www.saferhealthcarenow.ca

Scaling up MedRec Measurement –

Experiences from Alberta

November 2014

www.saferhealthcarenow.ca

MedRec Quality Audit Month 2015

Throughout February 2015 we are

encouraging all acute and long term care

sites to participate in MedRec Quality Audit

Month to evaluate the quality of their

established admission MedRec processes.

Register to participate at

www.saferhealthcarenow.ca!

2

www.saferhealthcarenow.ca

www.ismp-canada.org

Doc Mike Evans discusses the importance of

keeping a medication list

http://youtu.be/f2KCWMnXSt8

www.saferhealthcarenow.ca

www.ismp-canada.org

MedRec Stay Informed and Connected

Receive ISMP Canada’s MedRec Newsletter

Hear about:

– Upcoming MedRec webinars

– New toolkits

– National MedRec Audit Month

– New MedRec publications

– MedRec related workshops

Join Now!

visit http://www.ismp-canada.org/register/medrec.php

www.saferhealthcarenow.ca

Describe your level of activity with MedRec

auditing in your setting

ce Poll

Just Getting Making

None Started Progress

Almost Fully

there Implemented

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Click on the arrow icon

and then click on the appropriate location/response

on the slide

Scaling up MedRec Measurement -

Experiences from Alberta

Greg Duchscherer, RRT, BHS, PMP

Project Manager, Provincial Medication

Reconciliation

Lynn Whitten, RN, BN, MSA

Project Manager, Calgary Zone Medication

Reconciliation Team

Alim Amershi, DipMM, B.Comm

Project Coordinator, Calgary Zone Medication

Reconciliation Team

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Alberta Health Services

Albertans = 3.9 Million (661,848 km2)

AHS Employees = 96,000

Physicians = 8,400

Sites = 450

Five Zones and Cancer Control

In 2012-2013:

2,116,474 Emergency Department Visits

8,230 Acute Care hospital beds

108,855 Home Care clients

22,533 Continuing Care beds

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Objectives

• Overview of MedRec Implementation in AHS

• Approach to Evaluation of Medrec in AHS

• Results so far…

• Lessons Learned

• Next Steps

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• Major Patient Safety Initiative

• Accreditation Canada Required

Organizational Practice (ROP)

• Varied Past:

– Multiple approaches

• Desired Future:

– Coordinated, integrated

approach

History of MedRec in AHS

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Approach & Zone Implementation

Ambulatory Care settings 2014 - 2015

Discharge / Transfer 2014

Admission Acute Care/ Homecare &

LTC 2011 - 2013

Provincial Planning

2011- 2015

North Zone Implementation

Edmonton Zone Implementation

Central Zone Implementation

Calgary Zone Implementation

South Zone Implementation

Provincial

MedRec

Planning

Phased in Approach “Viral Spread” model

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Our Goal

• To have MedRec completed on all patients

(where appropriate) across the AHS continuum

by the end of 2015.

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“Seeing the Issue”

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Measurement for Improvement

• How will we know a change is an improvement?

• “Measurement is only a handmaiden to improvement,

but improvement cannot act without it”

• “Measurement for the purposes of learning not

judgment”

• “Remember, measurement is a means for answering

questions. It is not an end in itself”

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Approach to Evaluation of MedRec

Success Measure (target 80%, goal 100%) – % patients with MedRec Completed on Admission (Acute Care, LTC &

Corrections)

Quality Measure (target 80% of patient audit sample

have all quality elements) – Two or more sources for BPMH

– Actual med use verified by patient/family

– Complete medication information

– Every med accounted for in orders

– Rationale included for hold and discontinued meds

Outcome Measure (target less than 10%, goal 0) – % patients with one or more outstanding discrepancies

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Acute Care – Measures

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Acute Care – Quality Elements

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Zone Acute Care – Measures

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Reporting & Learning System Data

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Reporting & Learning System Data

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Lessons Learned - Provincial

• Limitations of data representation

• Not having a ‘pure’ patient outcome measure

• Subjectivity of Measure 5

• Inter-rater reliability:

– Evidence from PSM data

– Link to education and ongoing training

• Digestible data to managers

• Support for QI at the “bedside”

Calgary Zone Experience

Lynn Whitten, RN, BN, MSA

Project Manager, Calgary Zone Medication Reconciliation Team

Alim Amershi, DipMM, B.Comm

Project Coordinator, Calgary Zone Medication Reconciliation Team

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Calgary Zone Project Team

Project Manager

Project Coordinators

Physician Lead

Pharmacy consultant

Administrative Support

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Calgary Zone Map

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Our Approach in the Zone

Key Areas Of Focus

•Engagement Strategies

•Use of Objective Data

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Governance Committee Structure

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Early Adopters

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Site/Program Lead Model

• Influential, well known and respected early adopters

• Regular monthly reporting requirements

– % of uptake by individual units & programs

• Each site responsible to conduct their monthly audits

- site determined who would conduct audits

- monitor audit submissions

- use raw data from PSM to develop site

& service reports

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Results so far...

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Progress Reports

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Site/Program Service Comparisons from

PSM

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Hospitalists Measurement

September - October

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Surgery

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Lessons Learned

• Persistence, persistence, persistence….

• Focus on local culture: it’s a team effort, different

process in different units

• Look for common goals Improved Patient Care!

• Metrics helps drive the change

• Internal competition helps

• Break down process into parts to identify gaps and

areas for improvement

• Identify gaps BUT celebrate successes!!

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Next Steps – Calgary Zone

• Focus on Ambulatory Care

• Sustainability

• Share learning's

• Teams must have access to data for

improvement

• Developing solutions to address gaps.

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Next Steps - Provincial

• Homecare and Supportive Living Audit Tool

• Discharge Audit Tool

• Ambulatory Care Audit Tool

• Emergency Department/Urgent Care Audit Tool

• Transfer Audit Tool

• Database and Reporting Dashboard for AHS

• Auditor Education and resources

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Conclusion

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Thank You

www.saferhealthcarenow.ca

Upcoming MedRec Webinars

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Thank you for attending

Our next MedRec webinar will take

place in January 6th, 2015.

Topic: MedRec Quality Audit Month

Information call.

www.saferhealthcarenow.ca

Safer Healthcare Now! website

http://www.saferhealthcarenow.ca/EN/events/

NationalCalls/2014Webinars/Pages/default.aspx

ISMP Canada website

http://www.ismp-canada.org/medrec/#webinars

Safer Healthcare Now! MedRec Community of Practice

http://tools.patientsafetyinstitute.ca/Communities

/MedRec/default.aspx

For real time notification of content posting, “like” the

Medication Reconciliation Network on Facebook

www.facebook.com/MedicationReconciliation

All Safer Healthcare Now! webinars are posted within the

week to the following locations:

www.saferhealthcarenow.ca

www.ismp-canada.org

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We encourage you to report

medication incidents

Practitioner Reporting https://www.ismp-canada.org/err_report.htm

Consumer Reporting www.safemedicationuse.ca/