Our Med Rec
Success Story
Nadia Facca, RPh
Pharmacy Lead & Chair of Med Rec
Sustainability Team
LHSC
London Health Sciences Centre
(LHSC)
•Multi-site acute care teaching hospital in London,
Ontario
•Over 900 beds
•15, 000 staff
•Regional academic programs including renal,
cancer, neonatology and pediatrics, transplant,
emergency, medicine, surgery, cardiology, CNS,
mental health
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Sharing Our Success @ LHSC
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Successful Corporate Implementation of
Medication Reconciliation at Admission, Transfer,
Post-op and Discharge achieved by June 2012
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Acknowledged by ISMP to have achieved “All Star”
Status for Medication Reconciliation
Cross Country MedRec Check-up
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Our Overall Goal with Med Rec
“Our goal is to set a new standard around how
we collect medication information and how it
is used.
Obtaining the best possible patient medication
history, and reconciling that history with the
patient’s needs prior to prescribing any new
medications, will reduce adverse drug events”
-Neil Johnson, VP
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Inspiring Quotes from Residents at
LHSC …
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“Just print off the form and check the boxes…it’s
so easy”
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“…the residents will all agree that med rec went
from tedious and annoying to extremely
beneficial and time-saving…”
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Project Team Members
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Catherine Sellery
Deb Laman
Pam Andress
Gail Barbour
Ilya Bogorad
Karyn Calwell
Carrie Ann Channon
Mary Anne Davies
Kim Delamere
Michelle Douglas
Debbie Karcz
Sherri Lawson
Sheona Baker
Saira Zafar
Mark Goldszmidt
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Lila Neumann
Diana Lemaire
Chuck Loblaw
Maureen MacPherson
Michele Martin
Lori O’Brien
Janice Sumpton
Stefanie Luxton
Sonia Dhaliwal
Samantha Lee
Rachel Runnels
Soha Ahrari
Nadia Facca
OUR QUALITY IMPROVEMENT
APPROACH
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The Stepping Stones to Med Rec
Success @ LHSC
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“It’s very important that you find something that you care
about, that you have a deep passion for, because you’re
going to have to devote a lot of your life to it.”
– George Lucas
COMMITMENT
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Commitment
Lessons learned from three failed previous
attempts
• A number of factors prevented successful
adoption including:
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No formal policy, procedures
Not an Required Organization Practice for
Accreditation
Pharmacy owned the process…no Multidisciplinary
Focus
No Corporate Wide Sponsors
Lack of Physician Engagement
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Commitment
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New CEO: October 2010
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New Director of Pharmacy: Spring 2011
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Interdisciplinary Champions Appointed
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Support from other Influential Leaders
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Commitment
‘Key Messages’ shared with all…
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Medication Reconciliation is not an option and
will be done on every inpatient at LHSC
It is an interdisciplinary process including
physicians, nurses, pharmacists
It is a combined paper/electronic process
It is a Required Organizational Practice for
Accreditation Canada
It is Mandatory!!
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”Life is not a dress rehearsal. Stop practicing what you’re
going to do and just go do it. In one bold stroke you can
transform today".
- Marilyn Grey
CHALLENGES
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Challenges
No additional funding to support process
• Lack of engagement
• Pervasive perception that med rec involves more
work and no benefit
• “Why do this on paper when it would be so much
easier to do this electronic?”
• Education of all involved in process
• Evaluation
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Challenges
“It's not so much that we're afraid of change or
so in love with the old ways, but it's that place
in between that we fear . . . . It's like being
between trapezes. It's Linus when his blanket
is in the dryer. There's nothing to hold on to”.
- Marilyn Ferguson
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Challenges
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“Admission, Transfer AND Discharge???”
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Challenging Patient Populations
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Surgery
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Mental Health
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Areas with existing pre-printed (paper) orders
Transfer from one hospital to the other (within LHSC)
Obstetrics
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“If everyone is moving forward together, then success takes
care of itself”.
- Henry Ford
COLLABORATION
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Collaboration
Medication Reconciliation
Steering Committee
Medication Reconciliation
Project Team
Unit Working Teams
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Board of Directors
MAC
DTC
Drug & Therapeutics
Committee
Medication Reconciliation
Project Structure
Collaboration
Demographics of
Project Team Members:
Project Leader
• Project Manager
• Pharmacy Leadership
• Pharmacists
• Pharmacy Student
• Physicians and Residents
• Nursing Leadership
• Nursing Educators
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Frontline Nurses
• Clinical Informatics
• Decision Support
• Medical Affairs
• Risk Management
• Forms Management
• Communications
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Collaboration
Unit Specific Working Teams
Consisted of Unit Leadership, Nursing
Educators, Frontline Nursing Staff, Physicians,
Unit Clerks, Pharmacists
• Met with members of the Project Team to learn
about new forms and new process
• Project Team provided Units with various
standardized educational materials
• Discussed how Med Rec would be implemented
in their clinical area with current resources
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FORMS…
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“The real art of conversation is not only to say the right thing
at the right place but to leave unsaid the wrong thing at the
tempting moment”.
