Medication Reconciliation Measuring For Success

‘MAKING IT HAPPEN’

Med Rec and VTE Prevention Workshop

September 2017

Objectives

• Types of Measures

• Data collection tools

• Challenges of eMeds data (Lisa Shaheen and Aiden Shi)

• Measuring for Success: Local Perspective (Lucy Nair)

• Group Discussion

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Why do we need data?

3

Define the problem

Defining measures

Define what improvement is

Assess impact

Demonstrating success / further gaps

IHI Model for Improvement

Family of Measures

4

How does the implemented system impact patients, staff, other stakeholders or

the community?

Are the changes designed to improve

one part of the system causing new problems in other parts of the

system?

Are the parts/steps of the implemented

system performing as planned? Are we on

track in our efforts to make improvement?

Outcome Balancing Process

Reduction in medication omissions/discrepancies

on transfer

% Patients with all components of

medication reconciliation

? Intervention dependent

Data collection tools

• Comprehensive Audit Tool – Detailed information

– Quality aspects

– Small sample

• Snapshot Audit Tool – Process measure not quality

– Six components from admission to discharge

• National QUM Indicators – Indicator 3.1

– Indicators 5.8 and 5.9

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Quality Audit Reporting System®

• Online tool to conduct audits and questionnaires • Structured under NSQHS Standards • Generates reports • Assists in developing action plans • Can evaluate across various levels from LHD to

facility to ward

Quality Audit Reporting System®

Quality Audit Reporting System®

Presenting results

• Plot results over time using a ‘Run Chart’

• Assists in visualising progress

Making Measurement “Fun”

• Measurement for judgement vs measurement for learning/improving

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“Without data you’re just another person with an opinion”

W. Edwards Deming

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Smarter Safer Better

eMeds: Measuring for

Success

Challenges of eMeds Data

14th September 2017

Lisa Shaheen Project Officer, NSW TAG/eHealth NSW

Aiden Shi Application Specialist, eHealth NSW

Smarter Safer Better

Medication Reconciliation

• “is a formal process of obtaining and verifying a complete and

accurate list of each patient’s current medicines, matching the

medicines the patient should be prescribed to those they are

actually prescribed.” (QUM Indicator 3.1)

• Meds Rec Process:

1. Obtain Best Possible Medication History (BPMH)

2. Confirm the accuracy of the history

3. Reconcile the history with prescribed medications

4. Supply accurate medicines information

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Step 1&2: Obtain a BPMH & Confirm accuracy

Add Medication

Document Source

Document status

Medication list

Sign later or complete

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Step 3: Reconcile history with prescribed medications

Order details

Reconcile history

with current

medications: − Orders prior

− Orders after

Reconcile & Sign

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Step 4: Supply accurate medicines information

Inpatient orders

Reconciliation

status

History orders

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Clinical consultation groups:

• CEC - Continuity of Medication Management Expert Advisory Group

(CMMEAG)

• NSW Therapeutic Advisory Group

• Prince of Wales: Pharmacy department – Medication Safety, Quality Use

of Medicines

• Cerner Reference Group – technical input

Medication Reconciliation Report

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• Align to NSQHS accreditation standards

− Standard 4: Medication Safety

• Tool for monitoring and quality improvement

• EM002 – Meds Rec Compliance Audit

− Audit on history and reconciliation completion rates

• EM003 – Meds Rec Current Inpatients

− Workflow based report broken down per patient

Medication Reconciliation Report

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EM002 – Meds Rec Compliance Audit

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EM002 – Meds Rec Compliance Audit

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EM003 – Meds Rec Current Inpatients

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• Workflow unfamiliarity – consistent clinical practice

• Accuracy of documented information

• Usability – presentation of information contained on MMP

• Admission Reconciliation – conflicting system semantics

• Hybrid systems

− MMP process remains on paper

− Adhoc clinical note in PowerChart

Dependencies and Limitation

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• What do we have?… Quantitative data - statistics

• What do we need?...Qualitative data - ‘meaningful data’

− Information to influence clinical practice

• Manual data interpretation – What does the data show?...

• Who will use this information?...

− Reporting/Accreditation – DTC, governance units

− Quality improvement processes – ward staff & QUM/Patient Safety Officers

• What will people do with it?...

• How will people use this information?...

Challenges – Clinical Application

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• Progress:

− Design & build – currently completing in SESI domain

− Testing – planned to start in next few weeks

• Testing sign off

• Available for all Cerner eMeds LHD sites

− Specifications to be supplied to sites with MedChart (SVH & HNE)

Report Availability

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Questions

Lucy Nair, Director of Pharmacy

Bankstown-Lidcombe Hospital

Medication Reconciliation: Measuring for success

Bankstown-Lidcombe Hospital (BLH)

• 433 bed principal referral A1 hospital that is part of the South Western Sydney Local Health District (SWSLHD)

• Employs over 1,500FTE (2,000+ staff)

• 34 FTE Pharmacy Staff (27/40 people are Pharmacists)

Background – MMP Project

• AC90 Surveyor Recommendation (4.6.1): Ensure that a best possible medication history is documented for each patient.

• Stakeholders identified, a multi-disciplinary team and a clear action plan were established

Measuring for success

1. Audit

Measuring for success

2. Compile data so it is easy to understand

Measuring for success

3. Feedback results to ALL staff • Posters • Emails • Meetings (e.g. DTC, HCQS, MSC)

Measuring for success

4. Keep it on the agenda

• The multidisciplinary team continues monthly meetings as the Medication Safety Committee

• Education occurs in Facility Orientation (with more detailed education available to nursing and medical on a monthly basis or as required)

• HETI online modules continue to be completed

• PJB rounds attended daily by all disciplines

• Executive sponsorship remains strong

• Resistance managed prior to launch

• Patient/Carer involvement continues

Measuring for success

5. Recognise and Reward • SWSLHD Quality Award ‘Patients and Carers as Partners’ (2015)

• Oral presentation at SHPA National Conference (2015)

• ACHS Award ‘Clinical Excellence and Patient Safety’ (2016)

• Poster presentation at APAC Forum (2016)

ACKNOWLEDGEMENTS

Karma Mekhail Dr Wendy Harmer Linda Campbell Carol Farmer Kim Bassot Bianca Camuglia Vinstein Brillante Natalie Raffoul Innocent Mtandabari Theresa McMahon Dr Vincent Ngian Michael Glynn Jenny Morris (and the ED staff) All clinical staff at Bankstown-Lidcombe Hospital

QUESTIONS?

Group Discussion

• What data is collected?

• How is it presented?

• Who sees the data?

• Can collection or use be improved?

• What is one thing you can do next Tuesday that will improve how the data is collected or used?

How do we know that the change

is an improvement

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Thank you

Questions:

For further information:

CEC-MedicationSafety@health.nsw.gov.au

www.cec.health.nsw.gov.au

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