www.saferhealthcarenow.ca

Using technology to support MedRec:

Two hospitals, two approaches.

Andrew Liu, HBSc., BSc.Phm., RPh., Clinical Manager, Department of

Pharmaceutical Services, Toronto East General Hospital, ON.

Josianne Gauthier, B. Pharm, M. Sc Pharm, CRE, Clinical Pharmacist and

Team leader of Medication Reconciliation Implementation, Whitehorse

General Hospital, YT.

September 2014

www.saferhealthcarenow.ca

Welcome also to our

francophone attendees

Bienvenue à nos participants

francophones

Hélène Riverin

Conseillère en sécurité et en amélioration

Safety Improvement Advisor

Bienvenue!

www.saferhealthcarenow.ca

Pour nos participants francophones..

Pour accéder aux diapositives en français :

-Cliquez sur l'onglet « FRENCH »

OU

Envoyer un courriel à

helene.riverin@csssvc.qc.ca

Surveiller la boîte « Chat » pour voir les commentaires des

conférenciers traduits en français

www.saferhealthcarenow.ca

Safer Healthcare Now! website

http://www.saferhealthcarenow.ca/EN/events/

NationalCalls/2014Webinars/Pages/default.aspx

ISMP Canada website

http://www.ismp-canada.org/medrec/#webinars

Safer Healthcare Now! MedRec Community of Practice

http://tools.patientsafetyinstitute.ca/Communities

/MedRec/default.aspx

For real time notification of content posting, “like” the

Medication Reconciliation Network on Facebook

www.facebook.com/MedicationReconciliation

All Safer Healthcare Now! webinars are posted within the

week to the following locations:

www.saferhealthcarenow.ca

Cross Canada MedRec Check-Up

To have something added to this map,

please contact: medrec@ismp-

canada.org

www.saferhealthcarenow.ca 6

NOW AVAILABLE for

download on the Safer

Healthcare Now!, ISMP

Canada and Canada Health

Infoway websites. Toolkit

developed to support

organizations migrate from

a paper-based system to an

electronic system for

MedRec.

www.saferhealthcarenow.ca

Safer Healthcare Now! MedRec

2014-2015 Year-at-a-glance

• Feb. 2015- 2nd MedRec Quality Audit

Month

– Information Call/Kick Off- Jan. 6th, 2015.

– Quality Audit Results- Mar. 31st, 2015.

• 6 national calls/webinars

• Updates to Home Care Getting Started Kit

• Updates to MedRec Cross Canada

Check Up Map

• Developing MedRec FAQ documents

7

www.saferhealthcarenow.ca

www.ismp-canada.org

8

ISMP Canada MedRec Projects

2014-2015

• Doc Mike Evans YouTube video- MedRec

• MyMedRec- Free app to help

patients/families keep a list of

their medications (For Blackberry,

Android and iPhone)

www.saferhealthcarenow.ca

www.ismp-canada.org

MedRec Stay Informed and Connected

Receive ISMP Canada’s MedRec Newsletter

Hear about:

– Upcoming MedRec webinars

– New toolkits

– National MedRec Audit Month

– New MedRec publications

– MedRec related workshops

Join Now!

email bcarthy@ismp-canada.org or

visit http://www.ismp-canada.org/register/medrec.php

www.saferhealthcarenow.ca 10

Please complete our poll

www.saferhealthcarenow.ca

Audience Poll Click on the arrow icon

and then click on the appropriate location on the slide in

response to this question:

Which information system is in use in your

facility?

