Medication Reconciliation (MedRec) Implementation at Alberta Health Services

The Provincial MedRec TeamIan Creurer, Greg Duchscherer, Meenakshi Kashyap, Christine Lazzer, Dawn

McDonald, Dawn Vallet-MacDonald, and Gingie Welsh

Long TermCare

HomeCare

EmergencyDepartment

SupportiveLiving

Acute Careand Clinics

• Alberta Health Services (AHS) is incorporating Medication Reconciliation (MedRec) processes into everyday practice of all care settings by the end of 2015.

• MedRec is one of the largest safety and quality improvement projects currently underway in AHS.

A Major Organisational Priority

A Required Organisational Practice (ROP)

MedRec: A High Priority Patient Safety Initiative

Th

e B

ackg

rou

nd

We needed a coordinated and consistent approach to implementing

MedRec across all care settings in AHS. Our

implementation

strategy is based on

MedRec best practices and Accreditation Canada’s

ROP standards. MedRec has been a national and international patient safety initiative since 2005.

Implementing MedRec• Improves patient safety by reducing medication errors and risk of adverse drug events• Enhances patient and family centered care• Improves communication between healthcare providers (HCPs) across all settings• Increases continuity of care and collaboration between HCPs• Decreases the taking of multiple medication histories and rework by different HCPs

Wh

y M

edR

ec?

Patients have a shared responsibility in medication safety.

Patients are most vulnerable

to medication errors during

transitions of care. “Care is

safer when our knowledge

of a patient’s medications is

clear, correct and up to

date.”

WORKING GROUP• MEDREC POLICY• DEFINE HIGH RISK• MEDREC TOOLKIT • IMPLEMENTATION

APPROACH• ZONE TEAMS• SUCCESS

MEASURES• PRACTITIONER

ENGAGEMENT• INITIATE

PATIENT/PUBLIC ENGAGEMENT

ZONE TEAMS

(UNIT/ SERVICE OR PROGRAM

TEAMS)• DEFINE ROLES• PLACEMENT ON

CHART• LOCAL PLAN

EDUCATION ROLL OUT

PUBLIC, STAFF & PHYSICIANS

• EDUCATION• AWARENESS

CAMPAIGNS• TOOLS AND

RESOURCES

IMPLEMENT ADMISSION MED REC• ACUTE CARE• ACH SUPPORTIVE LIVING/HOSPICE & PALLIATIVE CARE • AHS LONG TERM CARE• AHS HOME CARE (select patients)• URGENT CARE (select patients)• EMERGENCY DEPARTMENT (select patients)• PreADMISSION CLINICS• Meet ACCRED ROP'S for Admission, Transfer and

Referral/Discharge within defined timelines

IMPLEMENT TRANSFER & DISCHARGE MEDREC

ADMISSION MED REC AMB CARE (select patients)

WORK WITH EDUCATIONAL INSTITUTIONS

COMPLETE MEDREC FOR

AMBULATORY CARE

PHASE 3:2015

PHASE 2:2014

PHASE I: 2011 – 2013

AdmissionAcute, Home & Long-term Care

2011 - 2013

AHSProvincial Planning

2011 - 2015

Discharge/ Transfer 2014

Ambulatory Care2014 - 2015

The Alberta Health Services (AHS) Provincial Phased-in Approach

North ZoneImplementation

Edmonton ZoneImplementation

Central ZoneImplementation

Calgary ZoneImplementation

South ZoneImplementation

AHS ProvincialMedRec Planning

A “Viral Spread Model”

Imp

lem

enta

tio

n A

pp

roac

hThe goal is to have

MedRec processes

incorporated into

everyday practice.

Ou

r P

artn

ers

To create awareness and an understanding of the role of each member on the healthcare team, AHS has developed:• MedRec educational tools and resources, MedRec policy and

process overview documents for healthcare providers• A communication strategy for healthcare providers and public• Engagement strategies for clinical staff and physicians,

educational institutions and professional colleges and associations

• Public and provider awareness campaigns

Medication safety is a shared

responsibility. Everyone has a

role to play.

In consultation with patient advisors and public focus groups province wide, AHS

rolled out a public awareness campaign on the importance of maintaining a MedList and

sharing it with your healthcare provider.

AHS developed a MedRec elearning module to educate healthcare providers on MedRec. (http://www.albertahealthservices.ca/8171.asp)

Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14

8987

83

90 8992 91

88 87

1619

24

19

2622

19

2521

AHS MedRec Success Measurements

% Patients Reconciled on Admission % Patiens with 1 or more Discrepancies on Admission

Success% patients with MedRec completed on Admission

Qualitytarget > 80% of patients have all quality elements. Results to date:• BPMH based on >1 source – 68% • Actual med use verified by interview – 81%• Each med has drug name, dose, route,

frequency on BPMH and Admission orders – 98%

• Every med in BPMH is accounted for in admission orders – 94%

• Prescriber has documented rationale for holds & discontinued meds – 81%

Outcome Measure % patients with one or more outstanding discrepancies

Target, less than 10%

Mea

suri

ng

Su

cces

sMedRec forms are an

excellent communication

Target, 80%

Goal, 100%

Goal, 0%

tool for all healthcare providers involved with patients’ medications

and also for measuring success.

Les

son

s L

earn

ed

Keys for Success

Active, visible senior

leadership support and

endorsement.

Audits help improve MedRec processes, develop education and ensure quality improvement.

Healthcare providers can

encourage patients to be

involved in their own

medication safety by focusing

on patient centered care.

A flexible approach that can

be adapted to suit local

processes and conditions.

Early engagement of all

healthcare providers

including physicians and

other stakeholders.

Project focus with a dedicated provincial project

team and zone-based implementation strategy.

Nex

t S

tep

s

• Continue to Support MedRec Implementation

• Continue to Engage External Stakeholders and Physicians

• Evaluate Effectiveness of the AHS Public Awareness Campaign

• Prepare for Project Closure and Sustainability

Contact us: medrec@albertahealthservices.ca

www.albertahealthservices/medlist