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FEBRUARY 2015 IS MEDREC QUALITY AUDIT MONTH:
WHAT YOU NEED TO KNOW TO PARTICIPATE
January 6th, 2015
Overview
What is MedRec Quality Audit (MRQA) month?
Why should I participate?
Who may participate?
How do you participate?
– How is the MedRec Quality Audit tool used?
Where can I find resources for MRQA month?
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Today’s Speakers
Jennifer Turple, Medication Safety Specialist, Institute for Safe Medication Practices Canada (ISMP Canada)
Virginia Flintoft, Manager, Safer Healthcare Now! – Central Measurement Team
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What is MedRec Quality Audit Month ?
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What is MRQA Month?
The Canadian Medication Reconciliation Quality Audit (MRQA) is designed to establish
a national perspective of the quality of the MedRec process on admission to acute, and
long term care.
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Selected Audit Tool Questions
Was MedRec performed?
Was the BPMH collected using more than 1 medication information source?
Was there a patient or caregiver interview to verify actual medication use?
Has every medication, as listed in the BPMH, been accounted for in the admission documentation? (i.e. are there any outstanding differences/discrepancies despite the MedRec process?)
Where differences between the admission documentation and the BPMH exist, were these differences resolved?
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What is MRQA month?
Data submitted to the Patient Safety Metrics System throughout the month of February will be aggregated.
Data will be analyzed allowing us to present national metrics on the quality of admission MedRec processes.
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Why should I Participate?
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Why participate?
Auditing the quality of admission MedRec processes will help to identify areas of excellence and areas for improvements.
Measurement is critical in the journey to improve the delivery of safe and effective care for patients.
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Presence of an Admission MedRec /BPMH
form on chart
“Percent Reconciled”
Are the processes “behind the form” of good quality?
“Percent of Patients who have each of the quality dimensions of MedRec
completed”
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MRQA Month 2013
103 sites across the country participated.
– 2340 patient/resident charts were audited.
85% of audits indicated that “MedRec was performed”
Only 29% of audits showed that all of quality components of admission MedRec were performed
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At the monthly management meeting of a large urban hospital, the head of patient safety announces: “We had a critical incident last week. A patient was
readmitted two days after discharge with severe hypoglycemia. The treating team discharged the patient on a new insulin regimen without realizing that the patient also had insulin 30/70 at home. The patient continued to take both her previous
regimen as well as the new one, and was found unresponsive by her husband. She’s in ICU and will probably have permanent neurological deficits.” After various
sighs and exclamations from the executives around the table, the chief medical officer asks incredulously, “Why didn’t this get picked up by medication
reconciliation?” Before anyone can answer, the executive adds: “We had that other case six months ago in which a patient was discharged without restarting his
Coumadin, and he ended up having a stroke. We implemented medication reconciliation a year ago. Why is this still happening?”
Reference: Fernandes et al., Healthcare Quarterly, 2012
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Why participate?
“As monitoring indicates implementation is successful, a plan can be developed to implement medication reconciliation throughout the organization, continuing to monitor and make improvements as required. As medication reconciliation is successfully implemented, organizations need to consider the sustainability of the process, continuing to monitor and make improvements as required.”
“It is important to monitor, in consultation with the coordination team and front-line staff, the extent to which the medication reconciliation policy and process are being followed. Monitoring should assess compliance with the overall medication reconciliation process (e.g., the quality of the collection of the BPMH, whether the BPMH is documented, and whether medication discrepancies are identified and resolved).”
Reference: Accreditation Canada ROP Handbook, Page 14 (MedRec As A Strategic Priority- Guidelines)
http://www.accreditation.ca/sites/default/files/rop-handbook-2014-en.pdf
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HOW OFTEN ARE WE DOING
EVERYTHING AS INTENDED?
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Endorsements
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Who may participate?
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Who may participate?
All organizations in any sector are encouraged throughout the month (and all year!) to use measurement to support MedRec quality improvement efforts.
Safer Healthcare Now! has made available a MedRec Quality Audit tool for acute and long term care sites to support collection of measures related to ADMISSION MedRec processes.
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Who may participate?
MedRec Quality Audit (MRQA) tool has been designed specifically to evaluate quality of admission processes to:
– Acute Care sites (admits to inpatient units)
– Long-term care sites
The MRQA tool to be used to audit the chart of a patient/resident at a point in time after an admission MedRec process has occurred. Therefore, you should have an established admission MedRec process in place in order to participate.
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How Do I Participate?
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Visit the Canadian
MedRec Quality
Audit webpage to
get started
www.saferhealthcare
now.ca/EN/events/ot
her/MedRecAudit
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STEP Register to participate in MRQA month
There is no cost to register! By registering you are committing to auditing your admission
MedRec process and submitting your data during the month of February.
Regardless of whether you are currently using the MedRec Quality Audit (MRQA) tool or you have never used the MRQA tool, we would like all organizations to register.
Registration allows the Central Measurement Team to contact you with information on how to access your site/unit-specific MRQA tool(s).
