CAPHC-SHN Paediatric Medication Reconciliation Collaborative

CAPHC-SHN Paediatric MedicationReconciliation Collaborative

Listen, Reflect and Move ForwardEarly Implementation Data Update and Key Learnings

Elaine OrrbinePresident & CEO

Canadian Association of Paediatric Health Centres

JoAnne WhittinghamCAPHC National Patient Safety Coordinator

Sixth Interactive Teleconference

Listen, Reflect and Move Forward

September 6th, 2006

Myth: Children are “Little Adults”

Child and youth health issues must be recognized and integrated within the overall health reform agenda

Key Challenges in Child and Youth Health Care



September 6th, 2006

The CAPHC-SHN Paediatric Medication Reconciliation Collaborative (PMRC)

16 health centres from coast-to-coast representing six provinces have established 18 paediatric medication reconciliation teams

Patient populations vary across the teams from children admitted to paediatric wards in community hospitals to more complex populations including nephrology, mental health and respiratory medicine within acute care settings

Collectively the teams have made significant progress in changing the way we do business

As we move forward, more teams are coming on board and will benefit from the wisdom of the experienced teams



September 6th, 2006

PMRC: Data Submissions

As of the end of June 2007: Baseline data from 18 teams

40 monthly submissions of baseline data Data collected on a median of 20 patients (range 10 to 94

patients per team ) and a total of 485 patients were reviewed Early implementation data from 16 teams

111 monthly submissions of early implementation data Data collected on a median of 50 patients (range 10 to 243

patients per team) and a total of 1360 patients were reviewed Full implementation data from 3 teams

14 monthly submissions of full implementation data Data collected on a median of 49 patients (range 5 to 92 patients

per team) and a total of 146 patients have been reviewed to date



September 6th, 2006

Baseline and early implementation data;Distribution of Type 3 Discrepancies

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n N

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Team/Patient Population

Baseline 0.67 1.17 0.5 0.6 0.43 0.57 0.2 0.6 0.24 0.25 1.25 0.27 0.14 0.43 1.2 0.07 0.41 0.63

Early Implementation 0.15 0.5 0.41 0.25 0.26 0.26 0.26 * 0.08 0.08 0.88 0.16 0.27 0.81 1 * 0.18 0.09

A B C D E F G H I J K L M N O P Q R



September 6th, 2006

Baseline and Early Implementation Data;Type 3 Discrepancies (System-wide)

Across the paediatric teams, a total of 485 patients were reviewed during the baseline stage and 261 Type 3 discrepancies were identified

The mean number of baseline Type 3 discrepancies identified ranged from 0.07 to 1.25

During the early implementation stage, a total of 1360 patients were reviewed and 389 Type 3 discrepancies were identified

The mean number of Type 3 discrepancies identified ranged from 0.08 to 1.00

Overall, for teams that have submitted early implementation data the mean number of Type 3 discrepancies per patient has decreased from a baseline value of 0.55 to an early implementation value of

0.29!



September 6th, 2006

Baseline and Early Implementation Data;Distribution of Type 2 Discrepancies by Team

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ean

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Team/Patient Population

Baseline 0.33 0 0 1.3 0.18 0.29 0.3 0.93 1.030.25 1 0.270.050.13 1.6 0.2 0.59 1.05

Early Implementation 0.040.13 0.231.060.35 0.1 0.26 * 0.160.360.52 0.36 0 0.5 0.1 * 0.24 0.17

A B C D E F G H I J K L M N O P Q R



September 6th, 2006

Baseline and Early Implementation Data;Type 2 Discrepancies (System-wide)

Across the paediatric teams, a total of 485 patients were reviewed during the baseline phase and 236 Type 2 discrepancies were identified

The mean number of Type 2 discrepancies identified ranged from 0 to 1.6 per patient

During the early implementation stage, a total of 1360 patients have been reviewed, to date, and 400 Type 2 discrepancies have been identified

The mean number of Type 2 discrepancies identified ranged from 0 to one per patient

Overall, for teams that have submitted early implementation data, the mean number of Type 2 discrepancies per patient has decreased

from a baseline value of 0.45 to an early implementation value of 0.29



September 6th, 2006

Key Learnings

From a system-wide lens there has been an overall decrease in discrepancies

13/18 teams have made more than a 50% reduction in Type 3 discrepancies

10/16 teams have made more that a 50% reduction in Type 2 discrepancies

HOWEVER, we need to look at both sides of the coin While some teams are close to their goal (a 75%

reduction in the baseline rate) not all teams consider these changes to be sustainable



September 6th, 2006

Team Example 1

2.0 Mean Number of Unintentional Discrepancies

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Mea

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Actual Goal

One month of baselineOverall rate 0.63 (12/19)

5 months of early implementationOverall rate 0.09 (9/100)



September 6th, 2006

Team Example 2


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Actual Goal

Four months of baselineOverall rate 0.43 (12/28)




September 6th, 2006

Team Example 3


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0.35

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Actual Goal

One month of baselineOverall rate 0.25 (3/12)




September 6th, 2006

Team Example 4


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Actual Goal

Four months of baselineOverall rate 1.25 (50/40)




September 6th, 2006

Team Example 5


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Actual Goal

Five months of baselineOverall rate 0.43 (40/94)




September 6th, 2006

Key Lessons Learned

The implementation of MedRec has been complex and resource intensive while teams have dealt with multiple competing priorities;

While the data shows significant progress in reducing discrepancies on a system level, there is still variability from month to month, as well as between teams in the discrepancy rates;

The majority of teams are not yet at the point where they feel they have reached “sustainability”

The concerns expressed by the paediatric teams are being echoed across the country

The next 12 months are dedicated to supporting all of our teams to reaching their goal rate, sustaining and spreading MedRec



September 6th, 2006

Key Lessons Learned: Challenges

Engagement of medical and corporate leadership Resistance to practice change Limited resources to continue to educate staff and

conduct audits Competing priorities with other initiatives Team fatigue and maintaining motivation

The main themes in barriers to sustainability include;



September 6th, 2006

Key Lessons Learned: Enablers

Where teams feel they are sustaining improvements, there is clear management support, staff with dedicated time to manage the project and engagement of front-line colleagues

Internal support from senior leadership, particularly those who have operational responsibility for patient safety, is key to implementation teams achieving sustainability;

Within the implementation and care teams, communication and education are key strategies to ensure staff buy-in and continued success of the initiative



September 6th, 2006

As we continue our journey

We would like to acknowledge and thank the following paediatric teams for their commitment and continued dedication!

Children's & Women's Health Centre of BC

Alberta Children's Hospital

Stollery Children's Hospital

Saskatoon Health Region

Winnipeg Children's Hospital

Children's Hospital of Eastern Ontario

Children's Hospital of Western Ontario

Credit Valley Hospital

Grand River Hospital

Hospital for Sick Children

Kingston General Hospital

McMaster Children's Hospital

North York General Hospital

Quinte Healthcare Corporation

IWK Health Centre

Janeway Child Health Centre

Documents

CAPHC-SHN Paediatric Medication Reconciliation Collaborative