Continuing the circle of care: MedRec in the Community
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Purpose of the Call: Horizon, Moncton, NB will: 1.Demonstrate the timeline for the development of a provincial bilingual medication reconciliation form and process 2.Identify how technology provided an avenue for a multi-site team collaboration 3.Distinguish the key elements in a provincial bilingual medication reconciliation form Saskatoon Health Region Home Care, SK will: 1.Share how they developed a nurse driven, paper-based MedRec program to support home care clients in medication management. 2.Outline their current MedRec process 3.Showcase their current Med Rec/BPMH form and data collection form for the audit process. Watch the recording here: http://bit.ly/1fOTJwt
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Continuing the circle of care: MedRec in the Community
- 1. www.saferhealthcarenow.ca Continuing the circle of care: MedRec in community March 25, 2014
- 2. www.saferhealthcarenow.ca Welcome also to our francophone attendees Bienvenue à nos participants francophones Hélène Riverin Conseillère en sécurité et en amélioration Safety Improvement Advisor Welcome!
- 3. www.saferhealthcarenow.ca Pour nos participants francophones.. Pour accéder aux diapositives français: ‐Cliquez sur l'onglet "FRENCH" OU ‐Envoyer un courriel à helene.riverin@csssvc.qc.ca Suivre la boîte «Chat» pour les commentaires du conférencière traduit en français
- 4. www.saferhealthcarenow.ca Where to find our webinars…
- 5. www.saferhealthcarenow.ca SHN MedRec Home Care Resources 5 http://www.ismp‐canada.org/medrec/#mrhc
- 7. www.saferhealthcarenow.ca Speakers • Ann Nickerson, B.Sc. Pharm. FCSHP • Michelle Anglehart, RN, CNS, CON(C) Horizon Health Network ‐ Moncton, NB will: 1. Demonstrate the timeline for the development of a provincial bilingual medication reconciliation form and process 2. Identify how technology provided an avenue for a multi‐site team collaboration 3. Distinguish the key elements in a provincial bilingual medication reconciliation form 7 Horizon Health Network - New Brunswick
- 11. Evolution of Medication Reconciliation at our Home Care Program Phase 1 Phase 2 Phase 32008‐2012 2013‐2014 2015 • Safer Healthcare Now! Pilot • Development of MedRec Form • Implementation 5/29 units • Provincial Initiative (EMP Nursing P&P) • Formed MedRec subcommittee • Provincial Bilingual MedRec Form • Complete circle of care • Goal: Provincial roll out 29 NB home care units
- 14. Face‐to‐face (Central location for 2 initials meetings) Videoconference (Tandberg system – 6 meetings) Online meeting software (Adobe connect + Teleconference – 3 meetings) Phase 2 – Using Technology
- 15. Phase 3 ‐ Continuing the circle of care A Do not takeZopiclone 7.5mg by mouth 1 tablet each night 1 tablet 3 times dayMetformin 500mg by mouth 1 1 B at meals Before going To bed anymore Tylenol 500mg by mouth 1 tablet 4 times a day 2013/09/02 Marcus Welby MD
- 16. Phase 3 ‐ Changes/New Orders (Section 2) Code letter of physician Code number of pharmacy List medication (name, strength/unit and route) Date and initials when discontinued/changed How the client take the medication, if the same A Written of label (dose, frequency/time of administration) Initials – Professional who is documenting Date started or changed FN 2013/09/07 FN2013/09/05 1 tabletCiprofloxacin 500mg by mouth1 FN 2013/09/08 A 1 Ativan 1mg by mouth 1 tablet Twice a day Bedtime, as needed
- 19. Conclusion System for improvement using: ● PDSA cycle (Plan, Do, Study, Act) Can be replicated in any health home care program Ultimate goal: ● Increase patient safety ● Comply with Accreditation Canada
- 21. www.saferhealthcarenow.ca Speakers: • Colleen Stoecklein, RN, BSN • Liz Moran-Murray, BScPhm Saskatoon Health Region Home Care will: 1. Share how they developed a nurse driven, paper‐based MedRec program to support home care clients in medication management. 2. Outline their current MedRec process 3. Showcase their current Med Rec/BPMH Form and their data collection form for the audit process. 21 Saskatoon Health Region
- 22. Continuing the Circle of Care: MedRec in the Community Presented by: Colleen Stoecklein, RN, BSN, Clinical Educator Liz Moran-Murray, BScPhm, Clinical Pharmacist
- 23. • Brief history review • Outline the current MedRec process • Review our BPMH/MedRec form • Audit process Objectives
- 24. Brief History • In the spring of 2007 with the support of Safer Healthcare Now! Saskatoon Home Care formed a Medication Reconciliation Committee • Developed Quality Improvement Charter. – Objective: reduce adverse drug events and minimize client harm through the implementation of medication reconciliation on admission to Home Care
- 26. Brief History continued • Piloted the Med Rec form with 6 nurses; changes made • 2009 Med Rec was rolled out to approximately 150 nurses. Present: 200 nurses • The form has been revised 28 times so far, this is ongoing… • Subtle process changes have been made
- 27. Current Process • MedRec is targeted at clients requiring medication management • MedRec is completed on admission, at 6 month reviews, after hospitalization and if significant number of medication changes • Admission MedRec is completed by the RN and subsequent reviews may be completed by the RN/LPN
- 30. Process Once BPMH Has Been Completed • Faxed to physician/NP for reconciliation • Average time for return of reconciled form is less than 3 days • If the nurse has not heard back within the week a phone call is made to prompt physician • medication administration does not begin until reconciled form has returned. Exception: the nurse has received discharge orders from acute care
- 31. MedRec continued • Once the MedRec has been reconciled, the nurse faxes a “fyi” copy to the community pharmacy (our form does not meet requirements to be a prescription) • Future medication changes are not recorded on this form. Any new physician orders are added to the chart sequentially • MedRec is completed in the home & provides this “snapshot in time” of current medication use
- 32. Audit Process • MedRec audits are completed quarterly • This is a labour intensive process since we don’t currently have an electronic chart • On audit days we come in at 0530 so that we have 2.5 h to look at the nursing charts that will be going out for the day. After the nurses leave the office we audit the rest of the med management charts.
- 33. What We Measure for Senior Leadership 1) % of clients with completed MedRec 2) % of clients identified with 1 or more discrepancies 3) Types of discrepancies identified
- 34. What We Measure for Home Care • In addition we audit several qualitative process measures related to nursing & physician process completion • This information is shared with nurses & physicians for ongoing education • We receive feedback from nurses that has also helped refine the process
- 36. Challenges • Physician engagement: clarification of discrepancies that may be vague, turn around time • Nursing not prompting unreconciled forms in a timely fashion • Since there is a high incidence of dementia in this caseload, this can be a barrier to obtaining a definitive medication list if family member is unavailable/not involved • Audit process time consuming
- 37. Our Success • Nurses find the form easy to use and achieves a more thorough med list • Physician comments on form indicate increasing engagement with process • It improves communication within the circle of care – “everyone is in the know”
- 39. www.saferhealthcarenow.ca Questions 1. Raise your hand and we may be able to open your phone line 2. Send feedback via the “chat” box • Select “All participants” • Type message • Click “Send” All Participants
- 41. www.saferhealthcarenow.ca Upcoming MedRec Webinars 41 April 8th, 2014 Making a PDiF-ference – Results of the Pharmacy Discharge Facilitator Initiative for high-risk medical inpatients. May 6th, 2014 Safety, Sleuthing and Students: A Novel Collaborative MedRec Event – University of British Columbia