Western Node Collaborative

Saskatoon Health Region

Medication Reconciliation

Background

• Saskatoon Health Region:– largest health region in Saskatchewan– provides 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

TeamLeads

Quality ServicesCandice BrydenGerry Belton

Janice Seeley Marlene Strenger

PhysicianChampion (vacant at present)

P r o j e c t T e a m s

St. Elizabeth’sMonique Bollefer (Lead)Russom OckbaghziEllen KachurYvonne BerscheidBrenda HantkeBev Weyland

RUH 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 Kappel

RUH 5000Lilah Weinberger (Lead)Leah GilmoreDoris SmithEva Lehnert ThielNoelle RohatinskyKathy BueRenee KennedyCrystal Richter

SCH 4300Jane Richardson (Lead)Mark SheridanAudrey SeredaTess GiegNadine ClarkeMarie GiffordShannon Stone

Advisory Committee

Background

• Pilot sites for medication reconciliation project include:

– Surgery 5000, Royal University Hospital– Pediatrics, Royal University Hospital– Gynecology / PAC, Saskatoon City Hospital– 6th Medicine, St. Paul’s Hospital– St. Elizabeth’s Hospital, Humboldt (rural site)

Background

• Rationale for improving– Enhanced patient safety

• What are you trying to improve?– Clarity and completeness of medication

histories and orders from admission to discharge

– Reduce medication history and ordering workload

Background

• Important dates:– Start date: October / November 2005– Region wide target implementation dates:

• Admission: December 2006• Transfer and discharge: Spring 2007• Link with SK Health Pharmaceutical Information

Program (PIP): June 2007

Background

• Why?– Evidence for improving patient safety is compelling– Requirement for CCHSA accreditation– CEO and Senior Leadership completely endorses– Enhances efficiencies; eliminates duplication of

workload– Key component of seamless care strategies

• Resources:– No dedicated resources– Group of interested, enthusiastic health care

professionals agreed to participate

Aim

• Purpose: Improve patient care by reducing adverse drug events through medication reconciliation

• Scope 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 months• Reduce # undocumented intentional discrepancies by 75% in 12

months• Increase overall success at reconciling medications by increasing the

Medication Reconciliation Success index by 75% in 12 months

Goals

• Admission to Discharge:– Develop 1 form for admission medication reconciliation

for use in SHR. • Form to serve dual purpose of physician’s 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 form– Modify the current business process to integrate the

preadmission data with patient’s acute care medication profile

– Develop a new process where automation will generate a patient medication profile on transfer and discharge

Changes Tested

• Preadmission Medication List Physician Order Form

– Focus groups (Pharmacy, Nursing, Physicians)

– Satisfaction survey with each PDSA cycle

– Changes made to content and design based on feedback

• Medication reconciliation process

– Focus groups

– Satisfaction survey with PDSA cycle #1

• Test effectiveness of and reaction to medication reconciliation form

– Survey

– Missing information check-list

– BPMH

Results: Run Charts of Key Measures

1.0 Mean Number of Undocumented Intentional Discrepancies

0.000.200.400.600.801.001.20

Nov

2005

Dec

2005

Jan

2006

Feb

2006

Mar

2006

Apr

2006

May

2006

Jun

2006

Jul

2006

Aug

2006

Sep

2006

Oct

2006

Nov

2006

Dec

2006

Month

Mea

n

Actual Goal

2.0 Mean Number of Unintentional Discrepancies

0.00

0.10

0.20

0.30

0.40

0.50

0.60

Nov

2005

Dec

2005

Jan

2006

Feb

2006

Mar

2006

Apr

2006

May

2006

Jun

2006

Jul

2006

Aug

2006

Sep

2006

Oct

2006

Nov

2006

Dec

2006

Month

Mea

n

Actual Goal

3.0 Medication Reconciliation Success Index

0%20%40%60%80%

100%120%

Nov

200

5

Dec

200

5

Jan

200

6

Feb

200

6

Mar

200

6

Apr

200

6

May

200

6

Jun

200

6

Jul

200

6

Aug

200

6

Sep

200

6

Oct

200

6

Nov

200

6

Dec

200

6

Month

Per

cen

tag

e

Actual Goal

Pediatrics – Includes OTCs and Herbal Products (n=6)

