Hospital Code Name: Counties Manukau (Middlemore)

1. Innovation Poster Session HRT1215 – Innovation Awards Sydney 11th and 12th Oct 2012 Using ART to get Bang for Buck –Systematic prioritisation to deliver medication safety interventions Presenter: Sanjoy Nand Hospital Code Name: Counties Manukau (Middlemore) 4-4d_HRT1215-Session_NAND_CMDHB_NZ

2. KEY PROBLEM Medication reconciliation service was inconsistent and could not be delivered to all patients due to pharmacist resource constraints Large variation in the way medication reconciliation was provided with no means of identifying and prioritising patients that could potentially benefit most from the intervention Not achieving the maximum value for the effort “Medication reconciliation has been shown to be the most effective means of reducing medication related errors and harm in inpatients and during points of transfer”

3. AIM OF THIS INNOVATION Identify the patients most likely to benefit from medicines reconciliation and other clinical pharmacist interventions and deliver these in order to maximise benefit from available resources Develop and test a systematic means of prioritising patients at high risk of medication related harm – ART tool (Assessment of Risk) Goal - 80% of all high risk patients in adult medical and surgical wards would receive medication reconciliation within 48 hours of admission (blue sky goal – within 24 hours)

4. BASELINE DATA

5. KEY CHANGES IMPLEMENTED Identification of high risk patients (risk of medication related harm) using a tool that uses a number of criteria (including information from modified GTT) Dynamic electronic tool to apply criteria and display risk information (ART tool) Application of consistent process through all wards – high risk patients prioritised first KPI development, performance measured and displayed

6. ART tool

7. OUTCOMES SO FAR Target of 80% or more high risk patients receiving a medication reconciliation within 48 hours is achieved.

8. LESSONS LEARNT To reduce variation and achieve consistency we needed a systems approach – all pharmacists use one method to prioritise Utilise technology to help – data sources already available – having an interface to gather information and use to prioritise was key to success Quality and value rather than quantity Had to do a number of tests (PDSAs) to improve – learning and improvement was incremental – just had to start somewhere