Medication reconciliation in long-term care: where do I begin?

1. Medication reconciliation in long-term care: where do I begin? November 15th, 2011 0900 to 1000 pst November 4, 2011

2. Clinical Care Management (CCM) • Ministry of Health chose nine quality improvement areas to support through the CCM initiative • BC Patient Safety & Quality Council providing a supportive role to the Health Authorities • Resources and information on website • http://www.bcpsqc.ca/quality/medrec.html • Med Rec in Long-term Care • Quality Lead – Mary Lou Lester • Clinical Lead – Dr. Keith White

3. December Virtual Learning Opportunity • Tuesday, December 13th from 0900 to 1000 PST • Medication Reconciliation in Long-term Care: How do we measure up? • Guest speakers: • PH/VCH med rec team • Jill Veenendall, BCPSQC Measurement Quality Lead

4. Safer Healthcare Now! andMedication Reconciliationin the Long-Term Care Setting Jennifer Turple Medication Safety Specialist- MedRec ISMP Canada

5. Tools and Resources How- to Guide Quick Reference Provides: Graphics, diagrams, posters and forms Tips Definitions Information on measurement, and QI methodologies

6. Tools and Resources • MedRec Community of Practice • A website where registered users can: • Share tools such as MedRec forms, educational materials, presentations, business cases, etc. • Post and/or respond to questions • Receive alerts on newly posted contents, upcoming webinars, and general announcements.

7. Community of Practice Uses Sharepoint software Free! Simple registration process Set up alerts to automatically send updates (of your choice) to your email

8. Community of Practice Demo

9. Education National Calls/Webinars via Webex December 6th MedRec Success Stories from across the Continuum (Acute Care, Home Care, Ambulatory and Long-Term Care) January 10th Medication Reconciliation in Long Term Care – A Fully Integrated Electronic Solution

10. Education • Virtual Action Series- MedRec to Go! • An online “course” that gives guidance to acute care facilities on creating a reliable MedRec on discharge process. • Consists of 5 x 1.5 hour virtual sessions over 5 months. • Next series will begin in February 2012.

11. MedRec to Go! • This series: • Encourages developing a multidisciplinary team of care providers including representation from LTC facilities. • Shares experiences of many acute care- LTC collaborations that have resulted in improved transfer of medication information.

12. MedRec to Go! Information Session November 24th and January 17th Registration Deadline January 17th

13. Looking for Practice Leaders in LTC! To acknowledge the broad diversity of healthcare systems in Canada, we now want to broaden this definition to include MedRec reliably implemented across all transitions of care for: An entire program or targeted patient group such as a region wide Home Care program or province wide renal program or > 50% of all applicable patients/clients served by your organization 

14. Cross Canada Checkin • Map link and Demo

15. Facilitating Med Rec in Residential Care and Assisted Living Anita Lo BSc (Pharm) Pharm D Fraser Health Med Rec Facilitator November, 2011

16. Learning Objectives • The role of a Med Rec Facilitator • Strategies used to facilitate Medication Reconciliation in residential care

17. Fraserhealth (FH) Med Rec Facilitator • FH hired 3 facilitators (2Rx and 1 RN) • FH is moving forward with Program Management and residential care is one of the programs that concerns 12 FH acute sites • As Med Rec Facilitators, we have a critical mission : • We must successfully meet the rising challenges (ensuring safety at each transition point of care ) and complexities of the Healthcare environment

18. Role of a Med Rec Facilitator Learn more about the current and future state Build processes Develop tools Implement practice change Remove or alleviate barriers to sustain practice change

19. Bringing Med Rec to FH RCAL Create a realistic Timeline • Short term opportunities (0-2 month) • Establish team, set realistic goals, connect and bond • Medium term opportunities (2-4months) • Process mapping, introduce tools, PDSA cycles, work with a work plan • Marketing and promoting Med Rec • Long term opportunities (4-6 months) • Discuss sustainability

20. Bringing Med Rec to FH RCALShort term opportunities (0-2month) • Establish teams (Stakeholders/key players) • Steering committee memberships –Regional Directors (Pharmacy and Nursing), Physician lead, QI, PPI, & Med Rec Expert Leaders -responsible for goals and objectives • Working group memberships- Local nursing staff, Unit clerks, Res Care Coordinators, Pharmacists, & Clinical Nurse Educators, Access coordinators. -work with tools and flow of work. • Schedule meetings – q2weeks for WG and monthly for SC.

21. Bringing Med Rec to FH RCALShort term opportunities (0-2month) Set realistic goals Establish a Charter (Goals and objectives) to catch VPs/Exec Dir/Medical Directors’ attention An agreement on what’s possible, and what’s not (eg. measurements) Connect and bond Review past pilot experience and lessons learned Start with small group discussions prior to bigger group discussion to secure “buy-ins”.

22. Bringing Med Rec to FH RCALMedium term opportunities (2-4 month) • Process mapping • Identify current state and seek opportunities of improvement in the future state • Introduce tools • Consider Electronic vs manual tools • Internal transfers (within FH) • From Acute Care to Residential Care • From one FH site to another • External transfers (Direct admit) • From Assisted Living Facilities

26. Making the tools accessible • Work with local IT/IS • Assess what is available • Assess what is currently useful • Modify and refine current tools with Med Rec in mind • Assess who needs access • Get physicians to test+input+refine tools

27. Bringing Med Rec to FH RCALMedium term opportunities (2-4 month) PDSA (Plan-Do-Study-Act) cycles Identify things that can be tested (can be process or tools) Eg. redundancy of a residential care fax covering sheet During our tests period (Sept 20-October 17, 2011) 12 admits (3 deceased, 1 transferred out to Geriatric care, 1 was a recurring res where the form was not applied) 7 of the remaining has 100% compliance in having the form on the chart, prescribers orders indicated, and signatures complete 28% put a date, 57% put college ID 57% initialed and indicated they have reviewed meds on admission.

28. Bringing Med Rec to FH RCALMedium term opportunities (2-4 month) Create and follow a step by step work plan A lot of work but rewarding at the end Preparation, Planning, Education, Go-live, Evaluation, Sustainment What is the task in the above? Who’s responsible for the task? When is the time to finish this? How are we doing- What is the status of this task?

29. Marketing and Promoting Med Recis a continuous process • Clarify what is Medication Reconciliation • Med Rec versus Med Review • Internal resources • Clinical Nurse Educator (CNE) is a “huge” component • It’s better from a RNs perspective as the Audience is largely Nursing (RNs, Unit Clerks, LPNs and nursing managers) • Rx is your next best friend • External resources • Build an ongoing Communication Plan (Manager to staff, physician to physician, Pharmacy staff meetings, attend RCC meetings, use FAQs for go-live) • Physicians connections (use what works right now….eg. How to roll out preprinted orders)

30. Bringing Med Rec to FH RCAL Long Term Opportunities (4-6 month) • Empowering and sustaining • Leaders are people who find the possibilities in others • Empower and work with the frontline staff by • Discussing the possibility of increased patient safety • Highlight shaping best practice possibilities • Reassuring ongoing support is at local sites • Build infrastructures (see diagram next)

31. Sustaining the practice

32. Milestones

33. RCALMed Rec Pearls • Realistic timeline • Connect- Build a team (find a physician who’s interested) • Assess tools- Keep it simple • Learn from each others – encourage and empower the staff

34. If you have any Questions?Please feel free to connect with me:Anita.Lo@fraserhealth.ca