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Purpose of the Call: •Review the results of the Canadian MedRec Audit Month •Discuss lessons learned from the audit month – strengths and areas for improvement •Suggest future value of audits and audit tools for your organization •Gather ideas about how to improve the quality of MedRec at admission Watch the recorded webinar: http://bit.ly/19aUYbU
Citation preview
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Canadian MedRec Quality Audit Month:
Results and Future Direction
Marg Colquhoun, Virginia Flintoft and Alex TiteuDecember 2013
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Where to find our webinars…
www.ismp-canada.org/medrec
See “Education and Training”
http://www.saferhealthcare
now.ca/EN/events/National
Calls/Pages/default.aspx
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Outline
• Background
• Audit Month results
• Interactive discussion
• Accessing your results in the Patient
Safety Metrics System
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BackgroundMedRec Quality Audit Tool
• Launched in June 2013
• Collects data on the quality completion of admission MedRec in acute and long term care settings
• Completed through chart audit post-completion of admission MedRec processes
• Organization specific tools are generated through Patient Safety Metrics System (PSMS)
• Completed tools are faxed, and data is presented in PSMS
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• Across Canada, there are ongoing challenges
related to the effective and reliable completion
of MedRec processes.
• Measurement of MedRec processes can help to
identify areas of excellence and areas for
improvements � MedRec Quality Audit Month – October 2013
BackgroundCanadian MedRec Quality Audit Month
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• Call to action national call/webinar on October 1st, 2013.
• Sites registered to participate
– Central Measurement Team (CMT) facilitated the creation of
audit/data collection forms
• MedRec Audit Month Workbook published
• Sites submitted data to the Patient Metrics System throughout the
month of October
– CMT corrected any data submission error reports and
resubmitted
• Preliminary results (e.g. numbers of participating sites) were
presented October 30th, during Canada’s Virtual Forum
on Patient Safety and Quality Improvement
BackgroundAudit Month Methodology
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Audit Month Results
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Audit Month Results
• Audit participation
• Results by column
• Calculated results
• Relationships between variables
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Audit “Participants”
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Sites = 103
Patient/Resident Charts
= 2,340
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“Participants” by Province/Territory
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103 sites
2,340 patients
Number of Patients
Provinces/Territories
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“Participants” by Sector
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103 sites
85%
N=1,992
15%
N=348
Acute Care
LTC
Acute Care
LTC
77%
N=79
23%
N=24
2,340 patients
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• Audit participation
• Results by column
• Calculated results
• Relationships between variables
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0
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A. ‘Admission via’
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57%
50%
N=2,298
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=
15
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B. ‘Med Rec Performed’
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75%95%
N = 2,328
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• 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
Literature suggests…..
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C. ‘BPMH -greater than one source’
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60%
N=2,040
74%
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Literature suggests…
• 66% of Canadians have sometimes used non-prescription medication in the past six months.
• 57% sometimes took vitamins and minerals, while 34% sometimes took herbal and natural products.
2004 Survey of Canadians’ Use of OTC Medications http://www.bemedwise.ca/english/usagesurvey.html
• Adherence- “the extent to which a person’s behavior [in] taking medication…corresponds with agreed recommendations from a health care provider” (World Health Organization, 2003).
• 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
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D.‘Med Use Verified by Pt/Caregiver’
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57%
N=2,044
63%
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E.‘Each med w/ name dose, route, etc.’
25
77%
N=1982
92%
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Literature suggests….
• 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
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F.‘Meds on BPMH+Admin Order’
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73%
N=2,006
87%
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G.‘Prescriber documented rationale’
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64%
N=1,946
84%
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• Audit participation
• Results by column
• Calculated results
• Relationships between variable
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Audit Month Results
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To calculate a MedRec Quality Score,
each “Yes” (or “Unable to Perform”) is
assigned 1 point for each of the highlighted
columns
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Percentage of Patients by Score
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29%
N=1,937
55%
Scores
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• Audit participation
• Results by column
• Calculated results
• Relationships between variables
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Audit Month Results
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% Med Rec Performed by Score
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7% 0%
55%
29%
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Compliance w/ 1st 3 elements
by “Admit via”
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Results Summary Comments
• Because this is the first audit using these criteria, we do
not have historical data to compare our progress�it is
likely that we have collectively improved
• However, audit tool results demonstrate need for ongoing
and specific improvements
• Many people believe they are doing MedRec but they may
not be doing it well
– The foundation of the process – the BPMH needs work
• Validity of the BPMH –results are disappointing
– It will be useful to use the scores and correlations in
future audits to measure improvement
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Results Summary Comments
• Need to critically evaluate admission
processes to ensure quality of MedRec
processes at other transitions
• Sites will need to understand the need
for training people to use the audit tool –
materials are available to support this
process
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Discussion
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Accessing Your Data in
the Patient Safety Metrics
System
Virginia Flintoft & Alex Titeu
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Data Collection (Audit) Form
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Contact Patient Safety Metrics team at:
Contact ISMP Canada MedRec team at:
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Upcoming MedRec Webinars
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Jan 14, 2014 The MARQUIS Project Dr. Jeffrey
Schnipper
Feb 11, 2014 Engaging Patients in MedRec
March 25, 2014 MedRec in Home Care
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On behalf of the ISMP Canada MedRec
Team, CPSI and the Patient Safety
Metrics Team
All the best in 2014!