Cerner Meditech Other

11

Setting a New Standard in Quality and Value

e-Medication Reconciliation on Admission - Cerner

Andrew Liu, RPh. Clinical Manager

Dept. Pharmaceutical Services

September 9, 2014

13

Inpatient Care Beds 516 Inpatients 20,000/yr Emergency visits 70,000/yr

• Single site community teaching

hospital serving southeast Toronto • TEGH has over 2,500 employees and 440 physicians

Setting a New Standard in Quality and Value 14

Toronto East General Hospital 2006

• Mostly paper chart

• Separate electronic pharmacy information system (MS Meds)

• Cerner Powerchart (Labs)

• No provincial electronic drug profile access yet

Setting a New Standard in Quality and Value 15

Medication Communication Problems

• Transcription errors (paper MAR)

• Slow turnaround of written/reconciled orders

• Unlinked MAR / Pharmacy med profile inaccuracies

• Previous Best Possible Medication History (BPMH) lost in archived chart

• BPMH lost in current chart

Challenging Med Rec

Setting a New Standard in Quality and Value 16

Path to eMed Rec

• 2008 Cerner Pharmnet (Pharmacy)

– linked to electronic chart (Powerchart)

• 2009 Computerized Provider Order Entry (CPOE) and e-Medication Administration Record (eMAR)

Setting a New Standard in Quality and Value 17

Setting a New Standard in Quality and Value 18

Path to eMed Rec

• 2010 Existing e-medication history documentation and reconciliation modules – Real-time BPMH documented using standardized

drug library, readily available for all patient visits

– BPMH could be directly converted to inpatient orders

• 2011+ e-Clinical documentation expanded – Including standard Med Rec consultation note

– Real-time med rec data auditing

Setting a New Standard in Quality and Value 19

Med Rec @ TEGH

• Proactive and retroactive approach

• Elective surgical patient pathway (proactive) – Preoperative clinic pharmacist

– Inpatient surgeon / resident

• Acute inpatient pathway (mostly retroactive) – Inpatient clinical pharmacists

– Most responsible physician

Setting a New Standard in Quality and Value 20

Setting a New Standard in Quality and Value 21

Setting a New Standard in Quality and Value 22

Setting a New Standard in Quality and Value 23

Setting a New Standard in Quality and Value 24

Benefits of eMed Rec

• Simple, efficient ordering of multiple medications – Reconciliation tool

• Virtually no transcription errors • BPMH readily available for all future encounters • Real-time availability of BPMH • Foundation for Med Rec on discharge • Automatic drug product translation in Pharmacy

dispensing system (single Cerner ‘interface’) • Enhanced real-time auditing possible

Setting a New Standard in Quality and Value 25

Challenges of eMed Rec

• Standardized use of application features – ‘fill in the blank’ fields such as compliance data not readily

viewable by provider (use Med Rec note)

• Details: – Difficult to track history of medication changes (Med Rec

note) – Inflexibility of display options – ‘Live’ BPMH (?proxy access for staff/students in training) – Pushing alerts/flags to providers – Complexity of data mining

• Does not correct incomplete Med Rec, inaccurate info • Duplicate documentation due to e-prescriptions • Downtime

Setting a New Standard in Quality and Value 26

Conclusion

• Perfection vs Progress

• Upfront key supports (CPOE, eMAR, Drug library) facilitated success

• Simplicity reproducibility

• Success: downstream demand for 100%

Setting a New Standard in Quality and Value 27

Toronto East General Hospital, 825 Coxwell Avenue, Toronto, Ontario, M4C 3E7

Tel: (416) 461-8272 Fax: (416) 469-6106

www.tegh.on.ca

Acknowledgements:

Kieu Lee, Heidi Huang

Questions: Andrew Liu anliu@tegh.on.ca

Thank you!

Medication Reconciliation Using Iatric Software

Josianne Gauthier B.Pharm, M.Sc Pharm, CRE

Clinical Pharmacist

Whitehorse General Hospital

Context

Whitehorse General Hospital

• 55 acute care beds

• 210-230 admissions/month

• 52 Family Physicians

• 6 Surgeons

• 180 Nurses

• 5 Pharmacists

Information Systems

• Meditech 5.64 (MAGIC workstation)

• Patient Discharge Instructions (Iatric Systems)

– For Med Rec at Admission and Discharge

• Medical chart is mostly paper-based

• No territory-wide Electronic Medication Record (EMR)