– Dorothy Nevill
CONVERSATIONS
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Conversations
Implementation Phases vs. Pilot Areas
• Entire Hospital vs. Key Areas
• Clear Communication for Implementation Phases:
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Phase 1 (Oct 2011): Sub Acute Medicine Unit/Palliative Care at Victoria
Hospital
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Phase 2 (Nov 28, 2011): Orthopaedics Surgery at University Hospital
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Phase 3a (Feb 29, 2012): All of University Hospital
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Phase 3b (May 30, 2012): All of Victoria Hospital
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Conversations
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Crucial Conversations®
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Timing is everything…
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Educational sessions
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Medical Leaders, Staff Physicians, Residents, Students
Pharmacists, Pharmacy Technicians
Nurses, Unit Clerks
Quality & Patient Safety Council
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Conversations
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Various communication strategies were used
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E-casts, articles, weekly tips via email, newsletters
Kickoff sessions at each hospital prior to implementation
Visible, active support during implementation by project
team members
Risk Management Involvement (AEMS)
Support via email, phone, pager
Follow-up with unit leadership and staff postimplementation
Wrap up meetings post-implementation at both hospitals
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"Success is not final, failure is not fatal: it is the courage to
continue that counts”.
- Winston Churchill
COURAGE
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Courage
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Courage to ask the question “Why will this not
work on your unit/with your patient(s)?”
To be able to respond appropriately
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Resist the urge to allow customization of
forms/process unless absolutely necessary
“Don’t give up”
Being truthful and manage expectations
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May have to say “No…we are doing it this way”
“Med rec will add work to your day…but it’s about patient
safety and we will be electronic in less than 2 years”
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Summary of the Stepping Stones
to Med Rec Success at LHSC
Commitment
• Challenges
• Collaboration
• Conversations
• Courage
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“Learn from yesterday, live for today, hope for tomorrow.
The important thing is not to stop questioning”.
-
Albert Einstein
WHERE ARE WE AT TODAY?
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LHSC Med Rec Sustainability Team
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Involves a subset of Members from the Corporate
Project Team and Steering Committee
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Meet regularly to discuss issues/concerns and
also lead any PDSA cycles to evaluate ongoing
process
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Creation of mandatory online training (iLEARN
modules)
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Dissemination of stats to clinical areas and staff
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Preparing for conversion to electronic platform
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MEASURES
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Process Measure
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Health Records Data Abstraction
Coding every Patient chart according to predefined
criteria*
• Will “code” a Med Rec form as
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Complete
Partially Complete
Missing Form
Not Applicable
Blank
*Caveat: Revision to criteria was made in July – August 2012
(post-implementation)
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Admission Data – University Hospital
100%
90%
80%
70%
60%
Complete
50%
Partially Complete
Complete + Partially Complete
40%
MISSING
30%
N/A
20%
Blank
10%
0%
Mar-12
Apr-12
May-12
Jun-12
Jul-12
Admission Form
University Hospital
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Aug-12
Sep-12
Verification of BPMH Data - University
Hospital
100%
90%
80%
70%
60%
Complete
50%
Partially Complete
40%
Complete + Partially Complete
N/A
30%
Missing
20%
Blank
10%
0%
Mar-12
Apr-12
May-12
Jun-12
Jul-12
BLUE FORM
University Hospital
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Aug-12
Sep-12
Admission Data – Victoria Hospital
80%
70%
60%
50%
Complete
Partially Complete
40%
Complete + Partially Complete
30%
MISSING
N/A
20%
Blank
10%
0%
Jun-12
Jul-12
Aug-12
Admission Form
Victoria Hospital
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Sep-12
Verification of BPMH Data – Victoria
Hospital
80%
70%
60%
50%
Complete
Partially Complete
40%
Complete + Partially Complete
30%
N/A
20%
Missing
10%
Blank
0%
Jun-12
Jul-12
Aug-12
BLUE FORM
Victoria Hospital
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Sep-12
Discharge Data – University Hospital
90%
80%
70%
60%
Complete
50%
Partially Complete
40%
Complete + Partially Complete
N/A
30%
Missing
20%
Blank
10%
0%
Mar-12
Apr-12
May-12
Jun-12
Jul-12
Discharge Med Orders
University Hospital
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Aug-12
Sep-12
Discharge Data – Victoria Hospital
60%
50%
40%
Complete
Partially Complete
30%
Complete + Partially Complete
N/A
20%
Missing
Blank
10%
0%
Jun-12
Jul-12
Aug-12
Discharge Med Orders
Victoria Hospital
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Sep-12
Outcome Measure
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Retrospective chart review
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Comparison of medication discrepancies at
discharge pre-implementation to postimplementation
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Goal: to see a 50% reduction in discrepancies
Data will be submitted for publication
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Thank You !
[email protected]
[email protected]
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