Medication Reconciliation in Home Care:Medication Reconciliation in Home Care:Measures for PilotMeasures for Pilot

Olavo Fernandes PharmD, Olavo Fernandes PharmD, ISMP CanadaISMP Canada

SHN ! Medication Reconciliation Home Care Pilot Nov 12, 2008SHN ! Medication Reconciliation Home Care Pilot Nov 12, 2008

Creating the most “up to date” medication Creating the most “up to date” medication record (best possible medication history)record (best possible medication history)

Patient and Family Interview

Medication Information from all

other sources

document

“up to date” medication

record (BPMH)

“medication discrepancies that

require clarification”

Compare:Compare:

Review and follow

up where indicated

Examples:

•Medication vial inspection

•Referral record

•Community pharmacy

•Hospital Discharge Summary

Process For Identifying “Medication Process For Identifying “Medication Discrepancies That Require Clarification” In Discrepancies That Require Clarification” In

Home CareHome Care

Creating the most “up to date” medication record (best Creating the most “up to date” medication record (best possible medication history)possible medication history)

Compare : Compare : • Patient / Family InterviewPatient / Family Interview ( a systematic and ( a systematic and

comprehensive, medication history interview- comprehensive, medication history interview- representation/ snapshot in time of what representation/ snapshot in time of what medication the client is actually taking) medication the client is actually taking)

Vs.Vs.• all other available sources of medication all other available sources of medication

informationinformation (home care referral records, (home care referral records, inspection of medication vials/ samples, community inspection of medication vials/ samples, community pharmacy information, hospital medication pharmacy information, hospital medication discharge summaries, unfilled prescriptions etc)discharge summaries, unfilled prescriptions etc)

• IDENTIFY: IDENTIFY: Medication Discrepancies That Genuinely Medication Discrepancies That Genuinely Require Clarification” Require Clarification”

Process For Identifying “Medication Process For Identifying “Medication Discrepancies That Require Clarification” In Discrepancies That Require Clarification” In

Home CareHome Care

•• Note process must include Note process must include patient/ patient/ family medication historyfamily medication history interview interview

•• Reconciliation process allows for Reconciliation process allows for clinician professional judgmentclinician professional judgment to to discern which “discrepancies discern which “discrepancies genuinely require clarification “genuinely require clarification “

•• Herbals/ Non-prescription Herbals/ Non-prescription (over-the counter drugs)- will not classify (over-the counter drugs)- will not classify

as a discrepancy requiring clarification – as a discrepancy requiring clarification – unless prescribed by physician (or other unless prescribed by physician (or other prescriberprescriber))

SHN! Home SHN! Home Care Pilot MeasuresCare Pilot Measures

1.1. Percentage of Eligible Clients with a Best Percentage of Eligible Clients with a Best Possible Medication HistoryPossible Medication History (BPMH) (BPMH) conducted by a Home Care clinicianconducted by a Home Care clinician

2.2. Time to complete Best Possible Time to complete Best Possible Medication HistoryMedication History (BPMH) in Home Care (BPMH) in Home Care

3.3. Percentage of Eligible clients with at Percentage of Eligible clients with at least one discrepancy that requires least one discrepancy that requires clarificationclarification

4.4. Classification Classification or characterization of actual or characterization of actual discrepancies that require clarificationdiscrepancies that require clarification

• Also serves as a communication and documentation tool to Also serves as a communication and documentation tool to other cliniciansother clinicians

1. Percentage of Eligible Clients with a 1. Percentage of Eligible Clients with a Best Possible Medication HistoryBest Possible Medication History (BPMH) conducted by a Home Care (BPMH) conducted by a Home Care clinicianclinician

• The percentage of “eligible” clients The percentage of “eligible” clients receiving a formal BPMHreceiving a formal BPMH

• ““Eligible”Eligible”= discharged from acute care + Kelly’s = discharged from acute care + Kelly’s

patientspatientsrisk assessment tool positive risk assessment tool positive

• This is a measure of the percentage This is a measure of the percentage of clients eligible for medication of clients eligible for medication reconciliation in this month's sample reconciliation in this month's sample who who actually had a BPMH completed actually had a BPMH completed within one week following transfer within one week following transfer to home careto home care. .

1. Percentage of Eligible Clients with a 1. Percentage of Eligible Clients with a Best Possible Medication HistoryBest Possible Medication History (BPMH) conducted by a Home Care (BPMH) conducted by a Home Care clinicianclinician

• Numerator:Numerator: Total number of clients Total number of clients with a completed BPMH.with a completed BPMH.

• Denominator :Denominator : Total number of Total number of clients in this month's sample clients in this month's sample eligible for medication eligible for medication reconciliation.reconciliation.

