Introduction to the Medicines Reconciliation care bundle

• Introduce the Meds Rec Care Bundle

• Discuss measures, operational definitions and rationale.

• Discuss data collection process and frequency

• Discuss ways to involve patients

• Share resources, challenges and learning

Aims of session

Medicines Reconciliation – what is it?

• National Definition “The process that the healthcare team undertakes to ensure that the list

of medication, both prescribed and over the counter, that I am taking is exactly the same as the list that I or my carers, GP, Community Pharmacist and hospital team have. This is achieved, in partnership with me, through obtaining an up-to-date and accurate medication list that has been compared with the most recently available information and has documented any discrepancies, changes, deletions or additions resulting in a complete list of medicines accurately communicated”

Medicines Reconciliation – why is it important?

• Patient Safety!• Lots of evidence of patient harm in literature:72% of adverse events after discharge due to medications (Foster et al 2004)38% of readmissions considered to be medicines related, 61% of these

preventable (Witherington etc al 2008)14% of pts > 65 years old are discharged with medication discrepancies and

have a higher risk of readmission (Kohn et al 2007) etc etc etc……• 19.3% of GP negligence claims relate to prescribing and medication (3.8%

of these due to supplying incorrect or inappropriate medication)

Medicines Reconciliation – why am I here?!

• Want to reduce patient harm and improve patient safety relating to medicines

• Meds rec one piece of this wider “safer medicines” workstream• Will do meds rec already within your practice but1) is there a standard process?2) is it safe and reliable? 3) could it be improved?4) is it done for “every patient every time”?

Perception versus Reality

Medicines Reconciliation in primary care

• How do we perform meds rec accurately?

1. Develop standard reliable process for dealing with discharge information in your practice

2. Record that meds rec has been done (read code)3. Record action taken on any changes (read code(s))4. Record discussion of any changes with pt (read code(s))

Do this using a “care bundle”….

Medicines Reconciliation – care bundle measures• Has the Immediate Discharge Document (IDD) been workflowed on the day of

receipt?

• Has medicines reconciliation occurred within 2 working days of the IDD being workflowed to the GP?

• Is it documented that any changes to the medication have been acted on?

• Is it documented that any changes to the medication have been discussed with the patient or their representative within 7 days of receipt?

• Have all the above measures been met?

Medicines Reconciliation Care Bundle – Data Collection

Data collected is for local use, to allow practice teams to gain a better understanding of their systems and make the necessary changes.

Data is displayed in a run chart and allows you to see improvements over a period of time.

Data for improvement - not judgement.

Medicines Reconciliation – local GG&C practice resultsMeds Rec % Care Bundle Compliance

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Nov

11

Dec

11

Jan

12

Feb

12

Mar

12

Apr

12

May

12

Jun

12

Jul 1

2

Aug

12

Sep

12

Oct

-12

Nov

-12

Dec

-12

Jan-

13

Median

Linear (Subgroup)

% compliance

Month

Target 90%

General improvements to process: small tests of change with PDSA cycles

Improvement – stable but not reliable Trakcare!

Beginning to see reliable process?

Medicines Reconciliation

GG&C discharge “issues”

0%10%20%30%40%50%60%70%80%90%

100%

% of Dx Rxs with element

completedFo

rmul

atio

n

Dos

e

Freq

uenc

y

Dur

atio

n

New

Med

s

Cha

nged

Sto

pped

Alle

rgy

Element measured

% of Dx Rxs completion

Medicines Reconciliation – practical hints and tips• Collecting care bundle compliance data on 5 patients per month• Prioritise patients over 75 years old on 10 or more medicines- if insufficient patient numbers in this cohort per month, reduce the

number of medicines or reduce the age• First data return in June – consider using first couple of months to

determine your patient cohort and think about your systems and processes

• Docman can be used to find your discharged patients• Using EMIS/Vision standard reporting template may make it easier for you

to data collect/measure• Info on reporting mechanism to follow – national template being

developed

Medicines Reconciliation – practical hints and tips

• Measure 1Difficult to give exact hints and tips as how practices process discharge Rxs will

vary depending on how they receive them….."Workflow" does not necessarily mean using electronic methods or Docman.

This wording relates to whatever existing process you have in place to move the necessary written/electronic paperwork to the relevant personnel for timeous action

Important point is that the day it was “workflowed” is clearly visible when it comes to data collection

Usually an admin/receptionist function

Medicines Reconciliation – practical hints and tips

• Measure 2Strongly recommend this is done by a clinician as likely clinical decisions will

be made on a discharge prescriptionUse Read code #8B318This is set up in EMIS template/Vision guidelineYou don’t have to use read codes however needs to be clearly recorded to

aid data collection

Medicines Reconciliation – practical hints and tips

• Measure 3Likely this will be completed at same time as Measure 2 - clinician to

document any changes to medicines on dischargeAll read codes available on same EMIS template/Vision guidelineSome practices may wish to use synonymsAgain important point is it is easy to find when it comes to data collectionTick N/A only if there are no changes to the meds following discharge – this

equates to a Yes for the care bundle compliance

Medicines Reconciliation – practical hints and tips• Measure 4This is the measure most practices struggle withPractices have been inventive about how to communicate changesGold standard = face to face or telephoneNote on the repeat slip of changesLetter to patientSome GPs ask competent member of admin staff to contact patient with

changesMethod will depend on patientUse read code #8B3S0

Measure 5

• Have all measures been met? Yes or No• Bundle compliance is a team effort and needs support from admin and all

those involved in your meds rec process in the practice• Can be collated by anyone in team – admin, practice manager, GP,

nurse….• Important thing is to look at your data to identify potential improvements

to the process: small tests of change and PDSA

Medicines Reconciliation – what’s in it for you?!• Bundles, Trigger Tool and Safety Climate Survey recognised evidence for GP appraisal• Safety is core to revalidation• Standard robust reliable process reduced variation more efficient process workload benefits

less stress

• Improved practice team working

Medicines Reconciliation – what’s in it for you?!• GG&C acute services also concentrating on meds rec• Whole system approach to improving meds rec has primary care,

secondary care and ultimately patient benefits• Potentially fewer admissions• Who wouldn’t want to improve patient safety……?

Care bundles

1. Shed new light on our current practice

2. Act as a catalyst for improvement in care

3. Can lead to increased awareness

Any Questions?