Using technology to support MedRec: Two hospitals, two approaches.
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1 Using technology to support MedRec: Two hospitals, two approaches. Andrew Liu, HBSc., BSc.Phm., RPh., Clinical Manager, Department of Pharmaceutical Services, Toronto East General Hospital, ON. Josianne Gauthier, B. Pharm, M. Sc Pharm, CRE, Clinical Pharmacist and Team leader of Medication Reconciliation Implementation, Whitehorse General Hospital, YT. September
2 Bienvenue! Welcome also to our francophone attendees Bienvenue à nos participants francophones Hélène Riverin Conseillère en sécurité et en amélioration Safety Improvement Advisor
3 Pour nos participants francophones.. Pour accéder aux diapositives en français : -Cliquez sur l'onglet «FRENCH» OU Envoyer un courriel à [email protected] Surveiller la boîte «Chat» pour voir les commentaires des conférenciers traduits en français
4 All Safer Healthcare Now! webinars are posted within the week to the following locations: Safer Healthcare Now! website NationalCalls/2014Webinars/Pages/default.aspx ISMP Canada website Safer Healthcare Now! MedRec Community of Practice /MedRec/default.aspx For real time notification of content posting, like the Medication Reconciliation Network on Facebook
5 Cross Canada MedRec Check-Up To have something added to this map, please contact:
6 NOW AVAILABLE for download on the Safer Healthcare Now!, ISMP Canada and Canada Health Infoway websites. Toolkit developed to support organizations migrate from a paper-based system to an electronic system for MedRec. 6
7 Safer Healthcare Now! MedRec Year-at-a-glance Feb nd MedRec Quality Audit Month Information Call/Kick Off- Jan. 6 th, Quality Audit Results- Mar. 31 st, national calls/webinars Updates to Home Care Getting Started Kit Updates to MedRec Cross Canada Check Up Map Developing MedRec FAQ documents 7
8 ISMP Canada MedRec Projects Doc Mike Evans YouTube video- MedRec MyMedRec- Free app to help patients/families keep a list of their medications (For Blackberry, Android and iphone) 8
9 MedRec Stay Informed and Connected Receive ISMP Canada s MedRec Newsletter Hear about: Upcoming MedRec webinars New toolkits National MedRec Audit Month New MedRec publications MedRec related workshops Join Now! [email protected] or visit
10 Please complete our poll 10
11 Click on the arrow icon Audience Poll and then click on the appropriate location on the slide in response to this question: Which information system is in use in your facility? Cerner Meditech Other 11
12 e-medication Reconciliation on Admission - Cerner Andrew Liu, RPh. Clinical Manager Dept. Pharmaceutical Services September 9, 2014 Setting a New Standard in Quality and Value
13 Single site community teaching hospital serving southeast Toronto TEGH has over 2,500 employees and 440 physicians Inpatient Care Beds 516 Inpatients 20,000/yr Emergency visits 70,000/yr 13
14 Toronto East General Hospital 2006 Mostly paper chart Separate electronic pharmacy information system (MS Meds) Cerner Powerchart (Labs) No provincial electronic drug profile access yet 14 Setting a New Standard in Quality and Value
15 Medication Communication Problems Transcription errors (paper MAR) Slow turnaround of written/reconciled orders Unlinked MAR / Pharmacy med profile inaccuracies Previous Best Possible Medication History (BPMH) lost in archived chart BPMH lost in current chart Challenging Med Rec 15 Setting a New Standard in Quality and Value
16 Path to emed Rec 2008 Cerner Pharmnet (Pharmacy) linked to electronic chart (Powerchart) 2009 Computerized Provider Order Entry (CPOE) and e-medication Administration Record (emar) 16 Setting a New Standard in Quality and Value
17 17 Setting a New Standard in Quality and Value
18 Path to emed Rec 2010 Existing e-medication history documentation and reconciliation modules Real-time BPMH documented using standardized drug library, readily available for all patient visits BPMH could be directly converted to inpatient orders e-clinical documentation expanded Including standard Med Rec consultation note Real-time med rec data auditing 18 Setting a New Standard in Quality and Value
19 Med TEGH Proactive and retroactive approach Elective surgical patient pathway (proactive) Preoperative clinic pharmacist Inpatient surgeon / resident Acute inpatient pathway (mostly retroactive) Inpatient clinical pharmacists Most responsible physician 19 Setting a New Standard in Quality and Value
20 20 Setting a New Standard in Quality and Value
21 21 Setting a New Standard in Quality and Value
22 22 Setting a New Standard in Quality and Value
23 23 Setting a New Standard in Quality and Value
24 Benefits of emed Rec Simple, efficient ordering of multiple medications Reconciliation tool Virtually no transcription errors BPMH readily available for all future encounters Real-time availability of BPMH Foundation for Med Rec on discharge Automatic drug product translation in Pharmacy dispensing system (single Cerner interface ) Enhanced real-time auditing possible 24 Setting a New Standard in Quality and Value
