1 Western Node Collaborative Chinook Health Region Medication Reconciliation.

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Western Node Collaborative

Chinook Health Region

Medication Reconciliation

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Background

• CHR is embarking to improve the process of medication reconciliation in efforts to decrease the possibility of adverse drug events to our patients. This includes increasing awareness of physicians, nursing staff, pharmacists and patients’ role in medication reconciliation.

• The project charter started Sept 05 and expected to be done by Dec 06

• The project charter will meet the organization’s goal to establish a culture of patient safety.

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• CHR two units participating are: – Pincher Creek Acute Care (Med-Surg) – LRH 5A (Geriatric Rehab & Acute Care of the Elderly)

• Patient population: – Pincher Creek: Pediatrics, mental health, adults,

med/surg, maternity, palliative, ICU– LRH 5A: geriatrics, rehab, acute medicine

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Aim

• Project Charter: To eliminate undocumented intentional discrepancies and unintentional discrepancies by reconciling all medications for all patients. To prevent adverse drug events (ADEs) by implementing medication reconciliation.

• Decrease the number of undocumented intentional discrepancies and unintentional discrepancies by 75% by December 2006. Charter will consist of medication reconciliation of adult patients on Lethbridge Regional Hospital 5A and Pincher Creek Acute care with 5 or more medications.

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Team Members

• Nursing Staff• Pharmacists• Multidisciplinary

members• Managers

• Directors• Vice Presidents• CEO• QI Manager

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Changes Tested

PDSA 1

Objective:

Reminder memos posted on chart racks and next to telephones will help reduce the number of undocumented intentional discrepancies by 30%.

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Memo(PDSA # 1)

• “Attention all physicians, nursing staff and pharmacist: if there is a change in medication orders please indicate reason for change directly on the Dr’s Orders Form. You have just helped eliminate a medication discrepancy and possibly avoid an adverse drug event. Thank you”

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PDSA 2Objective:

Place blue “Medication Reconciliation Communication Forms” on patient charts that require admitting medication order clarification. This will help reduce the number of undocumented intentional and unintentional discrepancies by 30%.

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Medication Reconciliation Communication Form

Patient/Room: _________________________ Date/Time (hr):________________Attention Doctor: ____________________Please clarify the following medication orders on the patient’s chart:

Form to be removed from chart and returned to Pharmacy

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Mean Number of Undocumented Intentional Discrepancies - ACE 5A Lethbridge Regional Hospital

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

1.80

2.00

Month

Mea

n

Actual Goal

PDSA 1PDSA 2

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Mean Number of Undocumented Intentional Discrepancies - GARU 5ALethbridge Regional Hospital

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

Month

Mea

n

Actual Goal

PDSA 2

PDSA 1

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Mean Number of Undocumented Intentional Discrepancies - Pincher Creek, AB

0.00

0.50

1.00

1.50

2.00

2.50

3.00

Month

Me

an

Actual Goal

PDSA 1

PDSA 2

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Mean Number of Unintentional Discrepancies - ACE 5ALethbridge Regional Hospital

0.00

0.50

1.00

1.50

2.00

2.50

Month

Mea

n

Actual Goal

PDSA 1

PDSA 2

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Mean Number of Unintentional Discrepancies - GARU 5ALethbridge Regional Hospital

0.00

0.50

1.00

1.50

2.00

2.50

3.00

Month

Me

an

Actual Goal

PDSA 1

PDSA 2

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Mean Number of Unintentional Discrepancies - Pincher Creek Hospital

0.00

0.50

1.00

1.50

2.00

2.50

Month

Mea

n

Actual Goal

PDSA 1

PDSA 2

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Medication Reconciliation Success Index - ACE 5ALethbridge Regional Hospital

0%

20%

40%

60%

80%

100%

120%

Month

Per

cent

age

Actual Goal

PDSA 1

PDSA 2

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Medication Reconciliation Success Index - GARU 5ALethbridge Regional Hospital

0%

20%

40%

60%

80%

100%

120%

Month

Pe

rce

nta

ge

Actual Goal

PDSA 1

PDSA 2

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Medication Reconciliation Success Index - Pincher Creek Hospital

0%

20%

40%

60%

80%

100%

120%

Month

Pe

rce

nta

ge

Actual Goal

PDSA 1 PDSA 2

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Keys to Success and Lessons Learned

Successes• Buy in from all team members (frontline & executive)• Small group of physicians presently engaged• Previous PDSA cycles experience by some team

members • Group dynamics positive and energetic• Timing• Higher awareness of the importance of medication

reconciliation amongst nursing staff

Barriers• Lack of resources

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Next Steps

• Test revisions to current audit– Cues: Allergies, medications to include: OTC,

herbal, suppositories, eye drops, etc

• Initiate physician engagement

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Contact Information• Mary Schnell [email protected]• Bonnie Johnson [email protected]• Florrie Macdougall [email protected]• Julie Cuthbertson [email protected]• Mary Pederson [email protected]• Doug Pankoski [email protected]• Penny Kwasny [email protected]• Claire McCrank [email protected]• Colin Zieber [email protected]• Lila Ho-Takeda [email protected]• Donna Stelmachovich [email protected]• Janet Lapins [email protected]• Dr. Roland Ikuta [email protected]• Dr. Joel Weaver [email protected]