SPSP Medicines Prepared by: NHS Ayrshire and Arran
Medication Reconciliation: Story so far MR happening in primary care, acute adult, paediatrics and mental health Started in acute then mental health, paediatrics and primary care We will share examples from each area
GP Primary Care
Medication Reconciliation: Story so far SPSP -Primary Care launched April 2013 47 of 55 GP practices signed up in 2013 50 of 55 practices signed up in 2015 Launch meeting followed by local collaborative meetings Medicines reconciliation bundle Monthly benchmarking data
Medicines reconciliation Audit 10 of the following patients per month: all patients discharged from an acute medical admission all patients >75 discharged from an inpatient stay from anywhere Care bundle Has the Immediate Discharge Document been workflowedon the day of receipt? Has medicines reconciliation occurred within 2 working days of the Immediate Discharge Document being workflowedto the GP/Pharmacist? Is it documented that any changes to the medications have been discussed with the patient or their representative? Are all the above measures met?
Data All Ayrshire data Percentage of patients fully compliant with bundle Tests of change
Innovation Adverse events analysed using Enhanced Significant Event Analysis (Human factors/ergonomics framework) now being peer reviewed by NES Informed primary/secondary interface board New doctor induction delivered jointly by GPs and pharmacists Patients involved - occasionally
Patient Involvement / Patient Stories Story boards Patient stories used at collaborative meetings Always events Pilot project completed Teach-back for administrative and clerical staff Resources developed and training of practice managers
Successes and Challenges Successes Practices working together, sharing ideas and learning about QI Challenges Perceived workload and time away from practices Cultural shift Limited understanding of data and how to use to drive improvement Lack of effective interface working between primary & secondary care
Mental Health
% accuracy 100 80 60 40 20 Medicines Reconciliation Monitoring Park Ward % accurate meds rec Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Week 12 Week 13 Week 14 Week 15 Week No. Jul -Nov 13
NHS Ayrshire and Arran Scottish Patient Safety Programme PARK WARD 100% Accuracy In Patient Prescription Chart 90% 80% Percentage Co ompliance 70% 60% 50% 40% 30% 20% 10% 0% Letter sent to all medics advising them of correct procedures when prescribing and writing up medication Induction for junior doctors including information about medication prescribing Target (95%) Completion Rates 1 2 3 4 5 6 7 8 9 10 11 Week
I feel more able to trust the nurse when she talks to me about my medication while she is giving it to me The nurses have more time to spend with me as they are not looking in the trolley for medication. Everything feels safer and calmer now when I am getting my medication.
Paediatrics
Admission 10 notes per week audited Junior doctors at Friday handover meeting Check MR filed in notes Check compliance of completed forms No improvement noted Change in process planned
MR forms filed 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% week 1 week 2 week 3 week 4 week 5 week 6 week 7
MR compliance 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% week 1 week 2 week 3 week 4 week 5 week 6 week 7
Acute
Admission 10 case notes per week Check MR filed on notes and then check completion Junior doctors complete audit after Friday morning handover Despite reinforcement of importance- no improvement New tests to improve compliance planned
Compliance with MR forms filed 70% 60% 50% 40% 30% 20% 10% 0% week 1 week 2 week 3 week 4 week 5 week 6 week 7
Compliance with MR form completion 70% 60% 50% 40% 30% 20% 10% 0% week 1 week 2 week 3 week 4 week 5 week 6 week 7
Admission Med Rec 120.0 100.0 2 Sources? 80.0 Allergies? 60.0 Medicines plan documented for each medicine? 40.0 20.0 Safe and accurate transcription of clinically appropriate medicine on in-patient prescription chart? Consultant Review? 0.0
Identified errors 60 55 50 45 40 35 30 25 20 15 10 5 0 27 14 14 10 6 6 4 4 5 3 1 2 0 1 2 0 0 0 0 1 0 0 1 0 1 0 1 0 0 1 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Omissions Commissions Drug Interactions Wrong Dose Wrong Frequency Wrong Route Error Total
Discharge Med Rec 120.0 100.0 Patient demographics documented? 80.0 Any documented changes (doses, frequencies)? 60.0 Any documented discontinuations? 40.0 Any documented new medicines (indication)? Allergies? 20.0 0.0 Safe and accurate prescribing of clinically appropriate medication on interim discharge letter?
Identified errors 20 18 16 14 Omissions 12 Commissions 10 Drug Interactions 8 Wrong Dose Wrong Frequency 6 Wrong Route 4 Error Total 2 0
Innovation HEPMA implementation positive impact especially discharge information Demographic and clinician details Allergy information documentation improved from 5% to 99% Fewer omitted medicines
Key Points for Sharing: Ask NHS Ayrshire and Arran about HEPMA impact on Discharge MR Service change to focus on MR NHS Ayrshire and Arran would like to know more about Maternity units undertaking MR Community teams involvement in MR Data collection improvement