Results: Run Charts of Key Measures

1.0 Mean Number of Undocumented Intentional Discrepancies

0.00

0.20

0.40

0.60

0.80

Nov

200

5

Dec

200

5

Jan

200

6

Feb

200

6

Mar

200

6

Apr

200

6

May

200

6

Jun

200

6

Jul

200

6

Aug

200

6

Sep

200

6

Oct

200

6

Nov

200

6

Dec

200

6

Month

Mea

n

Actual Goal

2.0 Mean Number of Unintentional Discrepancies

0.00

0.10

0.20

0.30

0.40

0.50

0.60

Nov

2005

Dec

2005

Jan

2006

Feb

2006

Mar

2006

Apr

2006

May

2006

Jun

2006

Jul

2006

Aug

2006

Sep

2006

Oct

2006

Nov

2006

Dec

2006

Month

Mea

n

Actual Goal

3.0 Medication Reconciliation Success Index

0%20%40%60%80%

100%120%

Nov

2005

Dec

2005

Jan

2006

Feb

2006

Mar

2006

Apr

2006

May

2006

Jun

2006

Jul

2006

Aug

2006

Sep

2006

Oct

2006

Nov

2006

Dec

2006

Month

Per

cen

tag

e

Actual Goal

Pediatrics – OTCs and Herbal Products Removed (n=4)

Results: Run Charts of Key Measures

1.0 Mean Number of Undocumented Intentional Discrepancies

0.000.501.001.502.002.503.00

Nov

2005

Dec

2005

Jan

2006

Feb

2006

Mar

2006

Apr

2006

May

2006

Jun

2006

Jul

2006

Aug

2006

Sep

2006

Oct

2006

Nov

2006

Dec

2006

Month

Mea

n

Actual Goal

2.0 Mean Number of Unintentional Discrepancies

0.00

0.50

1.00

1.50

2.00

2.50

Nov

2005

Dec

2005

Jan

2006

Feb

2006

Mar

2006

Apr

2006

May

2006

Jun

2006

Jul

2006

Aug

2006

Sep

2006

Oct

2006

Nov

2006

Dec

2006

Month

Mea

n

Actual Goal

3.0 Medication Reconciliation Success Index

0%20%40%60%80%

100%120%

Nov

2005

Dec

2005

Jan

2006

Feb

2006

Mar

2006

Apr

2006

May

2006

Jun

2006

Jul

2006

Aug

2006

Sep

2006

Oct

2006

Nov

2006

Dec

2006

Month

Per

cen

tag

e

Actual Goal

6th Medicine – Includes OTCs and Herbal Products (n=2)

Results: Run Charts of Key Measures

1.0 Mean Number of Undocumented Intentional Discrepancies

0.00

0.50

1.00

1.50

2.00

2.50N

ov20

05

Dec

200

5

Jan

200

6

Feb

200

6

Mar

200

6

Apr

200

6

May

200

6

Jun

200

6

Jul

200

6

Aug

200

6

Sep

200

6

Oct

200

6

Nov

200

6

Dec

200

6

Month

Mea

n

Actual Goal

2.0 Mean Number of Unintentional Discrepancies

0.00

0.50

1.00

1.50

2.00

2.50

Nov

2005

Dec

2005

Jan

2006

Feb

2006

Mar

2006

Apr

2006

May

2006

Jun

2006

Jul

2006

Aug

2006

Sep

2006

Oct

2006

Nov

2006

Dec

2006

Month

Mea

n

Actual Goal

3.0 Medication Reconciliation Success Index

0%

20%

40%

60%

80%

100%

Nov

2005

Dec

2005

Jan

2006

Feb

2006

Mar

2006

Apr

2006

May

2006

Jun

2006

Jul

2006

Aug

2006

Sep

2006

Oct

2006

Nov

2006

Dec

2006

Month

Per

cen

tag

e

Actual Goal

Gynecology / PAC – includes OTCs and Herbal Products (n=4)

