Medication Accuracy at Transitions in Care Let s start!
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1 Medication Accuracy at Transitions in Care Let s Erica Van der Schrieck-De Loos MSc, Project leader WHO H5s NL CBO Dutch Institute for Healthcare Improvement EU Union Network PaSQ Med Rec conference, Zagreb, Croatia, 2 December 2013
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4 Patients (%) National guideline in daily practice before SOP A B C D E F G H I J K 1 2 Y Z Hospitals Van der Schrieck-De Loos et al.,
5 Patients (%) Quality of daily practice before SOP A B C D E F G H I J K 1 2 y z Hospitals CBO 2012
6 Iphoned.nl Future
7 (Inter)national solution Medication Accuracy at Care Transitions 1. System level 2. Macro level 3. Meso level 4. Micro level
8 1. System level 1. Dutch Inspectorate of Health Safety measures, november 2012
9 1. System level Commitment on this topic is definitely worth it. Due to the necessary deployment of extra staff hospitals appear quite often to actually carry out medication reconciliation. However, investment on this staff pays for itself quickly. Dutch Inspectorate of Health - IGZ November 2012: De Veiligheid telt : p.27, 28]
10 1. System level Commitment on this topic is definitely worth it. Due to the necessary deployment of extra staff hospitals appear quite often to actually carry out medication reconciliation. However, investment on this staff pays for itself quickly. IGZ 2012: De Veiligheid telt : p.27, 28]
11 1. System level Medication wrongly given or not given while necessary, therefore, leads to the patient and thereby to the hospital to undesirable situations and thereby to greater costs. IGZ 2012: De Veiligheid telt : p.27, 28]
12 1. System level Medication wrongly given or not given while necessary, therefore, leads to the patient and thereby to the hospital to undesirable situations and thereby to greater costs. IGZ 2012: De Veiligheid telt : p.27, 28]
13 1. System level 2. Patient Safety agreement MoH 22 May National news/patient safety report Prof. dr. Cordula Wagner, NIVEL, June NIVEL 2013: Implementatie VMS veiligheidsprogramma. Evaluatieonderzoek in NL ziekenhuizen.: p. 103
14 1. System level Global WHO High 5s network Australian Commission on Safety and Quality in Healthcare France Haute Autorité de Santé German Agency for Quality in Medicine/ German Coalition for Patient Safety NL - CBO Dutch Institute for Healthcare Improvement Singapore Ministry of Health Trinidad & Tobago Ministry of Health USA Agency for Healthcare Research & Quality WHO Collaborating Centre for Patient Safety: The Joint Commission
15 1. System level Clinician Ward Hospital Globally
16 1. System level Healthcare is a decade or more behind many other high-risk industries in its attention to ensuring basic safety To Err is Human, Institute of Medicine, 1999,
17 (Inter)national solution Medication Accuracy at Care Transitions 1. System level 2. Macro level 3. Meso level 4. Micro level
18 2. Macro level Crossed-flag-pin.com
19 2. Macro level Miscommunication about medications Evaluation of target population BPMH & inaccuracies 24 hours
20 2. Macro level 1. Failures home medications 2. Incorrect doses/dosage forms 3. Missed/duplicated doses
21 2. Macro level 4. Home medication after discharge 5. Duplicate therapy at discharge (hospital substitutions)
22 2. Macro level Incomplete or miscommunicated information at points of transition in the patient care process Admission Transfer Discharge
23 3. Meso level Nothing is paticularly hard if you divide it into small jobs Henry Ford
24 3. Macro level
25 3. Macro level
26 (Inter)national solution Medication Accuracy at Care Transitions 1. System level 2. Macro level 3. Meso level 4. Micro level
27 3. Meso level Early adopters Innovators Rogers: 1995
28 3. Meso level