• Goal/ Target: Goal/ Target: – 80% Practical Team Target (95% Ideal 80% Practical Team Target (95% Ideal

Goal) Goal)

2. 2. Time to complete Best Possible Time to complete Best Possible Medication History (BPMH)Medication History (BPMH) in Home in Home CareCare

• The elapsed time in minutesThe elapsed time in minutes from from the initial review of medications the initial review of medications from client referral (including from client referral (including preparation time), interview with preparation time), interview with the client and/or the family to the the client and/or the family to the time when all sources of information time when all sources of information have been gathered and the Best have been gathered and the Best Possible Medication History (BPMH) Possible Medication History (BPMH) has been completed, recorded and has been completed, recorded and ready to be sent to the Most ready to be sent to the Most Responsible Physician (MRP) or Responsible Physician (MRP) or Nurse Practitioner (NP). Nurse Practitioner (NP).

2. 2. Time to complete Best Possible Time to complete Best Possible Medication History (BPMH)Medication History (BPMH) in Home in Home CareCare

– This is a measure of the mean or average This is a measure of the mean or average time for this process to be completed for time for this process to be completed for the clients in each month's sample.the clients in each month's sample.

– Note: this Note: this does notdoes not include include time for actual time for actual reconciliation and clarifying discrepancies reconciliation and clarifying discrepancies

– doesdoes include include time to document the BPMH time to document the BPMH and investigate and identify all “readily and investigate and identify all “readily available” sources of information (readily available” sources of information (readily available includes patient sources, vials in available includes patient sources, vials in home home prior to making external contactsprior to making external contacts such as community pharmacy, discharging such as community pharmacy, discharging hospital or primary care physician)hospital or primary care physician)

2. 2. Time to complete Best Possible Time to complete Best Possible Medication History (BPMH)Medication History (BPMH) in Home in Home CareCare• Enter Time:Enter Time:

– Total amount of time (sum) in minutes Total amount of time (sum) in minutes to complete the BPMH for all clients in to complete the BPMH for all clients in this month's sample this month's sample

• Enter Patients in Sample:Enter Patients in Sample:– Total number of clients in this month's Total number of clients in this month's

sample with a completed Best Possible sample with a completed Best Possible Medication History Medication History

• Final result is a Final result is a mean time per mean time per patientpatient

• Goal/ Target: Goal/ Target: – Variable according to patient Variable according to patient

3. Percentage of 3. Percentage of Eligible clients with at Eligible clients with at least one discrepancyleast one discrepancy that requires that requires

clarificationclarification • The percentage of the The percentage of the

“eligible” clients with at least “eligible” clients with at least one medication discrepancy one medication discrepancy which required clarification which required clarification with a healthcare practitioner. with a healthcare practitioner.

3. Percentage of 3. Percentage of Eligible clients with at Eligible clients with at least one discrepancyleast one discrepancy that requires that requires

clarificationclarification • Numerator:Numerator:

– Total number of the clients with at Total number of the clients with at least ONE medication discrepancy that least ONE medication discrepancy that requires clarification with a clinician.requires clarification with a clinician.

• Denominator :Denominator : – Total number of clients with a Total number of clients with a

completed Best Possible Medication completed Best Possible Medication History (BPMH).History (BPMH).

• Goal/ Target: Goal/ Target: – Variable (more linked to medication Variable (more linked to medication

information transfer process of your information transfer process of your referring service)referring service)

Classification Classification or characterization or characterization coding:coding:“actual discrepancies that require “actual discrepancies that require clarification”clarification”

• The classification of each The classification of each medication as a discrepancy and medication as a discrepancy and the assignment of the the assignment of the discrepancies to a classification discrepancies to a classification category or codecategory or code

• Allows teams to learn Allows teams to learn most most common patterns of common patterns of discrepancies or potential causesdiscrepancies or potential causes in your local practice in your local practice

Classification Classification or characterization or characterization coding:coding:“actual discrepancies that require “actual discrepancies that require clarification”clarification”

• When selecting categorization code When selecting categorization code each medication order will have only each medication order will have only one discrepancy categorizationone discrepancy categorization. . Clinicians can select whichever one Clinicians can select whichever one they think is the most important. they think is the most important.