25 Challenges of emed Rec Standardized use of application features fill in the blank fields such as compliance data not readily viewable by provider ( use Med Rec note) Details: Difficult to track history of medication changes ( Med Rec note) Inflexibility of display options Live BPMH (?proxy access for staff/students in training) Pushing alerts/flags to providers Complexity of data mining Does not correct incomplete Med Rec, inaccurate info Duplicate documentation due to e-prescriptions Downtime 25 Setting a New Standard in Quality and Value
26 Conclusion Perfection vs Progress Upfront key supports (CPOE, emar, Drug library) facilitated success Simplicity reproducibility Success: downstream demand for 100% 26 Setting a New Standard in Quality and Value
27 Acknowledgements: Kieu Lee, Heidi Huang Questions: Andrew Liu Thank you! Toronto East General Hospital, 825 Coxwell Avenue, Toronto, Ontario, M4C 3E7 Tel: (416) Fax: (416) Setting a New Standard in Quality and Value
28 Medication Reconciliation Using Iatric Software Josianne Gauthier B.Pharm, M.Sc Pharm, CRE Clinical Pharmacist Whitehorse General Hospital
29 Context
30 Whitehorse General Hospital 55 acute care beds admissions/month 52 Family Physicians 6 Surgeons 180 Nurses 5 Pharmacists
31 Information Systems Meditech 5.64 (MAGIC workstation) Patient Discharge Instructions (Iatric Systems) For Med Rec at Admission and Discharge Medical chart is mostly paper-based No territory-wide Electronic Medication Record (EMR)
32 Implementation of PDI May 2012 Patient Discharge Instructions (PDI) software purchased from Iatric Systems Development of process and reports by clinical pharmacist with physicians, community pharmacists and nursing Started using PDI for every Med Rec at Admission Sept Started using PDI for Med Rec at Discharge (pilot project with clinical pharmacist and 2 physicians) Roll-out to other physicians
33 PDI Training Med Rec Team: 2 nurses in Emerg and on the ward 2 nurses in the Pre-Op Clinic Clinical Pharmacist Physician champion One-on-one training and in small groups of physicians Instruction Manual and video tutorial
34 Software allows to: 1) Gather electronically Home Medication history and print Med Rec at Admission form 2) Compare Home Medications and Hospital Medications and generate a comprehensive Discharge Order along with patient hand-outs
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37 Discharge Process When planning for discharge, physician logs into PDI Clinical Pharmacist, in collaboration with physician, can also log into PDI and prepare Med Rec at Discharge Current hospital medications are pulled over from Meditech Reconciliation by a simple click
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41 Discharge Process Discharge Orders, Medication List and Medication Schedule are printed Physician or pharmacist indicate in Physician s Orders where to fax Physician or pharmacist gives Medication List or Medication Schedule to patient with explanation of changes and new medications
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47 Successes Over 20 physicians trained on using the program Over 120 Med Rec at Discharge performed this year Better patient understanding, empowerment, involvement in their care Community partners very appreciative of improved communication
48 Challenges Development and customization of reports is time-consuming Limited information systems knowledge/support Physician engagement Users comfort with computer technology Time required for patients with complex medication profiles
49 Conclusion Systematic review of Home and Hospital Medications prevents errors; Good overall satisfaction with process and software used; Improved communication between patient and health care providers is worth the effort! Questions?
50 Please input your questions All questions will be addressed at the end of the webinar Ask questions or send feedback via the chat box Select All participants Type message Click Send All Participants
51 Please complete our poll 51
52 Upcoming MedRec Webinars Thank you for attending Our next MedRec webinar will take place in October 14 th, Topic: Ambulatory MedRec Details to follow. 52
53 All Safer Healthcare Now! webinars are posted within the week to the following locations: Safer Healthcare Now! website NationalCalls/2014Webinars/Pages/default.aspx ISMP Canada website Safer Healthcare Now! MedRec Community of Practice /MedRec/default.aspx For real time notification of content posting, like the Medication Reconciliation Network on Facebook
54 We encourage you to report medication incidents Practitioner Reporting Consumer Reporting
55 Medication Safety Self-Assessment Hospitals (acute care)(2006) free for Ontario* Long-term care (2012) free for Ontario* Complex Continuing Care and Rehabilitation (2008) free for Ontario* Community and Ambulatory Pharmacy (2007) free for Ontario* Operating Room Medication Safety Checklist (2009) free for Ontario* Oncology (2012) Anticoagulant Safety (VTE) free for Ontario* HYDROmorphone Safety Self-Assessment (2014) - $50 * Supported by the Ontario MOHLTC For more information visit or [email protected]
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