2013-03- 18 Lakeshore General Hospital Ashern, Mb Background Serves: RM of Siglunes: includes Town of Ashern RM of Grahamdale 5 First NaKons CommuniKes Closest hospital to South is Eriksdale: 35 min Closest hospital to North is Thompson or The Pas: 4-6 hours away Not including Nursing Sta0ons 1
Background HOSPITAL/UNIT: 14 Acute Care Beds ER: ResuscitaKon Room (1 bed) 1 Cardiac ObservaKon Area (1 Bed) 1 Treatment Room (1 Bed) 2 ObservaKon Stretchers 20 Bed PCH and 10 bed Dialysis Unit awached to Facility TEAM MEMBERS: 3 Doctors with onsite clinics who rotate 24hr call Clinical Team Manager CRN 9 RN (8 internakonal) 6 LPN (4 internakonal) 2 HCA/Ward Clerks PART TIME (not onsite) : Pharmacist, Pharmacist Tech, OT/PT, Home Care Coordinators Our MedRec Story 2 Main Forms Used Done on admission prior to doing MAR 1. Medica0on Prior to Admission Reconcilia0on and Order Form Pt Info / Demographics List of medicakons (taken prior to admit with indicakon r/t 5 R s) & When was the last dose To order or not to order Reasons for said Change Should Include: PRN & OTC Meds, drops, patches, creams, injectables, inhalers Informa0on Source ( Pt, Family, Bubble Pack, DPIN, Vials, Pharmacy, Home Meds List or Other) Signature of recorder with date and Kme MD signature with date and Kme All new orders are wriwen on the doctors orders sheet *DPIN printed for all admissions - Nurse driven process! 2
Our MedRec Story 2. Discharge Medica0on Reconcilia0on Form Pt Info / Demographics Admission and Discharge Date Drug, Dose and Frequency with indicakon regarding: Is it a New medicakon Is it a medicakon that is to be Con0nued as was taken at home Is it a Change in the medicakon that Pt was taking **** OR Is it a Stop in the medicakon Requires Doctors Signature Checklist : MedicaKon Ordered on Discharge is Compared with Admission Reconcilia0on Form Compared with last 24 hrs of meds taken (using MAR) Faxed to Pharmacy (Indica0on if Pt given original or copy of form) Faxed to Home Care (if applicable) Successes / Benefits Individual commitment to a group effort - that is what makes a Team work, a company work, a society work, a civiliza<on work. Vince Lombardi ContribuKng Factors to Success: Use of a 3 Nurse Check: Orders : Noted - Checked - Confirmed (starts with the DPIN) SupporKve Pharmacist and Pharmacist Tech Review Orders Consult with MD Educate Nursing Staff Local Pharmacy - Resource for InformaKon from Admit through to Discharge Planning PosiKve working relakonships with Home Care Coordinators OT/ PT *Informal teaching facility - orienta<on of staff is frequent and charts are seen and reviewed frequently through the training process allowing for errors to be caught 3
Barriers / Challenges Recruitment Resources CHALLENGES RetenKon Rural Barriers / Challenges InternaKonal Staff: Benefit or Challenge? Language barriers Between Nursing Staff in regards to processing orders and follow through Between Nurse and PaKents related to medicakon history Between Doctor and Nurses Cultural Differences R/T Nursing PracKce and Pt Care Working with in the Nursing Scope of PracKce in a new country (Cri0cal Thinking, use of DPIN, applicakon of APIE) may be unfamiliar or different TranslaKon and TranscripKon of MedicaKons, the secondary uses of MedicaKons and oeen the use of PRN medicakons Strength lies in differences, not in similari0es. Stephen Covey 4
Barriers / Challenges AddiKonal Staffing Issues: Agency staff / High turn over rate of Staff Pharmacy staff is P/T; Nurse unable to follow up with? outside business hours GENERAL CHALLENGES: Aging popula0on: poor historians related to medicakon and past medical history Non compliance of many PaKents including Pt s oeen leaving AMA PaKents who doctor shop and or hospital shop PaKents transferred from other facili0es or repat s back to our facility Frequent admissions and discharges All Resources are part 0me (not necessarily on site) Geographically isolated Doctor Compliance and preference with Med Rec Process Lessons Learned Remembering: Discharge planning starts at Kme of admission, including MedicaKon ReconciliaKon Using crikcal thinking skills specifically about medicakons being given Does this order make sense for my Pt with what has been presented to me? DocumentaKon if it is not charted it is not done! Importance Pt and or Family EducaKon related to medicakon administrakon and follow up Importance of a Team Approach / Including the MD None of us is as smart as all of us Ken Blanchard 5
Next Steps Pt Friendly Discharge MedicaKon List ( In Pt Friendly Terms / Beyond the 5 R s) This is what medicabon you are taking This is why you are taking it This is what it is doing for you This is how you are to take it... This is when you are to take it This is what you should watch for PracKcing consistency with the transcripkon process ConKnue exploring resources using more than one source of informakon to gather comprehensive history Encouraging adequate review of Admission medicakons by MD Discouraging orders that state ConKnue with all Regular MedicaKons 6