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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