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FRHS Kaizen Workshop #1. Medication Reconciliation (MRR) Admission / Discharge Only October 3-5, 2007. Kaizen #1: Medication Reconciliation Admit / Discharge. Mission: To improve the process of medication reconciliation to assure patient safety. Objectives:
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FRHS Kaizen Workshop #1 Medication Reconciliation (MRR) Admission / Discharge Only October 3-5, 2007
Kaizen #1: Medication Reconciliation Admit / Discharge Mission: To improve the process of medication reconciliation to assure patient safety. Objectives: 1. Achieve a 50% improvement in accuracy of medication information upon admission. • Reduce nursing time spent by 12.5%/day. • Reduce delays in medication administration by 50%. • Reduce medical errors by 80% • Support the new hospitalist program. Train-the-Trainer objectives 6. Learn Lean tools as process improvement method. 7. Diffuse improvement mindset throughout the hospital. 8. Reduce waste throughout all major processes.
Kaizen Team Work David, Beth, Steve, John, Rhonda, Beth H, Melissa, Carol, Mark, Missy, Vicky, Gloria, Alison, Patsy
VALUE STREAM MAP – MEDICATION RECONCILIATION Total Admission times: Min: 97.2min Max: 2.5 hr Process Efficiency: 100% max, 31% min ADMISSION Standardized process for FRHS physician offices in relaying med list. Discharge form placed on each chart at each location ER Create standing orders Get and/or Give meds Obtain list of current meds; Contact physician Contact external pharmacy Contact admitting physician to identify meds Reconcile meds Direct Admit How to get? Review initial orders Nurse write out med list (if needed); Fax order to internal pharmacy All pre-op meds discontinued when going tosurgery/transfer; Pharmacyout of loop; No auto discharge between units. 15 min External Transfer Review external facility list Computer versus manual documentation system for meds (ED gets but another area enters) Physicians don’t respond 15min Nursing making decisions outside scope of practice. Collaboration with pharmacy. incomplete orders are not written and relayed to pharmacy – i.e. no dose, route. 1-2 hours Physicians don’t write full admit med’s list; Nurses act on med’s list Nurses temp orders are cancelled and re-entered 20 sec to 15 min Admit/PCP don’t agree on med list for patient Education improvements for new people. 30 – 60 min
VALUE STREAM MAP – MEDICATION RECONCILIATION DISCHARGE Process Efficiency for discharge: 56% Best 30% Worse Case Yes DONE Physician discharge order form and signs Print Discharge Instructions Are meds complete? Computer generated list of all home meds and meds taken while hospitalized. No Should list only meds active on day of discharge. Complete separate forms as needed for transfers. Calls physician to complete list Physician task to write meds, activity, diet, etc. Enter full info into CPSI Incomplete physician meds; Or continue home meds; Physicians don’t respond till later. Discharge order about not on all charts. Educate nurses and physicians on location. Redo work to getting transfer forms completed. Physicians not writing complete list of meds for patient to continue to take. Redo 15 min 2 min Total Time: Min: 41 min Max: 112 min 2 min to 1 hr : Value Added : No value added