All MRQA audit data received in February will be included in the analysis (even if you have not registered).
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Registration
https://secure.e-registernow.com/cgi-
bin/mkpayment.cgi?MID=1527&state=step2direct&ev
ent=500000341952479
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STEP Determine the audit areas
Consider which care areas you would like to audit and how you might wish to group/analyze the
audit results. For example, would you like to collect and analyze audit data from multiple units?, across multiple
sites?, across a region?
Drill down Roll up
STEP Access your audit tool
You can:
Use a previously generated MRQA tool(s) in portrait format
OR
Have the Central Measurement Team assist to generate your MRQA tool(s)
OR
Generate the MRQA tool(s) yourself, using the Patient Safety Metrics System
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Generating the MRQA tool(s)
Details are available in the Frequency Asked Questions (FAQs) at:
http://www.saferhealthcarenow.ca/EN/events/ot
her/MedRecAudit/Pages/FAQ.aspx
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STEP Choose a sampling approach
Given that organizations differ in size, patient volumes, and availability of resources to conduct audits, we do not have
specific requirements for the number of charts to audit. Both the number of charts (sample size) and the method used to select
charts for audit is at the discretion of the end users.
We recommend a convenience sample of a minimum of 10 patient charts per area selected for audit.
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STEP Complete the audit
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Detailed instructions are available at:
http://www.saferhealthcarenow.ca/EN/events/other/MedRecAudit/Documents/EN-
MedRec%20Audit%20Month%20Instruction%20Booklet%202015.pdf
Use of the MRQA tool
Ideally an auditor(s) should:
– be someone familiar with the admission MedRec process(es), forms used and overall chart layout
– not audit their own work
– have some training or guidance provided (to ensure consistency in application of org-specific criteria)
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Identify the admission “route”
The criteria for a “yes” response to this question is up to the end users to determine. The aggregated data from this
column may be used as a measure of “Percent (%)
Reconciled at Admission”.
Use of the MRQA tool
When interpreting this result, consider the sampling strategy used. Comparing the results of
this measure against other units/orgs, should be done
cautiously.
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Use of the MRQA tool
Components of this section are based on key principles of collecting and documenting a BPMH including:
– Medication information source utilization (C)
– Patient involvement/interview to confirm actual medication use (D)
– Completeness of the medication information for each medication (E)
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Use of the MRQA tool
Auditors assess whether all of the medications, as listed in the BPMH, have been accounted for in the admission documentation.
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Use of the MRQA tool
Auditors assess whether prescriber has included a rationale for discontinuing or holding any medication listed in the BPMH (as applicable).
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Use of the MRQA tool
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Auditors assess whether the discrepancy has been communicated and resolved with the provider and documented in the patient’s chart
STEP Submit your results
Submit your results (via fax) to the patient safety metrics system
Using a high resolution setting, fax your audit tool to the number found on bottom of the audit tool
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Features: Free, cloud-based data collection and reporting tool Available in English and French User friendly and simple to navigate Accessible from website with login details Tracks >100 process and outcome measures over 14
interventions Provides real time reporting and export of data to CSV/Excel Reduces burden of data collection, entry and analysis Roll Up or Drill Down Reports (i.e. Unit Organization Health
Region Province National) with automated Run Charts Capacity to customize measures and reports
Patient Safety Metrics - Introduction
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Computer generated
barcode identifies
your audit area/unit
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Need this entered on every page So we may contact you if there is an error
Date is required on every form
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Fill in bubble completely (Sharpie is best)
Do not stack forms when filling in bubbles – avoid bleed through
Do not colour outside the line
Do not fold or use 3-hole punch
Fax form in FINE RESOLUTION (setting on fax machine)
Do NOT use a cover sheet
No extra markings on form
To void fill in the VOID bubble
Do not spill anything on the form
MRQA tool- Dos and Don’ts
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Where can I find more resources for MRQA Month?
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Resources
Patient Safety Metrics System: https://shn.med.utoronto.ca/metrics/Login.aspx
June 18th Audit Tool Call Slides/Recording: www.saferhealthcarenow.ca/EN/events/NationalCalls/2013/Documents/2013-06-18%20-%20MedRec/SHN%20-%20National%20Call%20-%20MedRec%20-%202013-06-18.asx
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Questions?
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Key Contacts:
ISMP Canada MedRec Team
www.ismp-canada.org/medrec
CPSI Central Measurement Team
Virginia Flintoft - 416-946-8350
Alexandru Titeu - 416-946-3103
We are here to help!
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February 2015 details coming soon
March 31, 2015 – 12 noon ET Audit Month Results
Please Note:
• Processes for logging on to national calls may be changing in the future (e.g. use of passwords to gain access to webinar/ in-advance registration)
• Further information regarding these changes and when they will come into effect will be communicated via email and website posts.
Upcoming webinars
Looking forward to your organization’s
participation in
Canadian MedRec Quality Audit Month!
Thank you for attending!
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