Your Discharge is Someone’s Admission

YOUR DISCHARGE IS SOMEONE’S ADMISSION

Kim Streitenberger Project Lead, ISMP Canada

Today’s Facilitator

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Welcome

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Mike Cass Patient Safety Improvement Lead, CPSI

Welcome to our francophone

attendees

Bienvenue à nos participants

francophones

Hélène Riverin

Conseillère en sécurité et en amélioration

Safety Improvement Advisor

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Pour nos participants francophones..

Pour accéder aux diapositives

français:

-Cliquez sur l'onglet "FRENCH"

OU

-Envoyer un courriel à

[email protected]

Suivre la boîte «Chat» pour les

commentaires du

conférencière traduit en

français

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Audio Access Only

WebEx does not support Windows XP If you have Windows XP

– Slides are available under “Medication Reconciliation” on the ISMP Canada website

– Q&A – email questions to [email protected]

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Questions ISMP Canada (Host)

Stay on after this call

MedRec Open Mike - Need help with MedRec?…stay on the line

and join the discussion - Meet and connect with others in MedRec - Submit your questions to medrec@ismp-

canada.org or ask them live

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By the end of this webinar you will: Understand the Accreditation Canada requirements

for medication reconciliation at discharge Learn from the experience of patients and

receiving healthcare providers Gain insight into practical strategies for

communicating accurate medication information at discharge

Objectives

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Please complete our poll

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Today’s Speakers

Colleen Cameron Clinical Pharmacist at Grand River

Hospital in Kitchener Ontario

Heather Howley Accreditation Canada

Lynette Zielinski Clinical Nurse Educator Home Care Saskatoon Health Region,

Saskatchewan

Devin Elias Community Pharmacist,

Saskatoon Health Region

Cynthia Berry Lead Medication Reconciliation

Pharmacist for the Saskatoon Health Region, Saskatchewan

Alice Watt Medication Safety

Specialist, ISMP Canada

Michael Hamilton Community and Long Term Care physician,

Newmarket Health Centre, Newmarket, Ontario Physician Lead and Medication Safety

Specialist, ISMP Canada

Your Discharge is Someone’s Admission: How the Patient’s Truth can be a MedWrecker

Colleen Cameron, RPh, Pharm.D. Grand River Hospital, Kitchener ON November 10, 2015

Hospital

Home

LTC

Retirement Home

Primary Care

Rehab

Ms. C is 72 years of age

Admitted to hospital for acute delirium, UTI, new onset diabetes, new onset atrial fibrillation.

PMH – HTN, seizures, recurrent DVTs on warfarin Social Hx: widowed, lives alone in home, Gr. 8 education, manages meds

& ADLs independently Meds – phenobarbital, carbamazepine, telmisartan/HCTZ, warfarin

Warfarin history – on between 7-8 mg/day for > 15 years. Has always had 5mg and 1mg tablets dispensed.

INRs pre-admission – consistently stable for years between 2.3-3.0

= 27mg

I put the 5mg vial behind my back and again asked her to put 7mg in her hand using only 1mg tablets.

= 7mg

I confirmed with her “Is that 7mg?” “Yes”

On discharge – delirium clearing and getting close to baseline, I took the home warfarin bottles out of her bag. “Can you please show me how you would take 7mg of

warfarin?”

Why the confusion?

COUNTING

MATH

Taking 7mg using is

Taking 7mg using is

On the next admission for hematuria pulmonary hemorrhage, GI bleed and an INR > 10, when we ask her what her warfarin dose is for her BPMH:

“I take 7 mg of warfarin every day.”

The Patient’s Truth

Outcome

Ms. C has been back in her home for 6 months.

She is independent with her ADLs and is managing her medications using warfarin

1mg tablets

She is still my Aunt

Morals of the story…

1. What we tell the patient is often very different than what their truth ends up being.

2. A medication history or list is simply a hint of what the patient may actually be doing.

Morals of the story…

3. The only hope we have of finding out the patient’s truth

– Talk and listen – Dialogue – Demonstrate (us and them) – Keep sleuthing…

4. The patient’s truth is often cause for

someone else’s admission.

Thank you for listening to my story!

Medication Reconciliation at Discharge Accreditation Canada Requirements

Heather Howley

Accreditation Canada

November 10, 2015

Qmentum: A quality improvement framework

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A process for organizations to regularly and consistently examine and improve their services

A tool to identify areas for improvement

A measure of an organization’s services compared against standards

Required Organizational Practices (ROPs) in Qmentum

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History of Medication Reconciliation ROPs

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2006:

At admission & discharge

(Service standards)

2010:

As an organizational priority

(Leadership standards)

2014:

Improved customization

Expanded requirements

MedRec at care transitions: Discharge requirements

• Unique to inpatient acute care

• Two medication lists need to be reconciled: – BPMH generated at admission

– Current medication list (e.g., MAR)

• The result is a single list (updated BPMH) of all medications the client should be taking

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MedRec at Care Transitions ROP (acute care version)

2015 ROP Handbook

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MedRec at Care Transitions ROP (discharge requirements)

Major The prescriber uses the Best Possible Medication History (BPMH) and the current medication orders to generate transfer or discharge medication orders.

Major The team provides the client, community-based health care provider, and community pharmacy (as appropriate) with a complete list of medications the client should be taking following discharge.

2015 ROP Handbook

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Care transitions that benefit from MedRec

• Admission

• Discharge (external transfer)

• Internal transfers where there is the potential to introduce medication discrepancies, e.g.:

– Medications are re-ordered or re-written

– Change in service environments where the most responsible prescriber changes

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The On-site Survey: Discharge requirements for MedRec

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REVIEW

TALK and LISTEN

RECORD

OBSERVE

Thank you!

