Thunder Bay Regional Health Sciences Centre (TBRHSC)

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2. Background Is a 375 bed academic health science centre with a mission to advance world-class Patient and Family Centred Care in an academic, researched-based acute care environment. We provide service to Northwestern Ontario with a population of 250,000 residents scattered over a geographical area the size of France. Rationale – Improve patient safety by developing a consistent approach to obtain BPMH and reconcile medications upon admission and transfer

3. Aim • Improve patient safety and risk for adverse medication events • Educate and engage critical care staff on the medication reconciliation process • Ensure Best Possible Medication History (BPMH) is obtained and documented on all critical care patients upon admission (process vs individual driven) • To reconcile and document all medication discrepancies on admission and transfer from critical care

4. Team Members • Chad Johnson, Clinical Nurse Specialist – Critical Care • Wendy Winslow, Manager – Critical Care • Larry Bertoldo, Pharmacist • Lisa Beck, Director – Trauma Program, ED & ICU • Marios Roussos, Intensivist • Adam Vinet, Manager – Emergency Department • Cece Girard, Critical Care Staff Nurse • Katrina Niemi, Critical Care Staff Nurse

5. Results • Development of e-based Med Rec course on hospital learning system • Course content had input from staff and outlined key med rec components and expected process • Development of 24/7 BPMH process upon admission using Pharmacist-Nurse collaborative model • Nurses do BPMH on weekends and when pharmacist is off

6. Results • Development of tools and resources to facilitate BPMH completion and involvement of family • Paper form for family • Triggers and reminders for staff to complete • Development of process, forms and tools to facilitate med rec upon transfer • Pre-printed transfer orders with med rec section • Availability of medication lists (BPMH vs current meds) for patient rounds

7. Results • Re-education of staff after 8 months of implementation to reinforce med rec key concepts and utilize actual case based scenarios • Using actual cases helped staff see relevance to change and importance of med rec • Ongoing engagement and recruitment of frontline staff, including ward clerks to champion project • Important to have several staff involved to sustain processes after project completed

8. Changes Tested • Audited staff for completion and comprehension of e-based Med Rec course • Results reveal 100% completion, course easily understood • Audited opportunities for RN to do BPMH within 24 hrs of admission to ICU • Results revealed more opportunity required • Audits & interviews with staff to identify and address barriers • Approaches modified based on feedback

9. Changes Tested • Monthly audits done to assess completion rates for nurse generated BPMHs on weekends and when pharmacist is off • Results reveal 75-80% completion rates • Audit quality of nurse generated BPMHs compared to pharmacist generated • Areas for improvement identified and areas to refocus education • Audit compliance with med rec upon transfer process planned for November

10. Lessons Learned • Need to follow-up individually (vs e-mail) with nursing staff to assess barriers to BPMH completion • Review and re-evaluate process frequently • Changed BPMH completion timeframe extended to 48 hours • Need a collaborative team approach model for success • Need to further engage physicians in process • Takes time to integrate process changes into practice

11. Lessons Learned • Audit data helpful to demonstrate results of specific strategies • Impact when manager notifies staff that audit will follow • Provides visual representation of successes • Current computer charting system does not facilitate streamline efficient med rec process • Need to further work with IT/IS to develop solutions

12. Next Steps • Focus on refining a consistent medication reconciliation process for all ICU transfers • Get buy-in from Intensivist group • Audit practice • Integrate med rec throughout other areas of the hospital • Utilize lessons learned, tools and resources to organizational strategy