Acknowledgements Michaela Baginski, Dr Kashmir De Silva, Natalie Elphick, Melissa Inskip, Dr Clair Langford, Veronica Murdoch, Karin Tarne, Erica Wales, Dr Phil Yang, Juliana Zvavanjanja. Members of Steering and Project Committees Lessons learnt Case for change Medication Reconciliation (Med Rec) is the process of obtaining, updating and communicating an accurate list of a patient’s medicines at transfers of care. Poor Med Rec leads to: • Patient harm: Medication errors or suboptimal treatment • Poor care experience: Not involving patients in the process • Wasted resources: Poor communication of medication changes can double risk of readmission At Wollongong hospital a Medication Safety audit (50 patients) conducted in 2015 suggested that the recommended process was followed in only 40% of patients and, between July and December 2015, there was an average of 4 significant incidents reported each month. Diagnostics – Identified Issues & Solutions Results Medication Reconciliation A Prescription for Safety Mark Farrah Pharmacy Department, Wollongong Hospital Goal To improve Med Rec on a pilot ward at Wollongong Hospital, through a multi-disciplinary approach, to align with National Accreditation Standards and the Local Health District’s objective of reducing preventable harm and improving the patient care experience. Objectives Increase the percentage of patients that have their medication reconciled within 48 hours of admission from 58% to 80% by March 2017 Increase the quality of medication reconciliation by increasing the percentage of medication reconciliation with a documented Best Possible Medication History (BPMH) from 42% to 80% by March 2017 Methods used Sustaining change • Ongoing education and audit to maintain quality • Report progress through Medication Safety Committee and at ward and pharmacy meetings • Promote links with other projects and quality initiatives such as eMeds, eMR2 and accreditation standards • Maintain SharePoint resource site on intranet • Review pilot solutions and roll out to other wards and areas • Continue to improve patient involvement in the Med Rec process and provide reward and recognition program for staff Contact Mark Farrah, Project Pharmacist, Wollongong Hospital Email: [email protected] Phone: (02) 4255 1529 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percentage of patients from pilot ward with documented record of medication reconciliation within 48hrs of admission Reconciled Target 0 2 4 6 8 10 12 14 16 18 20 Disagree Neutral Agree Strongly Agree JMO awareness: I am confident that I currently have the skills to take a BPMH for a patient under my care? (n=28) JMO Pre-presentation JMO Post-presentation 0 1 2 3 4 5 6 7 8 Novice Intermediate Expert Nurse awareness: What level would you describe your knowledge regarding medication reconciliation? (n=8) Pre-workshop Post-workshop 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percentage of patients with a Medication Management Plan (MMP) MMP Target 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percentage of MMPs with a Best Possible Medication History (BPMH) BPMH Target ISSUE EVIDENCE SOLUTION Low awareness and training about Med Rec and process. • Provide Med Rec training • Develop SharePoint resource site Documentation not consistent between healthcare professionals • Promote MMP as preferred documentation source Medication reconciliation isn’t completed at admission • Develop referral pathway to support early Med Rec 0% 20% 40% 60% 80% 100% JMO (57) Nurse (38) Have you ever received Med Rec training? Yes No 0% 20% 40% 60% 80% 100% Do you reconcile meds on admission? (JMOs - n=38) Routinely Occasionally Never 0% 20% 40% 60% 80% 100% JMO (57) Pharmacist (20) Where do you document Med Rec? Medical Record MMP Med Chart Pharmacist self‐audit MMP promotion Nurse workshop JMO presentation Referral to Pharmacist Time • Things can take longer than anticipated • Once things are agreed – act quickly Communication • Face to face is important to maintain momentum • Showcase efforts – SharePoint site allowed colleagues to keep up to date with the project Teamwork • Supportive project team helped implementation • Use influence of Sponsor to promote action and identify champions Intervention Staff survey (n=148) Audit (n=612) Root cause analysis Patient experience tracker (n=20) Process mapping (n=10) SharePoint site Clinical redesign methodology
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AcknowledgementsMichaela Baginski, Dr Kashmir De Silva, Natalie Elphick, Melissa Inskip, Dr Clair Langford, Veronica Murdoch, Karin Tarne, Erica Wales, Dr Phil Yang, Juliana Zvavanjanja.