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Proud to be a Top 25 employer for five consecutive years

Fier de faire partie des 25 meilleurs employeurs depuis 5 années consécutives

Thank you! Merci!

Accredited by Agréé par

Cynthia Berry Lead Medication Reconciliation Pharmacist for the

Saskatoon Health Region, Saskatchewan

Discharge Medication Reconciliation

2011 Call to Action!

• Accreditation!

• SK MoH

Provincial

Strategic and

Operational

Directive

• Recognition of

a flawed

system

Discharge/Transfer MedRec Timeline

2011-present

Autumn 2011: Interdisciplinary working group struck

to develop and implement MedRec for patients

discharged from acute care and newly admitted to

LTC

• PDSA cycles

• Role definition

• Rural versus urban

• Form

• Education and communication

• Measuring

Discharge/Transfer MedRec Timeline

2011-present

Autumn 2013: Interdisciplinary working group struck

to develop and implement MedRec for ALL patients

discharged from acute care to “home”.

• Baseline audit – discrepancies, practices

• Role definition

• Process exploration

• Form revision

Discharge/Transfer MedRec Timeline

2011-present

Winter – Spring 2014

• Buy in from Cardiologists and Clinical Nurse

Specialists = revised pre-printed discharge order

set

• Hesitation from our next targeted groups

• HURDLE: time to complete form well

Discharge/Transfer MedRec Timeline

2011-present

Spring 2014 onward:

• Exploration form generated from in-patient

pharmacy software

• Pilot with CTU Team Silver

• PDSA cycles with Silver, Red, Blue

• Evaluation of workload

• Fully implemented for all patients discharged from

RUH CTU (medicine)

Discharge/Transfer MedRec Timeline

2011-present

Spring 2014 onward:

• Creation of a form generated from in-patient

pharmacy software

• Pilot with CTU Team Silver

• PDSA cycles with Silver, Red, Blue

• Evaluation of workload

• Fully implemented for all patients discharged from

RUH CTU (medicine)

Current Discharge/Transfer Med Rec Form

Current Discharge/Transfer Med Rec Form

Current Discharge/Transfer Med Rec Form

• An accurate BPMH is VITAL to Discharge Med

Rec.

• Electronic tools are helpful in many ways

(reduction of transcription error), but come with

their own set of challenges (resources).

• Most discrepancies occur when the physician is

rushed. (Patient flow!)

• Physician champions and rapid PDSAs are keys

to success.

• Involve a community pharmacist!

Critical Learning Moments

Lynette Zielinski, RN Clinical Nurse Educator Home Care, Saskatoon

Health Region, Saskatchewan

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Devin Elias Community Pharmacist

Willow Grove Pharmacy, Saskatoon, SK

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Michael Hamilton Community and Long Term Care physician, Newmarket Health

Centre, Newmarket, Ontario Physician Lead and Medication Safety Specialist, ISMP Canada

Alice Watt Medication Safety Specialist, ISMP Canada

A Toolkit and Checklist for Healthcare Providers

Hospital to Home - Facilitating Safe Medications at Transitions

“A superb, comprehensive guide to implementing effective medication reconciliation, which is a key component of high quality healthcare transitions.”

Dr. Kenneth Boockvar

"... was really helpful for getting discharge medication lists to the service providers, like myself in a timely manner. Not having a discharge medication list can be

troublesome especially if there are cognitive challenges and/or poor patient support in the home, or no family doctor.“

CCAC Rapid Response Nurse

"... one of the most rewarding parts of my job is improving the patient's understanding of their medications and to help them feel more confident about

taking their medications when they go home. The checklist prompts me to systematically go through each step so that the medication information we send with

the patient and to their healthcare providers is accurate and complete. It's about passing the baton to ensure the patient can succeed at home.“

Clinical Pharmacist

Testimonials

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Questions ISMP Canada (Host)

Upcoming MedRec Webinars

February 9, 2015 BOOMR: Care Coordinated Cross Sectional Medication Reconciliation Initiative for LTC residents

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How can I access a previous Safer Healthcare

Now! MedRec webinar/national call? How do I access the Safer Healthcare Now!

MedRec Quality Audit Tool? Where can I find information about MedRec in the

home care setting? Where can I find patient and family resources for

medication reconciliation? Where can I find videos, eLearning modules or

onsite training on how to create a Best Possible Medication History (BPMH)?

Where can I find discharge MedRec resources? What is the purpose of the MedRec Quality Audit? How do I prepare for the MedRec Quality Audit? How do I complete the MedRec Quality Audit and

submit the results?

New Frequently Asked Questions

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Visit http://www.ismp-canada.org/medrec/#tab7 http://www.patientsafetyinstitute.ca/en/Topic/Pages/medication-reconciliation-%28med-rec%29.aspx

MedRec Communities of Practice Post your questions Respond to questions Share tools and

resources

http://tools.patientsafetyinstitute.ca/Communities/MedRec/default.aspx

Online Community Dedicated to MedRec

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We are here to help!

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For MedRec Content (MedRec Intervention Lead)

Institute for Safe Medication Practices Canada (ISMP Canada)

[email protected]

CPSI Patient Safety Intervention Lead

Mike Cass [email protected]

Stay on after this call

MedRec Open Mike - Need help with MedRec?…stay on the line

and join the discussion.

- Submit your questions to [email protected] or ask them live

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Please complete our poll

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MedRec Open Mike

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Your opportunity to: Ask MedRec related questions to the

ISMP Canada MedRec Team Pose questions to teams on the line to

get their input Share stories and tools/resources Exchange ideas about are doing and

what you have learned

What is Open Mike?

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How to ask questions?

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Lets start the discussion