Results: Run Charts of Key Measures

1.0 Mean Number of Undocumented Intentional Discrepancies

0.00

0.50

1.00

1.50

Nov

2005

Dec

2005

Jan

2006

Feb

2006

Mar

2006

Apr

2006

May

2006

Jun

2006

Jul

2006

Aug

2006

Sep

2006

Oct

2006

Nov

2006

Dec

2006

Month

Mea

n

Actual Goal

2.0 Mean Number of Unintentional Discrepancies

0.00

0.50

1.00

1.50

2.00

2.50

Nov

200

5

Dec

200

5

Jan

200

6

Feb

200

6

Mar

200

6

Apr

200

6

May

200

6

Jun

200

6

Jul

200

6

Aug

200

6

Sep

200

6

Oct

200

6

Nov

200

6

Dec

200

6

Month

Mea

n

Actual Goal

3.0 Medication Reconciliation Success Index

0%20%40%60%80%

100%120%

Nov

2005

Dec

2005

Jan

2006

Feb

2006

Mar

2006

Apr

2006

May

2006

Jun

2006

Jul

2006

Aug

2006

Sep

2006

Oct

2006

Nov

2006

Dec

2006

Month

Per

cen

tag

e

Actual Goal

St. Elizabeth’s Hospital – includes OTCs and Herbal Products (n=1)

Results: Run Charts of Key Measures

1.0 Mean Number of Undocumented Intentional Discrepancies

0.000.200.400.600.801.001.20

Nov

200

5

Dec

200

5

Jan

200

6

Feb

200

6

Mar

200

6

Apr

200

6

May

200

6

Jun

200

6

Jul

200

6

Aug

200

6

Sep

200

6

Oct

200

6

Nov

200

6

Dec

200

6

Month

Mea

n

Actual Goal

2.0 Mean Number of Unintentional Discrepancies

0.00

0.50

1.00

1.50

2.00

2.50

Nov

2005

Dec

2005

Jan

2006

Feb

2006

Mar

2006

Apr

2006

May

2006

Jun

2006

Jul

2006

Aug

2006

Sep

2006

Oct

2006

Nov

2006

Dec

2006

Month

Mea

n

Actual Goal

3.0 Medication Reconciliation Success Index

0%20%40%60%80%

100%120%

Nov

2005

Dec

2005

Jan

2006

Feb

2006

Mar

2006

Apr

2006

May

2006

Jun

2006

Jul

2006

Aug

2006

Sep

2006

Oct

2006

Nov

2006

Dec

2006

Month

Per

cen

tag

e

Actual Goal

Surgery 5000 – includes OTCs and Herbal Products (n=11)

Keys to Success & Lessons Learned

• Major Keys to Success– Enthusiastic and committed Advisory, Steering, and Ward team

members– 1:1 and small group educational sessions with staff– Increasing number of staff engaged in the process

• Barriers– Dedicated resources– Staff buy-in on certain pilot areas– Process – obtaining a complete and accurate medication history– Timelines – balance between Safer Healthcare Now / Quality

Improvement Methodology and Accreditation deadline– PDSA cycle turn around time

Keys to Success & Lessons Learned

• Lessons learned to date about these changes– Large 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”

required– Education sub-committee formed

Next Steps

• Changes we are planning on testing to help us achieve our goals: – Effect of a standardized method for providing education– Ability of staff to take a complete and accurate

medication history– Use 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 Information

• Barb Evans– barb.evans@saskatoonhealthregion.ca – Phone: 306-655-2268

• Jackie Mann– jackie.mann@saskatoonhealthregion.ca– Phone: 306-655-7946

• Janice Seeley– janice.seeley@saskatoonhealthregion.ca – Phone: 306-655-6832

Process Map – Pre-Assesssment Clinic