Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative

Brandon Regional Health Authority Home Care

Medication Reconciliation

Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative

Background

• Brandon Regional Health Authority – covers city of Brandon, MB and 3 surrounding rural municipalities – population of 49,750.

• 1 regional hospital – 315 beds- serving Brandon RHA and many outside regions

• 5 Long Term Care facilities (PCH) and 1 Primary Access Center

• Public Health, Home Care, and Mental Health programs/services

• Approximately 100 physicians and 14 pharmacies

Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative

Background

• Home Care working group developed in May 2007• Purpose - implementation of medication

reconciliation in the Home Care program.• Decision to focus on two trial areas:

– use of a BPMH form for all clients admitted to the service of medication assistance (new or existing clients)

– use of Universal Medication Form for clients• Initial trial done with a small controlled group of clients

being transferred into Respite Care (temporary bed in Long Term Care facility) where the LTC staff can give us feedback on the accuracy of the form at admission

Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative

AimPurpose: • To prevent adverse medication occurrences, through the

process of medication reconciliation, for Home Care clients receiving medication assistance

• To promote the use of a Universal Medication Form as a tool for all clients to maintain their own current medication list

Aim Statements: • At admission, to reduce medication discrepancies (types

TBD) for the target group by 75% by April 2008• Conduct a BPMH and reconcile discrepancies on 100% of

clients receiving medication assistance by April 2008

Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative

Team Members

• Mary Lou Lester – Pharmacist and Team Leader• Jayne Troop – Program Manager Home Care• Dianne Strock/Donna McIntyre Hunt – Nursing

Resource Managers• Kylie Robinson – Case Coordinator• Leslie Hayward – Intake Coordinator• Kristi Chorney – Quality/Risk Management• Liliana Rodriguez – Planning/Evaluation

Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative

Changes Tested

#1: Compare medication list obtained at admission to Home Care for next 5 patients to DPIN and/or inpatient profile (if recently discharged)

#3 Trial use of Universal Medication Form with 5 regular users of PCH Respite. Evaluate potential benefit of this form as a tool for all clients to maintain their own current medication list

#4 Contact Community Pharmacies to inform them of our work and why they may receive calls from home care staff to clarify client’s medication lists

P

PP

PP

S

D

A

DD

DD

SS

SS

AA

AA

#2: Trial using Home Care BPMH and Reconciliation form when collecting new client medication list or updating existing client medication list

Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative

Forms Sample

Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative

Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative

Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative

Results – BPMH form

• Total BPMH completed: 9• Average medications per patient: 11• Mean number of discrepancies per patient:

2.3• Most common discrepancy: Medication

omitted from home care list• Main source used for reconciliation:

Community Pharmacy

Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative

ResultsTime to Complete BPMH (minutes)

57

0102030405060708090

100

Jun Jul Aug Se Oct Nov De Jan Feb Mar Apr May

Month

Minu

tes

Average TimeGoal

Minimum: 10 minutes

Maximum: 120 minutes

Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative

Results

Time to Resolution of Discrepancies (Days)

5

0

2

4

6

8

Jun Jul Aug Sep Oct Nov Dec Jan Feb Ma Apr Ma

Month

Average days to resolve discrepanciesGoal

Minimum: Same Day

Maximum: 22 days

Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative

Results

Percentage of Clients in Target Population with a Reconciled Medication List Within 1 Week

67%

0%

20%

40%

60%

80%

100%

J un J ul Aug Sep Oct Nov Dec J an Feb Mar Apr Ma

Month

% of clients in target population with a reconciled medication list within 1 weekGoal

Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative

Results

Percentage of Discrepancies Resolved within 1 week

43%

0%10%20%30%40%50%60%70%80%90%

100%

Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May

Month

Perc

enta

ge

% of Discrepancies Resolved within 1 WeekGoal

Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative

Results Respite Trial• Total Reconciliations completed: 12• Percent of clients with UMF at admission present

and current: 67% (33% of forms were faxed by home care to PCH)

• Main source used for reconciliation: Physician, followed by Pharmacy and Family

• Average medications per patient: 5• Mean number of discrepancies per patient: 0.9• Percent of patients with 1 or more discrepancies:

33%• Most common discrepancy: Incorrect frequency

Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative

Keys To Success

• Good communication with all stakeholders prior to and during implementation of medication reconciliation project is critical – suggest sending letter to local pharmacies and physicians prior to

implementation explaining the project• Gather baseline data and report to your team on the

current situation prior to implementation to help motivate• Develop easy to follow procedures for the use of new

forms • Ongoing feedback from staff regarding what is working

and what is not– be prepared to make revisions as needed (benefit of your

planning cycles)

Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative

Lessons Learned• Our provincial DPIN database is not the best source to reconcile

medications; in our region a better source for Home Care is pharmacy and then physician

• The entire process of medication reconciliation takes time, but is worthwhile, as discrepancies are present even in blister pack medications.

• Our greatest source of discrepancies is often on hospital discharge

• The universal medication form may not work for all clients (needs a motivated client or caregiver), but is a worthwhile form to share with all new referrals to program.

• Selecting indicators that are easily measured will be a challenge

Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative

Next Steps

• Determine and finalize our indicators for success

• Make any final revisions in our forms and procedures based on feedback from users

• Begin planning how we will keep the BPMH current

• Promote use of Universal Medication Form for all clients– Include our seniors groups in getting this form

and message out to the public.

Coming Full Circle: AMI and Med Rec Across the Continuum. Western Node Collaborative

Contact Information

• Mary Lou Lester – pharmacist– lesterm@brandonrha.mb.ca– Phone: 204-578-4249

• Jayne Troop – Home Care Program Manager– troopj@brandonrha.mb.ca– Phone: 204-571-8420