Vancouver Island Health Authority Home & Community Care Medication Reconciliation

1. Vancouver Island Health Authority Home & Community Care Medication Reconciliation Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

2. Background Site: Cowichan Valley Home & Community Care (HCC) Patient Population: HCC clients moving to Duncan Manor or returning from Cowichan District Hospital Rationale: High incidence of hospitalizations and emergency room encounters in this population Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

3. Background Significance • VIHA: highest % of people with chronic disease(s) in BC 1 • 89% of HCC clients were admitted with a dx of chronic disease • People with chronic diseases more likely to have multiple prescriptions and complex drug regimes 1 Center for Health Services and Policy Research Feb 2005 Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

4. Background What Are We Trying To Improve Purpose: To improve client care by reducing adverse drug events through medication reconciliation on admission/return to Home Care. Timelines: May 2007 – May 2008. • Begin with clients in Duncan Manor • Spread to West Team (Duncan) clients Resources: Current HCC resources with some additional funding to support attendance at Learning Sessions Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

5. Aim To increase the % of completed BPMH for HCC clients To decrease the time for HCC clinicians to complete a BPMH To increase the % of completed medication reconciliations for HCC clients To decrease the time taken to complete medication reconciliation for HCC clients Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

6. Team Members ØClinical Leaders: Darcie Wolfe (Nursing), Holly Sulsbury (Pharmacist), Beth Langford (Home Support), Merry-Jo Levers (CNS – Seniors Health) ØDay to Day Leader: Jo Dunderdale ØFrontline Clinician: Julie Ferguson (CM), Tracy Stone (Leader) ØPharmacist Partner: Jim Potts ØAdministrative Leader: Margaret Harris ØEvaluation: Margaret Kun ØQI Advisor: Rosanne Beuthin ØPilot Site Manager: Lois Cosgrave Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

7. Changes Tested • Development and trial of a BPMH form combined with a Notice of Medication Administration form • Development and trial of a combined BPMH and Medication Reconciliation form • Obtaining an accurate list of medications from Acute Care via Liaison Case Manager • Obtaining an accurate list of all Duncan Manor clients admitted to hospital or going to emergency • Obtaining Pharmacare printout as source of info for BPMH Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

8. Results Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

9. Results Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

10. Results Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

11. Results Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

12. Results Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

13. Keys to Success and Lessons Learned Keys to Success: • Senior Leadership support • A great team • committed to quality improvement • share responsibility for work • communicate effectively • Support from Safer Healthcare Now! Advisors Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

14. Keys to Success and Lessons Learned Barriers: • Staff coverage over summer vacations • Lack of availability of team members over summer • No physician on team • Lack of additional resources Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

15. Keys to Success and Lessons Learned Lessons Learned: • Be patient – we won’t get it right the first time – it will take several PDSAs • Need to involve all stakeholders – staff, Pharmacists, Physicians, acute care, and clients • Learning is progressive – build on what you learn Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

16. Next Steps • Obtain Pharmacare printout from acute care and utilize as one source contributing to BPMH • Engage Physicians – develop a letter/fax cover sheet explaining the Med Rec process and attend Family Practice rounds and review process • Personal Medication List to support self management Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative

17. Contact Information Jo Dunderdale – johanna.dunderdale@viha.ca Margaret Kun – margaret.kun@viha.ca Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative