The Puzzle Gets Bigger

© ISMP Canada and Safer Healthcare Now! 2014

Optimizing Medications Time to Bring the Pieces Together

MedRec Update 2014

Margaret Colquhoun Project Lead ISMP Canada

National MedRec Co-Lead

© ISMP Canada and Safer Healthcare Now! 2014 © ISMP Canada and Safer Healthcare Now! 2014

Outline

• Leadership

• Quality Measurement

• Technology

• National Resources


David

Denison


2010- National MedRec Summit

Healthcare CEOs, senior leaders, representatives from national organizations,

provincial quality councils, physicians, nurses and pharmacists identified themes that

would accelerate and optimize MedRec across the continuum of care


“Senior leadership commitment is critical to

ensuring MedRec is implemented successfully

across an organization. It is essential to dedicate

resources to support the achievement of an

ambitious plan of action, and include MedRec as

a strategic priority with goals, timelines,

accountability for implementation, evaluation and

progress reporting. Accountability must rest with

the CEO with clear reporting expectations at the

board level.”

LEADERSHIP ACCOUNTABILITY

Got Med Wreck? Targeted Repairs from the Multi-Center

Medication Reconciliation Quality Improvement Study (MARQUIS)

Jeffrey L. Schnipper, MD, MPH, FHM

Director of Clinical Research, BWH Hospitalist Service Associate Physician, Division of General Medicine,

Brigham and Women’s Hospital Associate Professor, Harvard Medical School


• MARQUIS Study

• To discuss lessons learned from sites that have implemented the MARQUIS program and how they might be applied to Canadian hospitals

• To make the case for provinces, health systems, and hospitals to invest in medication reconciliation quality improvement efforts, and why physicians need to play a major role in these efforts

Find it at: http://www.ismp-canada.org/medrec/

7

Leadership


Quality Measurement

October was National MedRec Quality Audit Month


Need to critically evaluate admission processes

to ensure quality of processes at other transitions

MedRec

Quality

Audit

Tool


“Participants” by Province/Territory

10

103 sites

2,340 patients

Number of Patients

Provinces/Territories


“Participants” by Sector

11

103 sites

85%

N=1,992

15%

N=348

Acute Care

LTC

Acute Care

LTC

77%

N=79

23%

N=24

2,340 patients


Design of the Tool – the Literature • A review of published articles found that 10-67% of patients

had at least 1 prescription medication history error – when non-prescription medications were included the

frequency of errors was 25-83% • Authors suggest: “should be a comprehensive medication

history that includes an interview, inspection of medication vials or lists, or both and contact with community pharmacies, or family physicians.”

CMAJ, 2005 http://www.cmaj.ca/content/173/5/510.full.pdf+html

http://www.cmaj.ca/content/173/5/510.full.pdf+html



Column C Results (‘BPMH -greater than one source)

14

60%

N=2,040

74%


Literature suggests…

• 66% of Canadians have sometimes used non-prescription medication in the past six months.

2004 Survey of Canadians’ Use of OTC Medications http://www.bemedwise.ca/english/usagesurvey.html

• 12% of patients don’t fill their prescription at all.

• 12% of patients don’t take medication at all after they fill the prescription.

• 22% of patients take less of the medication than is prescribed on the label.

Adult Meducation http://www.adultmeducation.com/OverviewofMedicationAdherence_2.html

http://www.bemedwise.ca/english/usagesurvey.html

http://www.adultmeducation.com/OverviewofMedicationAdherence_2.html


Column D – Actual Med Use Verified by Pt./Caregiver

16


D Results: Med Use Verified by Pt/Caregiver

17

57%

N=2,044

63%


Literature suggests…. Column F

• Medication discrepancy was defined as a difference between the medication use history (BPMH) and the admission medication orders.

• In the sample of patients admitted to general medicine unit:

– 54% of patients had at least one unintentional discrepancy identified (most common type was omission of a regularly used medication)

– 38% of these discrepancies were judged to have the potential to cause moderate to severe discomfort or clinical deterioration

© ISMP Canada and Safer Healthcare Now! 2014 19


Results F.‘Meds on BPMH+Admin Order’

20

73%

N=2,006

87%


Overall National MedRec Quality Audit Results

2340 patients

29% (acute care)

55% (Long Term Care)

• 1906 Acute Care

• 329 Long Term Care

• Met all 5 quality criteria

• Met all 5 quality criteria

103 Organizations


Comments

• Audit tool results demonstrate need for ongoing and specific improvements

• Future audits to measure improvement are critical

• Many people believe they are doing MedRec but they may not be doing it well

– The foundation of the process – the BPMH needs work


Comments

• Need to critically evaluate admission processes to ensure quality of MedRec processes at other transitions

• Sites will need to train people to use the audit tool – materials are available to support this process

23


Pennsylvania Patient Safety Advisory -2013

• 501 reports involving MedRec breakdowns in 1 year

• 69% at admission

• Events most often at prescribing (40%)

• Drug omission most frequent (26.7%)


eMedRec in Canada Paper to Electronic Project

Online survey 212 people responded


Available Soon

To support organizations

migrate from a paper-

based system to an

electronic system for

MedRec


Motivation for Moving to eMedRec

• Integrates electronic data from multiple sources ( electronic and non-electronic)

• Provides electronic tools and user interfaces for comparing medication lists

• Facilitate discharge MedRec with multiple sources of information


Advantages of eMedRec

• Improved standardization, legibility, communication, accessibility

• Potentially improved compliance through soft stops (i.e., reminders that eMedRec needs to be completed and/or hard stops (orders cannot be placed until eMedRec is completed)

• Decision support tools to assist in comparing medication lists/identifying discrepancies integrated to generate warnings

• Integration with CPOE to facilitate improved ordering processes

• Improved efficiency of many medication-related processes in healthcare organizations (Poon et al., 2006).


Tools/Checklists Soon to be Available

• Organizational Readiness

• Steps to support the safe transition to eMedRec

• Ideal features of eMedRec,

• Evaluation of eMedRec


Judy

Colquhoun



Having a look at MedRec Nationally



Identified Themes -

2010 National MedRec Summit

INTER-PROFESSIONAL ENGAGEMENT


PUBLIC/CONSUMER/CAREGIVER ENGAGEMENT

PHYSICIAN ROLES


INTER-PROFESSIONAL ENGAGEMENT

Role of the pharmacy technician


National Health Leadership Conference



Free iPhone app for

patients to

track medications.

Android version

coming mid- 2014.

PR Campaign from North Bay

Regional Health Centre (ON)

Sunrise Health

Region (SK)’s PR

campaign “Be a

Champion of Your

Health”



www.SafeMedicationUse.ca


http://www.safemedicationuse.ca/


Toronto Zoomer Show, November 2013 35,000 consumers in attendance




Healthcare Practitioner Education


www.Rxbreifcase.com

http://www.rxbreifcase.com/


BPMH Training

Pharmacy Technicians Clinicians


Primary Care – 2 Page Information Sheet


Home Care

The Puzzle Gets Bigger

Health & Medicine

safer healthcare

caregiver16 ismp canada

continuum of care ismp

david denison ismp canada

quality of processes

nonprescription medication

quality criteria55

medication use history