Western Node Collaborative

Saskatoon Health Region

Medication Reconciliation

BackgroundSaskatoon Health Region:largest health region in Saskatchewanprovides services to almost 300,000 local residents and thousands of others from across the province who come to Saskatoon for specialized health services. On any given day, approximately 35% of hospital care in Saskatoon is provided to people living outside the Health Region. As an academic health sciences centre, the Health Region provides learning opportunities to future health care providers and participates in research that will build knowledge and improve care.

SHR Medication Reconciliation Project Structure

Jean Morrison (Executive Sponsor), Sandra Blevins, Brenda Thiessen, Janet Harding, Candice Bryden Steering Team Project Co-ChairsJackie MannBarb Evans TeamLeadsQuality ServicesCandice BrydenGerry BeltonJanice Seeley Marlene StrengerPhysicianChampion (vacant at present)P r o j e c t T e a m sSt. ElizabethsMonique Bollefer (Lead)Russom OckbaghziEllen KachurYvonne BerscheidBrenda HantkeBev WeylandRUH PediatricsBernie McDonald (Lead)Garth BruceVal GerlachShelley PeacockMargo Elmgren

SPH 6th MedicineBarb Kirkland (Lead)Cheryl FransooCarmen HamptonTrina MuchaSusie HoeppnerDonna StrilaefCaroline Westman Joy MacLaughlinNorma EngeleKaren WormsbeckerMaureen PrestonHolly MansellJudy KlassenJoanne KappelRUH 5000Lilah Weinberger (Lead)Leah GilmoreDoris SmithEva Lehnert ThielNoelle RohatinskyKathy BueRenee KennedyCrystal RichterSCH 4300Jane Richardson (Lead)Mark SheridanAudrey SeredaTess GiegNadine ClarkeMarie GiffordShannon Stone

Advisory Committee

BackgroundPilot sites for medication reconciliation project include:Surgery 5000, Royal University HospitalPediatrics, Royal University HospitalGynecology / PAC, Saskatoon City Hospital6th Medicine, St. Pauls HospitalSt. Elizabeths Hospital, Humboldt (rural site)

BackgroundRationale for improving Enhanced patient safetyWhat are you trying to improve?Clarity and completeness of medication histories and orders from admission to dischargeReduce medication history and ordering workload

BackgroundImportant dates:Start date: October / November 2005Region wide target implementation dates:Admission: December 2006Transfer and discharge: Spring 2007Link with SK Health Pharmaceutical Information Program (PIP): June 2007

BackgroundWhy?Evidence for improving patient safety is compellingRequirement for CCHSA accreditationCEO and Senior Leadership completely endorsesEnhances efficiencies; eliminates duplication of workloadKey component of seamless care strategiesResources:No dedicated resourcesGroup of interested, enthusiastic health care professionals agreed to participate

AimPurpose: Improve patient care by reducing adverse drug events through medication reconciliationScope and Boundaries:Pilot areas selected. Focus on admission process initially.Improvement Objectives (Admission):Overall: To reduce adverse drug events and patient harm through the implementation of medication reconciliation on admission throughout SHR.Pilot Aims:Reduce # unintentional discrepancies by 75% in 12 monthsReduce # undocumented intentional discrepancies by 75% in 12 monthsIncrease overall success at reconciling medications by increasing the Medication Reconciliation Success index by 75% in 12 months

GoalsAdmission to Discharge:Develop 1 form for admission medication reconciliation for use in SHR. Form to serve dual purpose of physicians order form and medication history documentation tool.Develop 1 process for admission medication reconciliation in SHR.Utilize PIP to generate on-line admission medication reconciliation formModify the current business process to integrate the preadmission data with patients acute care medication profileDevelop a new process where automation will generate a patient medication profile on transfer and discharge

Changes Tested Preadmission Medication List Physician Order FormFocus groups (Pharmacy, Nursing, Physicians)Satisfaction survey with each PDSA cycleChanges made to content and design based on feedbackMedication reconciliation processFocus groupsSatisfaction survey with PDSA cycle #1Test effectiveness of and reaction to medication reconciliation formSurveyMissing information check-listBPMH

Results: Run Charts of Key MeasuresPediatrics Includes OTCs and Herbal Products (n=6)

Results: Run Charts of Key MeasuresPediatrics OTCs and Herbal Products Removed (n=4)

Results: Run Charts of Key Measures6th Medicine Includes OTCs and Herbal Products (n=2)

Results: Run Charts of Key MeasuresGynecology / PAC includes OTCs and Herbal Products (n=4)

Results: Run Charts of Key MeasuresSt. Elizabeths Hospital includes OTCs and Herbal Products (n=1)

Results: Run Charts of Key MeasuresSurgery 5000 includes OTCs and Herbal Products (n=11)

Keys to Success & Lessons LearnedMajor Keys to SuccessEnthusiastic and committed Advisory, Steering, and Ward team members1:1 and small group educational sessions with staffIncreasing number of staff engaged in the processBarriersDedicated resourcesStaff buy-in on certain pilot areasProcess obtaining a complete and accurate medication historyTimelines balance between Safer Healthcare Now / Quality Improvement Methodology and Accreditation deadlinePDSA cycle turn around time

Keys to Success & Lessons LearnedLessons learned to date about these changesLarge scale change in process required. Not as easy as anticipated.Preadmission Medication List Physician Order Form appears to be working well.Medication reconciliation process requires further development.Further education on How to Perform a Medication History requiredEducation sub-committee formed

Next StepsChanges we are planning on testing to help us achieve our goals: Effect of a standardized method for providing educationAbility of staff to take a complete and accurate medication historyUse of PIP to generate on-line Preadmission Medication List Physician Order Form Use of automation to generate a patient medication reconciliation and order form on transfer and discharge

Contact InformationBarb Evansbarb.evans@saskatoonhealthregion.ca Phone: 306-655-2268Jackie Mannjackie.mann@saskatoonhealthregion.caPhone: 306-655-7946Janice Seeleyjanice.seeley@saskatoonhealthregion.ca Phone: 306-655-6832

Process Map Pre-Assesssment Clinic