Implementation of PDI

Patient Discharge Instructions (PDI) software purchased from Iatric Systems

Development of process and reports by clinical pharmacist with physicians, community pharmacists and nursing

Started using PDI for every Med Rec at Admission

Started using PDI for Med Rec at Discharge

(pilot project with clinical pharmacist and 2 physicians)

Roll-out to other physicians

2011

2011 - 2012

May 2012

Sept 2012

2013

PDI Training

• Med Rec Team: – 2 nurses in Emerg and on the ward

– 2 nurses in the Pre-Op Clinic

– Clinical Pharmacist

– Physician “champion”

• One-on-one training and in small groups of physicians

• Instruction Manual and video tutorial

Software allows to:

1) Gather electronically Home Medication history and print Med Rec at Admission form

2) Compare Home Medications and Hospital Medications and generate a comprehensive Discharge Order along with patient hand-outs

Discharge Process

• When planning for discharge, physician logs into PDI

• Clinical Pharmacist, in collaboration with physician, can also log into PDI and prepare Med Rec at Discharge

• Current hospital medications are “pulled over” from Meditech

• Reconciliation by a “simple click”

Discharge Process

• Discharge Orders, Medication List and Medication Schedule are printed

• Physician or pharmacist indicate in “Physician’s Orders” where to fax

• Physician or pharmacist gives Medication List or Medication Schedule to patient with explanation of changes and new medications

Successes

• Over 20 physicians trained on using the program

• Over 120 Med Rec at Discharge performed this year

• Better patient understanding, empowerment, involvement in their care

• Community partners very appreciative of improved communication

Challenges

• Development and customization of reports is time-consuming

• Limited information systems knowledge/support

• Physician engagement

• Users comfort with computer technology

• Time required for patients with complex medication profiles

Conclusion

• Systematic review of Home and Hospital Medications prevents errors;

• Good overall satisfaction with process and software used;

• Improved communication between patient and health care providers is worth the effort!

• Questions? josianne.gauthier@wgh.yk.ca

www.saferhealthcarenow.ca

Please input your questions

All questions will be addressed

at the end of the webinar

Ask questions or send feedback

via the “chat” box • Select “All participants”

• Type message

• Click “Send”

All Participants

www.saferhealthcarenow.ca 51

Please complete our poll

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Upcoming MedRec Webinars

52

Thank you for attending

Our next MedRec webinar will take

place in October 14th, 2014.

Topic: Ambulatory MedRec

Details to follow.

www.saferhealthcarenow.ca

Safer Healthcare Now! website

http://www.saferhealthcarenow.ca/EN/events/

NationalCalls/2014Webinars/Pages/default.aspx

ISMP Canada website

http://www.ismp-canada.org/medrec/#webinars

Safer Healthcare Now! MedRec Community of Practice

http://tools.patientsafetyinstitute.ca/Communities

/MedRec/default.aspx

For real time notification of content posting, “like” the

Medication Reconciliation Network on Facebook

www.facebook.com/MedicationReconciliation

All Safer Healthcare Now! webinars are posted within the

week to the following locations:

www.saferhealthcarenow.ca

www.ismp-canada.org

54

We encourage you to report

medication incidents

Practitioner Reporting https://www.ismp-canada.org/err_report.htm

Consumer Reporting www.safemedicationuse.ca/

www.saferhealthcarenow.ca

www.ismp-canada.org

Medication Safety Self-Assessment®

• Hospitals (acute care)(2006) – free for Ontario*

• Long-term care (2012) – free for Ontario*

• Complex Continuing Care and Rehabilitation (2008) – free for Ontario*

• Community and Ambulatory Pharmacy (2007) – free for Ontario*

• Operating Room Medication Safety Checklist (2009) – free for Ontario*

• Oncology (2012)

• Anticoagulant Safety (VTE) – free for Ontario*

• HYDROmorphone Safety Self-Assessment (2014) - $50

* Supported by the Ontario MOHLTC

For more information visit www.ismp-canada.org/MSSA or email mssa@ismp-canada.org