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Western Node Collaborative
RIVERVIEW HOSPITAL
Medication Reconciliation
October 2, 2006Zaheen Rhemtulla B.Sc. (pharm)
Riverview Hospital (RVH)
As part of British Columbia Mental Health and Addiction Services and governed under the Provincial Health Services Authority, Riverview Hospital provides specialized tertiary mental health services under 3 core programs:
- Adult Tertiary Psychiatric Program (225 inpatient beds + 20 ICU beds)specialized tertiary acute care and rehabilitation services to adults living with a serious mental illness
- Geriatric Psychiatric Program (145 inpatient beds)assessment and treatment services for inpatients as well as outpatient consultation services to patients who often have needs relating to end-stage dementing illness with severe chronic psychiatric and medical conditions
- Neuropsychiatry Program (49 inpatient beds)care to a specialized group of individuals who have cognitive, affective, and psychotic symptoms associated with brain injuries or disease that are beyond the capacity of acute care hospitals and community-based settings
Background Information
Recognizing that Medication Reconciliation is an evidence-based intervention that can prevent a high percentage of medication-related adverse events, Riverview Hospital first convened a MedRec team June 2005 in response to the Safer Healthcare Now Campaign and accreditation requirements.
Having supportive executive sponsorship and leadership buy-in,
the project now has a committed team of over 15 members from various disciplines including physicians, nurse clinicians, unit managers, pharmacists, and administrative staff as well as a full-time project leader. The team meet on a monthly basis to discuss the progress of the project which is being piloted on 5 wards throughout the hospital.
Goal for incorporating a medication reconciliation process for all
transition points of patient care throughout the hospital stay is December 2006
Project Charter
Based on studies documenting the high percentage of adverse events occurring in hospitals due to medication errors, particularly at points of transition, Riverview Hospital is focused on providing the best possible care to the patients it serves by developing and implementing procedures and systems that result in better documentation and eliminate unintentional medication discrepancies at interfaces of care.
Importance
Efficient transitions in care Better documentation Better communication Better safety Fewer hospitalizations Decreased costs Better patient care
Reason to adopt
To provide the best possible care to a very vulnerable patient population (e.g. pt’s with psychosis/Dementia)
Create standardization with all other health-care providers in order to provide “seamless care”.
Aims
Reduce the mean number of undocumented intentional discrepancies at admission by 75% from baseline by October 2006 on the 5 pilot wards (2 geriatric wards, 2 adult tertiary care wards, 1 ICU)
Reduce the mean number of undocumented unintentional discrepancies at admission by 75% from baseline by October 2006 on the 5 pilot wards
Increase the medication reconciliation rate (success index) to 100% by October 2006 on the 5 pilot wards
Medication Reconciliation Team
Project Leader: Zaheen Rhemtulla [email protected]
Administrative Leadership: Marilyn Macdougall [email protected] Risk Management: Peter Owen [email protected]
Clinical Support: Jane Dumontet [email protected] Dr. Heather Cherneski [email protected] Riola Crawford [email protected]
Gail Ancill [email protected] Bushell [email protected] Sanassy [email protected]
Tin Au [email protected]
Program Support: Ruby Virani [email protected] Valerie Eggen [email protected] Edwards [email protected]
Forensic Representatives: Ellen Haworth [email protected] Dave Wharton [email protected]
Riverview Hospital
Where are we in the process?
Admission:
BPMH reconciliation on all admissions to the hospital. This process has detected unintended discrepancies which are resolved in a timely manner. Implementing the use of the Medication History and Admission Orders form on all admissions to pilot ward.
Transfer:
Providing a “Medication Review” profile for all internal transfers between wards. The nurse from the receiving ward verifies the profile against the current orders. The verified medication profile is then signed by the physician and a copy is sent to pharmacy for updating. Any discrepancies are dealt with immediately.
Where are we in the process?
Discharge Trialing a pharmacy computer generated discharge profile
indicating all regularly scheduled medications the patient is to be taking upon discharge. The form is to be verified against current orders and signed by the physician(s) upon discharge.PRN medications are to be written in by the physician only if the patient requires them upon discharge.
Included on the discharge profile is the last given and next due date of any long-acting injections.Ensuring all wards are sending a copy of the current MAR from the ward in the discharge package or at discharge, leave or temporary transfer to another facility.
Changes Tested
Tested the “pre-printed” Medication History and Admission Orders Form on new admissions to pilot ward. Process involves Admitting sending the same day MAR from previous institution to the pharmacy. Pharmacy enters the MAR onto a Medication History and Admission Orders form and faxes back to ward for physician to reconcile with admitting orders. Any clarifications are done in pharmacy prior to submitting pre-printed order form.
Form is effective in reconciling medications, however, process needs to be built into regular pharmacy and ward routine – ie. Ward needs to notify pharmacy when patient arrives and “pre-printed” form is required; pharmacy needs proper staff trained to complete the form
1.0 Mean Number of Undocumented Intentional Discrepancies
0.00
0.50
1.00
1.50
2.00
2.50
Nov 2
005
Dec 2
005
Jan
2006
Feb 2
006
Mar
200
6
Apr 2
006
May
200
6
Jun
2006
Jul 2
006
Aug 2
006
Sep 2
006
Oct 20
06
Nov 2
006
Dec 2
006
Month
Me
an
Actual Goal
No data collected for Dec and Jan No data collected
for April
BPMH audits started
Better documentation results in decreased undocumented discrepancies
Pilot admissions form started on one ward – data inconsistencies as many regular staff on vacation
2.0 Mean Number of Unintentional Discrepancies
0.00
0.50
1.00
1.50
2.00
2.50
Month
Me
an
Actual Goal
BPMH audits started
No data collected for Dec and Jan
No data collected for April
3.0 Medication Reconciliation Success Index
0%
20%
40%
60%
80%
100%
120%
Month
Pe
rce
nta
ge
Actual Goal
No data collected for April
No data collected for Dec and Jan
BPMH audits started
Pilot admissions form started on one ward – data inconsistencies as many regular staff on vacationBetter
documentation increases success index
Keys to Success and Lessons Learned
Successes: Leadership buy-in and support, team commitment, funding for project
Barriers: time constraints, individual preferences of methods for documentation, varying needs on individual wards
Lessons Learned: Do as many; Plan, Do, Study, Act (PDSA) cycles as possible
Next Steps
Admissions:
Trial Medication History and Admissions Form on all admissions one ward at a time to determine if it is universal for all patients
Educate staff how to use to utilize form and procedures involved
Do audit to see if procedure is effective Transfers
Follow-up for with staff for any issues arising from the new procedure of providing reviews at transfer
Next Steps
DischargesReview the results of the trial and expand to all wards. Implement a process of including a patient profile from pharmacy for all discharges.
GOALImplement a sustainable and effective Medication Reconciliation process at every transition point of patient care
Contact Information
Zaheen RhemtullaProject Team Leader/Clinical Pharmacist
Riverview Hospital2601 Lougheed Highway
Coquitlam, BCV3C 4J2