Members of Steering and Project Committees
Lessons learnt
Case for changeMedication Reconciliation (Med Rec) is the process of obtaining, updating and communicating an accurate list of a patient’s medicines at transfers of care.
Poor Med Rec leads to:
• Patient harm: Medication errors or suboptimal treatment
• Poor care experience: Not involving patients in the process
• Wasted resources: Poor communication of medication changes can double risk of readmission
At Wollongong hospital a Medication Safety audit (50 patients) conducted in 2015 suggested that the recommended process was followed in only 40% of patients and, between July and December 2015, there was an average of 4 significant incidents reported each month.
Diagnostics – Identified Issues & SolutionsResults
Medication ReconciliationA Prescription for Safety
Mark FarrahPharmacy Department, Wollongong Hospital
GoalTo improve Med Rec on a pilot ward at Wollongong Hospital, through a multi-disciplinary approach, to align with National Accreditation Standards and the Local Health District’s objective of reducing preventable harm and improving the patient care experience.
ObjectivesIncrease the percentage of patients that have their medication reconciled within 48 hours of admission from 58% to 80% by March 2017
Increase the quality of medication reconciliation by increasing the percentage of medication reconciliation with a documented Best Possible Medication History (BPMH) from 42% to 80% by March 2017
Methods used
Sustaining change• Ongoing education and audit to maintain quality
• Report progress through Medication Safety Committee and at ward and pharmacy meetings
• Promote links with other projects and quality initiatives such as eMeds, eMR2 and accreditation standards
• Maintain SharePoint resource site on intranet
• Review pilot solutions and roll out to other wards and areas
• Continue to improve patient involvement in the Med Rec process and provide reward and recognition program for staff
ContactMark Farrah, Project Pharmacist,
Wollongong Hospital
Email: [email protected]
Phone: (02) 4255 1529
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Percentage of patients from pilot ward with documented record of medication reconciliation within 48hrs of admission
Reconciled Target
02468
101214161820
Disagree Neutral Agree StronglyAgree
JMO awareness: I am confident that I currently have the skills to take a BPMH for a patient under my care?
(n=28)
JMO Pre-presentation JMO Post-presentation
012345678
Novice Intermediate Expert
Nurse awareness: What level would you describe your knowledge regarding medication
reconciliation? (n=8)
Pre-workshop Post-workshop
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Percentage of patients with a Medication Management Plan (MMP)
MMP Target
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Percentage of MMPs with a Best Possible Medication History (BPMH)
BPMH Target
ISSUE EVIDENCE SOLUTION
Low awareness and training about Med Rec and process.
• Provide Med Rec training
• Develop SharePoint resource site
Documentation not consistent between healthcare professionals
• Promote MMP as preferred documentation source
Medication reconciliation isn’t completed at admission
• Develop referral pathway to support early Med Rec
0% 20% 40% 60% 80% 100%
JMO (57)
Nurse (38)
Have you ever received Med Rec training?
Yes No
0% 20% 40% 60% 80% 100%
Do you reconcile meds on admission? (JMOs - n=38)
Routinely Occasionally Never
0% 20% 40% 60% 80% 100%
JMO (57)
Pharmacist (20)
Where do you document Med Rec?
Medical Record MMP Med Chart
Pharmacist se
lf‐audit
MMP prom
otion
Nurse worksho
p
JMO presentation
Referral to
Pharm
acist
Time• Things can take longer than anticipated• Once things are agreed – act quickly
Communication• Face to face is important to maintain momentum• Showcase efforts – SharePoint site allowed
colleagues to keep up to date with the project
Teamwork• Supportive project team helped implementation• Use influence of Sponsor to promote action and
identify champions
Intervention
Staff survey (n=148)
Audit (n=612)
Root cause
analysis
Patient experience
tracker (n=20)
Process mapping (n=10)
ShareP
oint site
Clinical redesign
methodology
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