• It is often helpful to defer to the It is often helpful to defer to the alphabetical classification orderalphabetical classification order– for example is for a medication order for example is for a medication order

there may be an incorrect medication, an there may be an incorrect medication, an incorrect dose and an incorrect route…incorrect dose and an incorrect route…the clinician can select code : the clinician can select code : A drugA drug

DATA ENTRY & DATA ENTRY & SUBMISSIONSUBMISSION

Please open the Power Point Please open the Power Point Titled “ Measurement for Med Titled “ Measurement for Med

Rec Home Care 081112Rec Home Care 081112

Medication Reconciliation in Medication Reconciliation in Home CareHome Care

Pilot ProjectPilot ProjectCommunities of PracticeCommunities of Practice

Ann MacLaurinAnn MacLaurin

July 20, 2008

Overview on the use of the Overview on the use of the Communities of PracticeCommunities of Practice

INTRODUCTION

A Community of Practice (CoP) is an intuitive web-based online application that enables group collaboration and knowledge management. *

* CoP Info Guide 27 Jan 2006

Overview on the use of the Overview on the use of the Communities of PracticeCommunities of Practice

A CoP provides teams with the means to instantly establish online areas for:

1. group collaboration - temporary or ongoing

2. facilitate group interaction

3. share text content, images and files

4. enable real-time communication via chat and instant messaging

CoP Info Guide 27 Jan 2006

To access the Community of To access the Community of Practice (CoP)Practice (CoP)

• Go to the SHN home pageGo to the SHN home page

• http://www.saferhealthcarenohttp://www.saferhealthcarenow.ca/Default.aspxw.ca/Default.aspx

• On the left hand menu there On the left hand menu there is a link to the Community of is a link to the Community of Practice.Practice.

CoP: Information Guide CoP: Information Guide On the bottom of this page you will find a link to the CoP information guide

http://www.saferhealthcarenow.ca/Default.aspx?folderId=124

CoP: Information Guide CoP: Information Guide

To Join the Medication To Join the Medication Reconciliation CoPReconciliation CoP

http://www.saferhealthcarenow.ca/Defaulhttp://www.saferhealthcarenow.ca/Default.aspx?folderId=124t.aspx?folderId=124

COMMUNITIES

OF

PRACTICE

It is free and easy to join. It is free and easy to join.

To become a member fill in all To become a member fill in all the required information and hit the required information and hit

the Join buttonthe Join button

LoginLogin

LoginLogin

There are files for Acute Care and Long Term Care

Upon entering the CoP, you see the “What’s New” page. This page provides a summary of all new and recently added content and access to on-going opinion polls and the most recent note board posting.

Home Care FolderHome Care Folder

Medication Reconciliation In Medication Reconciliation In Home Care Pilot Project Home Care Pilot Project

Getting Started Tool Kit!Getting Started Tool Kit!Debbie Conrad RNDebbie Conrad RN

November 2008November 2008

CONTENTSCONTENTS• Highlights: Team commitment to the ProjectHighlights: Team commitment to the Project• High lights: Criteria for Population SelectionHigh lights: Criteria for Population Selection• Important datesImportant dates• SHN Frame work for Medication SHN Frame work for Medication

Reconciliation in Home CareReconciliation in Home Care• MeasurementsMeasurements• ToolsTools• Quick Reference GuidesQuick Reference Guides• Past Power Point PresentationsPast Power Point Presentations

TOOLSTOOLS• Team CharterTeam Charter• Medication Risk Assessment (MedRAT)Medication Risk Assessment (MedRAT)• Best Possible Medication History Best Possible Medication History

(BPMH)(BPMH)• Interview Guide/TipsInterview Guide/Tips• Data Collection ToolsData Collection Tools• Data SubmissionData Submission• PDSA ToolPDSA Tool

TOOLSTOOLS

• Narrative for each toolNarrative for each tool

• Basic tool for team development Basic tool for team development ( Narratives & samples included in ( Narratives & samples included in some)some)

• Sample Tools from Western Sample Tools from Western CollaborativeCollaborative

• Tool TemplatesTool Templates

QUICK REFERENCESQUICK REFERENCES

Quick Reference Guide for Data Quick Reference Guide for Data CollectionCollection

Quick Reference Guide for Getting Quick Reference Guide for Getting StartedStarted

Power point PresentationsPower point Presentations

• SHN Pilot-Getting Started in Home SHN Pilot-Getting Started in Home Care Sept 11’08Care Sept 11’08

• Medication Reconciliation in Home Medication Reconciliation in Home Care Oct’14 MeetingCare Oct’14 Meeting

• Presentation for Team Meeting Nov Presentation for Team Meeting Nov 12A12A

• Measurement for Med Rec Home Measurement for Med Rec Home Care -081112 Nov 12 BCare -081112 Nov 12 B

POINTS TO REMEMBERPOINTS TO REMEMBER

• Lessons Learned from Western Lessons Learned from Western CollaborativeCollaborative

• Testing Measures, Tools, Testing Measures, Tools, ProcessesProcesses

• Small tests of changeSmall tests of change• You are the experts!You are the experts!• Keep it Simple!Keep it Simple!