YOUR DISCHARGE IS SOMEONE S ADMISSION

Transcription

1 YOUR DISCHARGE IS SOMEONE S ADMISSION

2 Today s Facilitator Kim Streitenberger Project Lead, ISMP Canada 2

3 Welcome Mike Cass Patient Safety Improvement Lead, CPSI 3

4 Welcome to our francophone attendees Bienvenue à nos participants francophones Hélène Riverin Conseillère en sécurité et en amélioration Safety Improvement Advisor 4

5 Pour nos participants francophones.. Pour accéder aux diapositives français: -Cliquez sur l'onglet "FRENCH" OU -Envoyer un courriel à Suivre la boîte «Chat» pour les commentaires du conférencière traduit en français 5

6 Audio Access Only WebEx does not support Windows XP If you have Windows XP Slides are available under Medication Reconciliation on the ISMP Canada website Q&A questions to 6

7 Questions ISMP Canada (Host) 7

8 Stay on after this call MedRec Open Mike - Need help with MedRec? stay on the line and join the discussion - Meet and connect with others in MedRec - Submit your questions to medrec@ismpcanada.org or ask them live 8

9 Objectives By the end of this webinar you will: Understand the Accreditation Canada requirements for medication reconciliation at discharge Learn from the experience of patients and receiving healthcare providers Gain insight into practical strategies for communicating accurate medication information at discharge 9

10 Please complete our poll 10

11 Today s Speakers Colleen Cameron Clinical Pharmacist at Grand River Hospital in Kitchener Ontario Heather Howley Accreditation Canada Cynthia Berry Lead Medication Reconciliation Pharmacist for the Saskatoon Health Region, Saskatchewan Lynette Zielinski Clinical Nurse Educator Home Care Saskatoon Health Region, Saskatchewan Devin Elias Community Pharmacist, Saskatoon Health Region Michael Hamilton Community and Long Term Care physician, Newmarket Health Centre, Newmarket, Ontario Physician Lead and Medication Safety Specialist, ISMP Canada Alice Watt Medication Safety Specialist, ISMP Canada

12 Your Discharge is Someone s Admission: How the Patient s Truth can be a MedWrecker Colleen Cameron, RPh, Pharm.D. Grand River Hospital, Kitchener ON November 10, 2015

13 Home Rehab Hospital Retirement Home Primary Care LTC

14 Ms. C is 72 years of age Admitted to hospital for acute delirium, UTI, new onset diabetes, new onset atrial fibrillation. PMH HTN, seizures, recurrent DVTs on warfarin Social Hx: widowed, lives alone in home, Gr. 8 education, manages meds & ADLs independently Meds phenobarbital, carbamazepine, telmisartan/hctz, warfarin Warfarin history on between 7-8 mg/day for > 15 years. Has always had 5mg and 1mg tablets dispensed. INRs pre-admission consistently stable for years between

15 On discharge delirium clearing and getting close to baseline, I took the home warfarin bottles out of her bag. Can you please show me how you would take 7mg of warfarin? = 27mg I confirmed with her Is that 7mg? Yes I put the 5mg vial behind my back and again asked her to put 7mg in her hand using only 1mg tablets. = 7mg

16 Why the confusion? Taking 7mg using is MATH Taking 7mg using is COUNTING

17 On the next admission for hematuria pulmonary hemorrhage, GI bleed and an INR > 10, when we ask her what her warfarin dose is for her BPMH: I take 7 mg of warfarin every day. The Patient s Truth

18 Outcome Ms. C has been back in her home for 6 months. She is independent with her ADLs and is managing her medications using warfarin 1mg tablets She is still my Aunt

19 Morals of the story 1. What we tell the patient is often very different than what their truth ends up being. 2. A medication history or list is simply a hint of what the patient may actually be doing.

20 Morals of the story 3. The only hope we have of finding out the patient s truth Talk and listen Dialogue Demonstrate (us and them) Keep sleuthing 4. The patient s truth is often cause for someone else s admission.

21 Thank you for listening to my story!

22 Medication Reconciliation at Discharge Accreditation Canada Requirements Heather Howley Accreditation Canada November 10, 2015

23 Qmentum: A quality improvement framework A measure of an organization s services compared against standards A tool to identify areas for improvement A process for organizations to regularly and consistently examine and improve their services 23

24 Required Organizational Practices (ROPs) in Qmentum 24

25 History of Medication Reconciliation ROPs 2006: At admission & discharge (Service standards) 2010: As an organizational priority (Leadership standards) 2014: Improved customization Expanded requirements 25

26 MedRec at care transitions: Discharge requirements Unique to inpatient acute care Two medication lists need to be reconciled: BPMH generated at admission Current medication list (e.g., MAR) The result is a single list (updated BPMH) of all medications the client should be taking 26

27 MedRec at Care Transitions ROP (acute care version) 2015 ROP Handbook 27

28 MedRec at Care Transitions ROP (discharge requirements) Major The prescriber uses the Best Possible Medication History (BPMH) and the current medication orders to generate transfer or discharge medication orders. Major The team provides the client, community-based health care provider, and community pharmacy (as appropriate) with a complete list of medications the client should be taking following discharge ROP Handbook 28

29 Care transitions that benefit from Admission MedRec Discharge (external transfer) Internal transfers where there is the potential to introduce medication discrepancies, e.g.: Medications are re-ordered or re-written Change in service environments where the most responsible prescriber changes 29

30 The On-site Survey: Discharge requirements for MedRec REVIEW RECORD TALK and LISTEN OBSERVE 30

31 Thank you! Thank you! Merci! Proud to be a Top 25 employer for five consecutive years Fier de faire partie des 25 meilleurs employeurs depuis 5 années consécutives Accredited by Agréé par 31

32 Cynthia Berry Lead Medication Reconciliation Pharmacist for the Saskatoon Health Region, Saskatchewan

33 Discharge Medication Reconciliation

34 Accreditation! SK MoH Provincial Strategic and Operational Directive Recognition of a flawed system 2011 Call to Action!

