Admission MedRec at Lions Gate Hospital
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Admission Medication Reconciliation at Lions Gate Hospital Lean Transformation Services Laarnie St-Laurent, Lean Coordinator Lorelei Grosser, Lean Coordinator Carissa Looman, Lean Educator Admission MedRec at Lions Gate Hospital Objectives: •What is MedRec? • Why do MedRec? •How was MedRec implemented? Brief overview of Lean Methodology How Lean was used for implementation •How are we doing now? Audit Results •What are key “lessons learned?” Impacts of MedRec Admission MedRec at Lions Gate Hospital Ever wondered… • Right medication? • Right dose? • Right time? Admission MedRec at Lions Gate Hospital What is MedRec? Admission MedRec at Lions Gate Hospital What is MedRec? “Best Possible” Medication History Pharmanet (Prescribed Drugs) Reconciliation (Orders) Admission MedRec at Lions Gate Hospital Why do MedRec? Did you know… • “40-50% of patients on admission” are at risk of unintentional medication discrepancies? Medication errors may harm patients Of these, 6% are at risk of harm serious enough to increase length of stay from 2-8 days2. Admission MedRec at Lions Gate Hospital Why do MedRec? Some Local Data • At Lions Gate: About 38.8 daily admissions 12.5 patients at risk of unintentional discrepancies 0.75 patients daily at risk of staying 2 to 8 days longer About $246K additional costs per year (based on average cost of $450/patient/night) Steps to Achieving Continuous Improvement– sequence to approach the tools Mistake Proofing Other tools to improve flow and implement pull And Then: Repeat! Visual Controls Unit Layout/ Cell Design (Flow) Standard Work Rather than thinking specific tools do not apply, consider if their concept can provide benefit. Observe and Collect Data See for yourself & collect objective data that becomes the starting point for discussions Adapted from Virginia Mason Lean Leader Certification Materials VCH Improvement System Lean Tollgate Sustainment Audit/Refine Implementation/ Go-Live Future State Development Current State Analysis Project Definition LTS_VCH Improvement System_V1 Admission MedRec at Lions Gate Hospital How was MedRec implemented? Observations: Data Collection Admission MedRec at Lions Gate Hospital How was MedRec implemented? Future State Value Stream Map Triage MRO printed for certain areas in Emerg Emerg Nurse Emerg Doctor Admission •BPMH documented by RN or Pharmacist on •MRP reconciles home medications •MedRec Order (MRO) form processed Admission MedRec at Lions Gate Hospital How was MedRec implemented? Standard Operating Procedures: Who What How When Why Admission MedRec at Lions Gate Hospital How was MedRec implemented? Admission MedRec at Lions Gate Hospital How was MedRec implemented? Auditing and Breakthrough Lanes: Did not meet MedRec criteria Met MedRec criteria Admission MedRec at Lions Gate Hospital How was MedRec implemented? Auditing and Breakthrough Lanes: Why did not meet MedRec criteria? Admission MedRec at Lions Gate Hospital How was MedRec implemented? Auditing and Breakthrough Lanes: Did not meet MedRec? Now what???? Admission MedRec at Lions Gate Hospital How are we doing now? Organizational Targets Completion Rate 75% BPMH Completion 75% Reduction in unintentional discrepancies 75% Reduction in undocumented intentional discrepancies 75% Admission MedRec at Lions Gate Hospital How are we doing now? Area Elective Surgery: • Implemented on November 2011 Quantitative Results •100% have complete, accurate medication histories •100% receive post-op medication orders • 75% reduction in unintentional discrepancies • 85% reduction in undocumented intentional discrepancies Admission MedRec at Lions Gate Hospital How are we doing now? Area Emergent/Direct Admissions • Implemented on May 23, 2012 Quantitative Results •77.5% to 80% reconciliation rate (exceeded target of 75%) •47.5% “best possible medication history” completion rate •50% reduction in unintentional medication discrepancies •55% reduction in undocumented intentional medication discrepancies Comparison: Vancouver Coastal Site Average Completion Rate • Since Implementation Richmond Hospital 60% Vancouver General 78% Coastal Squamish General 60% St. Mary’s Hospital 65% Powell River General TBA Lions Gate Hospital 78% Admission MedRec at Lions Gate Hospital How are we doing now? Examples of “good saves” and Qualitative Results… MedRec Success Stories Unit Good saves… Emergency MD ordered only one of patient’s home meds at half the dose the patient was taking. When med history was taken by RN, MD ordered the rest of home meds (5 pages were missed). Pediatrics Patient’s Pharmanet only showed one medication. When BPMH was taken, patient was taking medication at a different dose than on Pharmanet and was also taking a number of other medications NOT on the Pharmanet. Daycare Surgical patient was seen in PSSU 2 weeks prior to surgery, but had filled other prescriptions since then. Daycare RN picked up on new meds when BPMH was done prior to surgery. Admission MedRec at Lions Gate Hospital Admission MedRec at Lions Gate Hospital Reference List: 1 Canada. Accreditation Canada. Required Organization Practice. Ottawa: Accrediation Canada, 2012. Print. 2 Canada. Optimizing Medication Safety at Care Transitions – Creating a National Challenge. Toronto: 2011. Print. Admission MedRec at Lions Gate Hospital Thank you for listening! Questions??? Admission MedRec at Lions Gate Hospital What is MedRec? Systematic Partnership Conversation February 27, 2013 Admission MedRec at Lions Gate Hospital How was MedRec implemented? 5 Steps to Lean Thinking 1 Specify Va lue 2 M a p t he Va lue St rea m 3 Est a blish Flow 5 W ork t o Perfect ion 4 Im plem ent Pull Source: James P. Womack. Lean Thinking. February 27, 2013 Admission MedRec at Lions Gate Hospital Medication Management Paper flow Audit & Refine Implement February 27, 2013
