Nina Muscillo and Andrew Hargreaves November 2014 Supporting Medication Reconciliation.

Nina Muscillo and Andrew Hargreaves

November 2014

Supporting Medication Reconciliation

Clinical Excellence CommissionThe Clinical Excellence Commission promotes and supports best practice clinical care, safety and quality across the NSW health system by:

• conducting high-level analysis and review that identifies risks and opportunities for improvement

• providing expert support, advice, tools and information

• working collaboratively with patients, clinicians, managers, health service partners and the broader community.

Overview• Continuity of Medication Management (CMM)

program

• Medication Reconciliation Toolkit- Development- Content- Piloting- Future plans

• Partnering with eHealth NSW

CMM Program

Support the safe and quality use of medicines at transfers of care

• Focus on medication reconciliation

• Provides Local Health Districts (LHDs) with tools, resources and support to meet Standards

• Guided by CMM Expert Advisory Group

Medication Reconciliation ToolkitDevelopment• Gap evident in NSW Health system

• In line with the National Safety and Quality Health Service Standards

• Adaptable to suit local needs

• Incorporates lessons learned from international programs

Medication Reconciliation ToolkitAims• Promote medication reconciliation as a

multidisciplinary activity

• Use clinical practice improvement/re-design methodology

• Embed into clinical practice (not as an add on)

• Continual improvement activity

• Sustain and spread

Building on Lessons Learned• Motivation of frontline staff

- Patient stories- Clinical champion/lead

• Collect early baseline data- Current gaps in care

• Leadership support- Additional roles and responsibilities

• Educational tools- Shared understanding

• Continual review and feedback- Build measurement into workflow

Medication Reconciliation ToolkitContent

1. Establishing governance

2. Improving practice

3. Education and Training

4. Monitoring and Evaluation

5. Sustaining and Spreading

Establishing governance

Improving practice

Education and Training

Monitoring and Evaluating

Sustaining and Spreading

Medication Reconciliation ToolkitPiloting

• 4 hospitals, metropolitan and regional

• Site visits to assist with:- Reviewing current practices and identifying gaps- Baseline data collection- Implementation plan

• Audit results being used to promote change

Medication Reconciliation ToolkitPiloting

‘Was

The user guide was clear and unambiguous

…useful for assessing current processes

(audit tool) was easy to use

Medication Reconciliation ToolkitFuture Plans

• CMM webpage

• Communication of the availability of the toolkit

• Official launch in early 2015

• Support pilot sites progress

Partnering with eHealth NSW

• Assist hospitals improve medication records on admission and discharge

• Support LHDs with the re-design of their medication reconciliation processes

• Collaborate to develop best practice electronic tools

eHealth NSW Electronic Medication Management Program• $170m program• Centrally led• Locally delivered• Safety and quality• 3 initial sites currently designing, building or

testing• Detailed planning studies conducted across

remainder of NSW

IMRAD Project – what’s in a name?

• Improving Medication Records on Admission and Discharge

• 3 streams of activity– Local Health District– Electronic Medical Record– Electronic Medication Management System

Clinical Systems Redesign

• Opportunities– Understanding problem– Solution design– Implementation / Monitoring

• Barriers– ?

Electronic Medical Record vs Electronic Medication Management

• Variation in adoption of full EMM systems– Readiness– Schedule/Cost

• Minimum Requirements– Documentation and validation of medication history– Documentation of changes to medications during

admission– Communication of final medication list to patient and GP– Medication list stored for reference during future

admissions

But…

• Medication reconciliation isn’t about widget’s and gizmo’s

• Medication reconciliation is about:– People– Process

Thank You