Improvement Model
Improvement Charter (Team Plan)
Medication Reconciliation in Home Care Pilot Project
Sponsor:
VON
Team Lead:
Kelly Budgell
Team Members:
Mary Anne Brunelle, Kathy Uhlman, Lyn Goguen-Fleck, Donna
Wentzell, Wanda Inglis, Andrea Rudolf-Nauss
WHAT ARE WE TRYING TO ACCOMPLISH?
Jan 29
Project Name:
What are we trying to
accomplish?
How will we know that a
change is an improvement?
What changes can we make that will
result in improvement?
Act
Plan
Study
Do
Purpose of Project
 Develop a comprehensive definition for Medication Reconciliation the Home Care Setting
 Identification and validation of key steps in the Medication Reconciliation as it applies to the home care
setting.
 Design and test strategies for implementation of Medication Reconciliation in Home Care across Canada
incorporating lesions learned from the Western Collaborative
 Establish a structured, sustainable guide for implementation of the medication reconciliation process in home
Care which will reduce the potential for Adverse Drug Events in the transfer of client care from the acute care
setting to the home care setting
Purpose of Pilot Teams
 Design and test strategies for implementation of medication reconciliation within their local agencies
 Test, refine, and develop tools and processes for Medication reconciliation in Homecare which will be
effective in the identification and resolution of discrepancies and the reduction of potential adverse drug
events from the acute care setting to the home care setting.
Scope and Boundaries:
 Create a process to identify clients at risk for Adverse Events in Home Care after discharge from an Acute
Care Setting
 Test, develop, and implement tools and processes for medication reconciliation in order to identify and
reconcile medication discrepancies in the transfer from the Acute to home care setting
 Monthly submission of data relating to the 3 core measures listed below
 The team will monitor efficiency of tools & processes used, identify opportunities for improvement and
implement changes related to the opportunities identified
 Share lessons learned, effective tools & processes
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Aim Statements:

Complete this charter and assign tasks to team members by Jan 1/09

Implement Medication Reconciliation Process using existing tools on selected target population by Dec
15/09

Establish baseline measure for sample population by Feb 15/09

The team comes together to flow chart present process for Reconciliation and identifying starting points for
improvement/change; date of this meeting Feb 15/09.

Reassess scope of target population by Feb 09. Make adjustments as necessary and implement

Set Target measures on target population with BPMH completed keeping in mind what the ultimate target is :
Examples below:
75% of target population will have BPMH done by month of Jan 31 2009
95% of target population will have BPMH done by April 2009
To decrease the time for trained service providers to complete a BPMH by 10% by Feb 28 2009
To decrease the time for trained service providers to complete a BPMH by 30% by March 2009


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HOW WILL WE KNOW A CHANGE IS AN IMPROVEMENT?
Measures:
1. Percentage of Eligible
Clients with a Best Possible
Medication History
(BPMH) conducted by a
Home Care clinician
2. Time to complete Best
Possible Medication History
(BPMH) in Home Care
3. Percentage of Eligible
clients with at least one
discrepancy that requires
clarification
4. Classification or
characterization of actual
discrepancies that require
clarification
Balancing measures:
1. Perception of time to
complete accurate
medication record (BPMH)
on transfer from an Acute
Care to Home Care setting.
2.
Perception of how many
clients transferring from an
acute care setting to Home
Care have discrepancies in
their medication regime.
3.
Satisfaction:
 Physicians
 Pharmacists
 Staff
Current Performance:
1. ?
Aims/Goals:
1. 99%
2.?
2.
3.?
3. Reduce by 25% by March 09
4.?
4. Reduce by 25% by March 09
Reduce by 25% March’09
Consider surveying/focus group of
service providers or talk amongst the
pilot team asking the questions:
1.
How long does it take in the
admission to complete an
accurate record of
medications?
2.
How many clients do you
feel have discrepancies on
admission which you need
to reconcile with the
physician or pharmacist?
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WHAT CHANGES CAN WE MAKE THAT WILL RESULT IN IMPROVEMENT?
Ideas for Change. Change Concepts and Ideas to Test.
Phase One:
Implement Medication Reconciliation process using your current tools and processes and identify ideas for
change:
 Select or develop your Medication Risk Assessment Tool to be carried by all trained clinicians
(care providers.)
 Initiate Medication Reconciliation process using present tools and processes in place at present.
Identify barriers/challenges to processes, needs for improvement and change.
 Baseline data collection
 Flow chart present process and share opportunities for improvement identified
 Select, refine or develop BPMH interview and data collection process to address areas for
improvements identified
 Select, refine or develop guidelines for client/family interview process
 Select, refine or develop BPMH forms to test.
 Select, refine, develop data collection tools and processes to test
Phase Two:
Test ideas for Change
 Test and refine BPMH interview and data collection processes ( interview guides, questions)
 Test and refine the BPMH and reconciliation form
 Use PDSA cycles and huddles to test and refine changes
 Address unique issue with Chart in the home: How will you fax information to the physician for
reconciliation yet have that same information remain on the client chart? Carbon copied BPMH
forms? Transcribing meds that need Reconciliation onto physician order form?
 Identify successes and share with other teams…
HOW WILL WE MANAGE THE IMPROVEMENT
PROJECT?
Phase Three:
Phase Four:
Principles for Working Together
 Mutual respect
 Regular meetings: short and snappy and focused, use huddles on the spot as much as possible to assess small
tests of change.
 Track small tests of change
 Share the workload
 Look for the opportunities and the keys to success rather than focusing on the limitations.
 Engage Executive Sponsor when barriers to implementation are beyond core team’s ability to address on
their own
 Share successes with each other, the organization, and the Communities of Practice
 Include other interested partners as identified
 Utilize your quality and risk managers/directors
 Consult with Atlantic Node proactively and as needed (before team gets overwhelmed)
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Roles & Responsibilities of team member
 Team Leader : organize and facilitate meetings, communicate with other team members, arrange/provide
education/awareness, data collation for delivery to Central Measurement Team (CMT)
 All Core Team Members Monitor and provide feedback for quality improvement
 Designated person to record all incoming data on Monthly Master Data Collection Sheets
 Executive Sponsor : Facilitate, resource and support adaptation of innovations
Meeting Schedule
 Monthly National Teleconferences with all pilot teams; Second Tuesday Monthly at 12 noon to 1pm EST
Teleconference Number: 1-800-747-5150 Access Code: 1114694#
 Pilot Team meetings
 Utilization of the Safer Health Care Now: Website & Communities of Practice ( This will be introduced to
you
 Face to Face Session to be announced
Key Dates (Exam mples)
Phase 1 – October 15 to November 15
Phase 2 –November 15 to January 31
Phase 3 –January 31 to March 15
Pilot team meetings: Nov 12, Dec 9, Jan 13, Feb 10, Mar 10, Apr 14, May 12
Data Submission deadline: Dec 19, Jan 25, Feb 25, Mar 25, Apr 25, May 25
Face to Face Session: April 27 and 28 2009
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