BPMH has > 1 source
Patient/caregiver as a source
Each med has all information required
Each med is accounted for & rationale included
Measurement
33

34.  Engage frontline staff
 Communicate results to all levels
 Display results creatively
 Acknowledge & celebrate successes
 Evaluate quality of processes
 Evaluate small tests of change & identify
action plans
Using the Data
34

35. 35
Measurement PDSA cycle
 The focus of measuring data is
 Using PDSA cycle for Process
Improvement

36. 36
Horizon Experience with PDSA
Low compliance in Quantity Data
Implement Quality Audits; Team Meetings
Resolving Medication Discrepancies
Modify MedRec Form; Quality Audits

37.  Resources, Support & Commitment
 Accountability Framework
 Current Data
 Limitations
 Engagement
 Creativity
 Acknowledgement
Reporting and Learning:
Lessons Learned
37

38. HOW TO GET YOUR
RUN CHARTS
Patient Safety Metrics
Alex Titeu

39.  You need an account for PSMetrics to
access your data and reports
 If you do not have an account, please
email metrics@saferhealthcarenow.ca
– Your First and Last Name
– Your Phone Number
– Name of the site(s) you want to access
reports
Patient Safety Metrics (PSMetrics)
39

40. 1. On the “Report” tab
2. Click on the “MedRec Quality” sub-tab
3. Click on one of the following reports:
– Quality Audit Bundle Compliance at Admission in
Acute Care (MedRec-Acute 12)
– Quality Audit Bundle Compliance at Admission in
Long Term Care (MedRec-LTC 7)
Organization Run Chart
40

41. 41

42. 42

43. 1. On the “Data” tab
2. Click on the “MedRec-Acute” or “MedRec-
LTC” intervention
3. Scroll to the “Measurement Worksheets” table
4. Look for measures “MedRec-Acute 12” or
“MedRec-LTC 7” for your “Unit”
5. Click “View/Add data” link
6. Click “Compliance Run Chart” Button
Unit-level Run Charts
43

44. 44

45. 45

46. 46

47. LYNN RILEY
ISMP Canada

48. Discussion/
Questions
48

49.  Improving the quality of MedRec
processes is our responsibility.
 Measurement and improvement are
possible.
 Identify the root cause before making
changes.
 Be creative in developing solutions.
 THINK OUTSIDE THE BOX!
Key points to remember…
49

50. Resources
IHI Open School
http://www.ihi.org/education/i
hiopenschool/Pages/default.
aspx
Improvement GSK
http://www.saferhealthcarenow.ca/EN/shnN
ewsletter/Pages/Improvement-
Frameworks-Getting-Started-Kit-guides-
system-change.aspx
MedRec GSKs and One Pagers
http://www.saferhealthcarenow.ca/EN/Interventions/medrec/Pages/
default.aspx
50

51. Upcoming MedRec Webinars
September 2015 Home Care new MedRec GSK and the
link to Acute Care and Long Term Care
November 2015 Accreditation Canada new MedRec
ROPs for 2016
February 2015 to be determined
51
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52. Beginning September 2015
MedRec Open Mike
- Need help with MedRec…stay on the line
after each national webinar
- Submit your questions prior to the Open Mike
session to medrec@ismp-canada.org or ask
them live
52

53. MedRec Communities of
Practice
 Post your questions
 Respond to questions
 Share tools and
resources
http://tools.patientsafetyinstitute.ca/Co
mmunities/MedRec/default.aspx
Online Community Dedicated to MedRec
53

54. Please complete our poll
54

55. We are here to help!
55
 For Audit forms and Data Questions
CPSI Central Measurement Team metrics@saferhealthcarenow.ca
Virginia Flintoft - 416-946-8350
Alexandru Titeu - 416-946-3103
 For MedRec Content (MedRec Intervention Lead)
Institute for Safe Medication Practices Canada (ISMP Canada)
medrec@ismp-canada.org
 CPSI Patient Safety Intervention Lead
Maryanne D’Arpino MDArpino@cpsi-icsp.ca