29 3. Meso level Cross links National platform National evaluation
30 3. Meso level 1. Goal 2. Measures 3. Implementation of interventions
31 3. Meso level Deming
32 3. Meso level Data in itself is not enough for improvement Massoud ISQua, Hong Kong, China 2011
33 3. Meso level Small changes = sustainable
34 3. Meso level 1-3 physicians are overconfident about the quality of care they provide Pronovost, Johms Hopkins Medicine, Armstrong Institute for PS & Q, jama.jamanetwork.com
35 3. Meso level Low hanging sweets
36 (Inter)national solution Medication Accuracy at Care Transitions 1. System level 2. Macro level 3. Meso level 4. Micro level
37 4. Micro level 1. Best Possible Medication History < 24 hours WHO H5s SOP 2009
38 4. Micro level An up-to-date and accurate patient medication list is essential to ensure safe prescribing in any setting WHO H5s GSK 2009
39 4. Micro level 1. Obtaining a complete and accurate list of each patient s current home medications: including name, dosage, frequency and route. WHO H5s GSK 2009
40 4. Micro level Compare BPMH vs Admission Medication Orders 2. Identify & Resolve Inaccuracies < 24 hours
41 4. Micro level 2. Using that list when writing admission, transfer and/or discharge medication orders, and WHO H5s GSK 2009
42 4. Micro level 3. Comparing the list against the patient s admission, transfer, and discharge orders. Identifying and bringing any discrepancies to the attention of the prescriber and, if appropriate, making changes to the orders. Any resulting changes in orders are documented. WHO H5s GSK 2009
43 4. Micro level 3. Comparing the list against the patient s admission, transfer, and discharge orders. Identifying and bringing any discrepancies to the attention of the prescriber and, if appropriate, making changes to the orders. Any resulting changes in orders are documented. WHO H5s GSK 2009
44 4. Micro level One of the most common leadership mistakes is expecting technical solutions to solve adaptive problems... Ron Heifetz Leadership without easy answers
45 4. Micro level Van der Schrieck-de Loos, EM et al The role of the client in patient safety, a necessity, not a desirability. CBO: UtrechtZonMw research report. Copy via E: e.vanderschrieck@cbo.nl Levelofhealth.com
46 4. Micro level
47 Hospitals require the med rec SOP
48 Pharmacist-based med rec reduces medication discrepancies in acute hospital admissions of elderly patients Van den Bemt PM, Van der Schrieck-de Loos EM, Van der Linden C, Theeuwes AM, Pol AG; The Dutch CBO WHO High 5s Study Group. Effect of Medication Reconciliation on Unintentional Medication Discrepancies in Acute Hospital Admissions of Elderly Adults: A Multicenter Study. Journal of American Geriatrics Society 2013 Jul 19. doi: /jgs [Epub ahead of print]
49 75% reduction < 1-5 months 40% - 90% 24 hours
50 SOP or not to SOP Future Iphoned.nl
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53 Medication Accuracy at Transitions in Care Let s Annemieke van Groenestijn, Advisor WHO H5s NL Erica Van der Schrieck-De Loos MSc, Project leader WHO H5s NL E: e.vanderschrieck@cbo.nl W: who.int/patientsafety/implementingchange/high5s CBO Dutch Institute for Healthcare Improvement EU Union Network PaSQ Med Rec conference, Zagreb, Croatia, 2 December 2013
54 Filmpje
55 3. SOP strategy Proactive Med Rec model STEP 1 STEP 2 STEP 3 BPMH LEADS TO Admission Medication Orders (AMO) Verify every medication in BPMH has been assessed by prescriber. WHO H5s GSK 2009 F7 p14
56 3. SOP strategy Retroactive Med Rec model STEP 1 STEP 2 STEP 3 STEP 4 Primary Admission Medication Medication Orders BPMH HIstory LEADS TO (AMO) Compare BPMH with AMOs and resolve any discrepancies WHO H5s GSK 2009 F7 p14
High 5s NewsBulletin. News in Brief
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