35 Discharge/Transfer MedRec Timeline 2011-present Autumn 2011: Interdisciplinary working group struck to develop and implement MedRec for patients discharged from acute care and newly admitted to LTC PDSA cycles Role definition Rural versus urban Form Education and communication Measuring

36 Discharge/Transfer MedRec Timeline 2011-present Autumn 2013: Interdisciplinary working group struck to develop and implement MedRec for ALL patients discharged from acute care to home. Baseline audit discrepancies, practices Role definition Process exploration Form revision

37 Discharge/Transfer MedRec Timeline 2011-present Winter Spring 2014 Buy in from Cardiologists and Clinical Nurse Specialists = revised pre-printed discharge order set Hesitation from our next targeted groups HURDLE: time to complete form well

38 Discharge/Transfer MedRec Timeline 2011-present Spring 2014 onward: Exploration form generated from in-patient pharmacy software Pilot with CTU Team Silver PDSA cycles with Silver, Red, Blue Evaluation of workload Fully implemented for all patients discharged from RUH CTU (medicine)

39 Discharge/Transfer MedRec Timeline 2011-present Spring 2014 onward: Creation of a form generated from in-patient pharmacy software Pilot with CTU Team Silver PDSA cycles with Silver, Red, Blue Evaluation of workload Fully implemented for all patients discharged from RUH CTU (medicine)

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42 Current Discharge/Transfer Med Rec Form

43 Current Discharge/Transfer Med Rec Form

44 Current Discharge/Transfer Med Rec Form

45 Critical Learning Moments An accurate BPMH is VITAL to Discharge Med Rec. Electronic tools are helpful in many ways (reduction of transcription error), but come with their own set of challenges (resources). Most discrepancies occur when the physician is rushed. (Patient flow!) Physician champions and rapid PDSAs are keys to success. Involve a community pharmacist!

46 Lynette Zielinski, RN Clinical Nurse Educator Home Care, Saskatoon Health Region, Saskatchewan

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50 Devin Elias Community Pharmacist Willow Grove Pharmacy, Saskatoon, SK 50

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52 Michael Hamilton Community and Long Term Care physician, Newmarket Health Centre, Newmarket, Ontario Physician Lead and Medication Safety Specialist, ISMP Canada 52

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54 Alice Watt Medication Safety Specialist, ISMP Canada

55 Hospital to Home - Facilitating Safe Medications at Transitions A Toolkit and Checklist for Healthcare Providers

56 Testimonials A superb, comprehensive guide to implementing effective medication reconciliation, which is a key component of high quality healthcare transitions. Dr. Kenneth Boockvar "... was really helpful for getting discharge medication lists to the service providers, like myself in a timely manner. Not having a discharge medication list can be troublesome especially if there are cognitive challenges and/or poor patient support in the home, or no family doctor. CCAC Rapid Response Nurse "... one of the most rewarding parts of my job is improving the patient's understanding of their medications and to help them feel more confident about taking their medications when they go home. The checklist prompts me to systematically go through each step so that the medication information we send with the patient and to their healthcare providers is accurate and complete. It's about passing the baton to ensure the patient can succeed at home. Clinical Pharmacist

57 Questions ISMP Canada (Host) 57

58 Upcoming MedRec Webinars February 9, 2015 BOOMR: Care Coordinated Cross Sectional Medication Reconciliation Initiative for LTC residents 58 58

59 New Frequently Asked Questions How can I access a previous Safer Healthcare Now! MedRec webinar/national call? How do I access the Safer Healthcare Now! MedRec Quality Audit Tool? Where can I find information about MedRec in the home care setting? Where can I find patient and family resources for medication reconciliation? Where can I find videos, elearning modules or onsite training on how to create a Best Possible Medication History (BPMH)? Where can I find discharge MedRec resources? What is the purpose of the MedRec Quality Audit? How do I prepare for the MedRec Quality Audit? How do I complete the MedRec Quality Audit and submit the results? Visit reconciliation-%28med-rec%29.aspx

60 Online Community Dedicated to MedRec MedRec Communities of Practice Post your questions Respond to questions Share tools and resources mmunities/medrec/default.aspx 60

61 We are here to help! For MedRec Content (MedRec Intervention Lead) Institute for Safe Medication Practices Canada (ISMP Canada) CPSI Patient Safety Intervention Lead Mike Cass 61

62 Stay on after this call MedRec Open Mike - Need help with MedRec? stay on the line and join the discussion. - Submit your questions to medrec@ismpcanada.org or ask them live 62

63 Please complete our poll 63

64 MedRec Open Mike 64

65 What is Open Mike? Your opportunity to: Ask MedRec related questions to the ISMP Canada MedRec Team Pose questions to teams on the line to get their input Share stories and tools/resources Exchange ideas about are doing and what you have learned 65

66 How to ask questions? 66

67 Lets start the discussion 67