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Thunder Bay Regional Health Sciences Centre (TBRHSC)

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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 • Educate critical care staff on the medication reconciliation process (in three to four months) • Ensure a best possible medication history (BPMH) is obtained and documented for all critical care patients (in 12-months) • To reconcile and document all medication discrepancies on admission and transfer from critical care (in 12-months)

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

  5. Results PDSA #1

  6. Results PDSA #1 (continued)

  7. Results PDSA #2

  8. Changes Tested • PDSA #1 • Implementation of nurse driven BPMH, a change from the pharmacist lead model • Nursing staff completed an e-learning module to learn how to obtain a BPMH and clinical tools were developed to assist nursing staff to obtain the BPMH

  9. Changes Tested • PDSA #2 • Tested the current weekend process of RNs completing the BPMH while pharmacist is off • Nurses are expected to complete BPMH on weekends when pharmacist is off to ensure a 24/7 process that is not fully reliant on one pharmacist • Want to ensure that current process is “process driven” and not individual dependant

  10. Lessons Learned • PDSA #1 • Need to focus and follow-up individually with nursing staff to asses why BPMH were not completed (identify barriers in completing) • PDSA #2 • Following up individually provided more details: • Why the BPMH was not obtained • Exposed ongoing barriers and questioned the expected BPMH time to completion • Need to consider having BPMH completion time extended to 48-hours

  11. Next Steps • Evaluate quality of BPMH • Currently we are focusing on quantity, getting nursing staff in the habit of completing/obtaining a BPMH • Medication reconciliation at transfer • Develop process • Get buy-in from intensivist group

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