Medication Reconciliation WSLHD A Clinical Services Redesign Project Carrie Marr Executive Director Organisational Effectiveness, WSLHD August 2015 eMEDs Executive Sponsor Margaret Macarthur Director of Pharmacy BMDH & Pharmacy Directorate,WSLHD Annie Chong eMEDs Pharmacist,WSLHD
Western Sydney LHD Strategic Challenges: – Population growth 2% per annum until 4 teaching hospitals 2021 (NSW average 1.2%) and 40% increase in people aged 65+ – Westmead – 45% local residents speak a language – Blacktown Mount Druitt (2 campuses) other than English at home (NSW – Auburn average 24%) – – Cumberland >50% adult population is overweight or obese 7 Community Health Centres – Diabetes rates higher than NSW average > 876,500 local residents > 9000 employees 2000 beds Improving access to information through technology is a key component of the strategy to enable clinicians to respond to the increase in demand for services.
We are “Paper -Lite ” Blacktown Hospital rolled out online clinical documentation in 2014; Why? – to provide secure, real time access to medical records for all staff at all locations; – new Clinical Services building designed without paper records storage; – preparing the ground for EMM.
Project Approach Clinical Services Redesign Framework
1. Planning: Scope • During the EMM program planning exercise a number of options were considered for how the District could implement solutions which would deliver benefits that are commensurate with the original EMM business case and represent best value for money. • Agreed scope of WSLHD EMM Program Project Auburn Blacktown Cumberland Mount Druitt Westmead Antimicrobial stewardship Pharmacy foundation projects Medications reconciliation Full electronic medications management 4
1. Planning: Governance structure • Setting up our governance structure 5
1. Planning: Schedule and Reporting • Setting up our schedule 6
Speaker change Planning WSLHD & Project Diagnostic & Results & Scope & Implementation Sustainability Paper-Lite Approach Solution Summary Governance
Stakeholder mapping & Communication Safety & Safe use of Targeted Stakeholder Engagement Quality in District Drug Medicines one-to-one Health Care Committee Committee clinician Councils engagement Departmental Clinical & Medical Staff Leadership Councils Specialty Forums meetings Patients Primary Care (Focus Providers Groups) Communication Meetings & Workshops One-to-one engagement Emails Corridor conversations 8
2. Diagnostic: Approach at Blacktown Hospital Objective : identify the key challenges in taking a Staff Interviewed BPMH and ensuring the accuracy of patient’s 40 medications across the patient journey. 3 39 35 3 • Informal interviews were conducted over a 2 25 30 week period with 39 Blacktown Hospital staff 25 across medical, nursing, and pharmacy staff. 20 • Interview questions covered the end to end 15 patient journey, with particular emphasis on the 10 admission and discharge process and the roles 8 5 and responsibilities of clinical staff in medication management. 0 Medical Nursing Pharmacy Other Total • Further issues identified through : 1. Interviews with GPs and Community Pharmacists 2. Patient focus group Review best practice Informal interviews Workshop to validate Interviews with GPs, Solution Design literature and with medical, findings and receive community Phase findings from the nursing, and feedback pharmacies and CEC Blacktown pharmacy staff to patient focus groups medication audit identify key issues
2. Diagnostic: Key Findings Overview & Ranking Key 1. ED Admission 2. Inpatient 3. Discharge Admitting Team Rework Roles and Responsibilities Discharge Documentation 1 3 6 Systematic Process Transfer of Medication 2 Day of discharge delays 4 7 Pharmacy Cover Patient Education 5 8 9. Performance Monitoring and Management • During a workshop on 16 th January 2015 1 2 5 Low High Blacktown clinical staff ranked the key 9 6 findings based on: 8 Impact Impact – the impact of the problem on the 1. 9 3 recording of accurate medications information. 4 7 Influence – the ability of clinicians and the 2. organisation to influence improvements in each of the problem areas. Low High Influence
3. Solution Design approach at Blacktown Hospital The problems identified and prioritised during the Staff Working Group Attendance diagnostic were used to structure the solution design phase. 107 3 100 • A kick of workshop was held on the 27 th of February and was attended by 30 clinicians . 32 80 • Working Groups were mobilised to develop 38 60 solutions to each of the problems. Clinicians were divided into 2 project work streams to focus on 40 their area of expertise: 1. ED / Admission 34 20 2. Discharge • The groups have met 14 times over an eight week 0 Medical Nursing Pharmacy Other Total period for one hour and actions were completed in between meetings. December January February March April Planning Diagnostic Solution Design Implementation Interviews Work Stream Meetings 11
3. Solution Design: Local Solutions The solutions generated in the Working Groups are designed to improve the accuracy and handover of medication information between all clinicians involved in a patient’s management. This includes the communication of information between community and hospital based clinicians. Medication Information Flow Emergency Pre-arrival Inpatient Discharge Department INBOUND Best GP Lists Initial Patient INFORMATION Possible D/S Medication Discharge Friendly Medication Patient History Summary Medication History List OUTBOUND INFORMATION Solutions 3. Medication 4. Discharge 2. Roles and 1. Pre-Arrival 5. Medication List Handling Responsibilities Summary 6. Patient Education 12
3. Solution Design: An Example Show this list to your Doctor My Contact Information is Is there a smarter way to take Emergency Contact My MEDS control of my medications? My MEDS YES! or Pharmacist My name is Medicine List + is an Phone Name app that helps you manage medications for yourself and the Fold Here people you care for. Reason (if known) TAKE CONTROL OF Why should I use it? YOUR MEDICATIONS Have an up to date medications record on you at all times that you When to take can easily share with your care team, including during emergencies. Scan the barcode on your medication to upload details to the app. How much Record other vital health to take information, e.g. allergies. Set alarms to remind you to take your medication. Medication name & strength Download for free at www.medicinelistplus.com.au 10. 11. 12. 13. 14. 15. 13 8. 9.
4. Implementation: Education & Communication • Weekly Working & Progress Group meetings • Email updates • Weekly Newsletters • Training sessions for all health clinicians • Announcement though Broadcast & Grand Rounds • Medication Reconciliation Launch morning tea • Champions modelling “bright blue” T -shirts for the week of the launch for ground support
5. Sustainability A key theme of the project was medications being everyone’s business, so all health clinicians involved with patient’s medication management will be accountable • Changes monitored at: • Admission (BPMH, Medication Reconciliation) • Discharge (Completion statistics, quality of discharges) • Changes monitored via: • Snapshot audits • Pharmacy interventions, medication lists provision • Surveys • Data from i.Pharmacy and Cerner • Hospital committee will continue to monitor progress regularly 15
Result & Dashboards 16
Summary: Enablers & Barriers of the project Barriers Enablers Introducing a paper tool when already Paper-Lite Interim solution Not everyone was aware Engaged staff early Certain critics of change Recognition of champions Extra workload beliefs Tailoring training material More accountability Engagement by own profession Lower uptake to start Clinical Lead Misunderstanding eMEDs team role progression Dedicated support by eMEDs team to facilitate Implementing at other sites My MEDS leaflet tool 17
Carrie Marr – WSLHD Executive Director Organisational Effectiveness carrie.marr@health.nsw.gov.au Annie Chong – WSLHD eMEDs Pharmacist annie.chong@health.nsw.gov.au
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