Medication Reconciliation in Home Care
Alberta Health Services
Home Living Programs
Edmonton Area
Presentation to National Medication
Reconciliation Pilot Project Team by:
Wendy Harrison
April 27 and 28, 2009
Who are we?
Alberta Health Services (AHS) was created in May
2008.
•
To provide a patient-focused health system that is
accessible and sustainable for all Albertans.
•
This organization brings together 12 formerly
separate health entities in the province. (9 of these
entities were geographic health regions).
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Alberta Health
Services
Edmonton Area
serves the cities
of Edmonton,
St. Albert and
Sherwood Park
and several
communities
and rural areas
around
Edmonton.
3
Home care services are provided to over 10,000 clients:
•
living in their own homes (includes apartments and lodges)
•
attending Adult Day Programs or the Comprehensive Home
Option for Independent Care of the Elderly (CHOICE) Program
•
Community Aids to Independent Living (CAIL)
•
Clients are admitted for:
•
short term services (e.g. immediately post-op following
surgery or for home parenteral therapy)
•
long term care (e.g. for chronic conditions)
•
palliative or end of life care
•
assistance to obtain basic medical aids and equipment
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Supportive Living services are provided to over
2000 clients living in congregate settings.
•
Services are intended for medically stable clients
who require basic support services on site, as well as
meals, laundry, housekeeping and life enrichment
activities. There are common areas for socializing
and the environment is safe and accessible.
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Project Aim
•
The aim of this project is to develop and trial a framework for
medication reconciliation in home care.
•
This pilot project will:
•
Explore and test processes to obtain, update, and communicate a
complete Best Possible Medication History (BPMH) with home care
clients
•
Identify core processes to aid in the BPMH and identification of
medication discrepancies e.g. use of risk assessment
•
Test measures for monitoring the process and outcomes for
medication reconciliation in the home care environment
•
Demonstrate evidence of involvement of client and/or family in the
process
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Change Ideas
•
To conduct a pilot study with Case Managers from all 6 Home Care
Networks
•
Test educational material for Best Possible Medication History
(BPMH), communication to prescriber, documentation and
reconciliation:
•
For those coming in as new participants in Phase II
•
Update for those who participated in Phase I
•
Track number of discrepancies
•
Track type of discrepancies
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Change Ideas, continued
•
Test Risk Assessment Tool (RAT) and gather information from
participants about how and when to use RAT
•
Create question journal to track questions asked, responses given,
and changes made.
•
Observe any impacts on triage function (assignment of clients to
case managers) as a result of pilot
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•
Queenie Choo, Executive Sponsor, Director, Home Living Programs
•
Wendy Harrison, Team Lead, Manager, Education & Practice
Development,
•
Kari Elliott, Manager, Quality and Research
•
Noreen Vanderburgh, Danielle Kuzyk, Sherilyn Houle, Pharmacists
•
Lisa Dubbeldam, Clinical Nurse Educators
•
Eileen Keogh, Occupational Therapy Professional Practice Leader
•
Liz Ross, Nursing Professional Practice Leader
•
Jane Newman, Home Care Supervisor
•
Yvonne Houle, Administrative Assistant Leader
•
Betty Fradgley, Education Manager, Supportive Living
•
Joanne Gordash, Nurse Practitioner, Supportive Living
•
Dr. Mary Hurlburt, Physician
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MEASURES
•
# of BPMH’s completed for eligible clients
•
Good News 
•
27 clinicians volunteered to participate
•
They rated education sessions as:
•
Thorough
•
Processes were easy to comprehend
•
Good preparation for medication reconciliation.
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MEASURES, continued
•
First data submission January 2009: 5 clients.
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February 2009: 2 clients
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March 2009: 8 clients
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April 2009: 21 clients 
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Rising time for completing BPMH 
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Small Tests of Change
Plan, Do, Study, Act (PDSA) :
•
Developed newsletter and posters
•
Key messages for supervisors
•
Brought supervisor onto committee
•
Strong Executive support e.g. Director stressed
medication reconciliation on walkabouts
•
Committee role as champions
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CHALLENGES TO WORK THROUGH
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Communication
•
Raising awareness and understanding of medication
reconciliation
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Responding to staff suggestions for improvement
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Changing processes takes time
•
Staff workload
•
Need to minimize perception of “one more
thing to do or add” for busy people
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MOVING FORWARD
•
Committee members encouraged participants and were on site to
answer questions
•
Outstanding executive sponsor support
•
Dedicated working group team members with positive outlook
•
Celebration of small steps
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Weekly update on progress
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e-mails to supervisors
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acknowledgement of staff involvement
•
varied approaches to communication
and sharing data with participants
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LESSONS LEARNED
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Communicate clearly and often
•
Provide time for clinicians to attend education and learn
about the documentation required
•
Listen and work with perceptions e.g. “We do this
already. Do we need extra paperwork?”
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KEY INSIGHTS
•
Clinicians value medication reconciliation
•
Processes need to support clinical practice and respect
impact on workload. e.g. reduce paperwork by
eliminating duplication of chart forms
•
Clinicians report practice change: no longer “just
recording lists of meds from pill bottles”
•
Risk assessment may indicate
next steps in assisting with medications
rather than serve as initial screening.
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NEXT STEPS
•
Continue to refine documentation and tools
•
Share documentation forms and education materials on
Communities of Practice website
•
Learn more about risk assessment for home care
clients related to medication safety
•
Continue with “spread”
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CONTACT INFORMATION
Name: Wendy Harrison
Email: [email protected]
Phone Number:
•
780-735-3351 (office)
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780-902-8249 (cell)
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