Using technology to support MedRec: Two hospitals, two approaches.

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 2014 www.saferhealthcarenow.ca

Bienvenue! Welcome also to our francophone attendees Bienvenue à nos participants francophones Hélène Riverin Conseillère en sécurité et en amélioration Safety Improvement Advisor www.saferhealthcarenow.ca

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All Safer Healthcare Now! webinars are posted within the week to the following locations: Safer Healthcare Now! website http://www.saferhealthcarenow.ca/en/events/ NationalCalls/2014Webinars/Pages/default.aspx ISMP Canada website http://www.ismp-canada.org/medrec/#webinars Safer Healthcare Now! MedRec Community of Practice http://tools.patientsafetyinstitute.ca/communities /MedRec/default.aspx For real time notification of content posting, like the Medication Reconciliation Network on Facebook www.facebook.com/medicationreconciliation www.saferhealthcarenow.ca

Cross Canada MedRec Check-Up To have something added to this map, please contact: medrec@ismpcanada.org www.saferhealthcarenow.ca

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 www.saferhealthcarenow.ca

Safer Healthcare Now! MedRec 2014-2015 Year-at-a-glance Feb. 2015-2 nd MedRec Quality Audit Month Information Call/Kick Off- Jan. 6 th, 2015. Quality Audit Results- Mar. 31 st, 2015. 6 national calls/webinars Updates to Home Care Getting Started Kit Updates to MedRec Cross Canada Check Up Map Developing MedRec FAQ documents 7 www.saferhealthcarenow.ca

ISMP Canada MedRec Projects 2014-2015 Doc Mike Evans YouTube video- MedRec MyMedRec- Free app to help patients/families keep a list of their medications (For Blackberry, Android and iphone) www.ismp-canada.org www.saferhealthcarenow.ca 8

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 bcarthy@ismp-canada.org or visit http://www.ismp-canada.org/register/medrec.php www.ismp-canada.org www.saferhealthcarenow.ca

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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 www.saferhealthcarenow.ca

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

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

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

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

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 Setting a New Standard in Quality and Value

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 2011+ 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

Med Rec @ 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

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

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

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

Acknowledgements: Kieu Lee, Heidi Huang Questions: Andrew Liu anliu@tegh.on.ca Thank you! Toronto East General Hospital, 825 Coxwell Avenue, Toronto, Ontario, M4C 3E7 Tel: (416) 461-8272 Fax: (416) 469-6106 www.tegh.on.ca 27 Setting a New Standard in Quality and Value

Medication Reconciliation Using Iatric Software Josianne Gauthier B.Pharm, M.Sc Pharm, CRE Clinical Pharmacist Whitehorse General Hospital

Context

Whitehorse General Hospital 55 acute care beds 210-230 admissions/month 52 Family Physicians 6 Surgeons 180 Nurses 5 Pharmacists

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)

Implementation of PDI 2011 2011-2012 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 2012 2013 Started using PDI for Med Rec at Discharge (pilot project with clinical pharmacist and 2 physicians) Roll-out to other physicians

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

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

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

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

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

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

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? josianne.gauthier@wgh.yk.ca

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Upcoming MedRec Webinars Thank you for attending Our next MedRec webinar will take place in October 14 th, 2014. Topic: Ambulatory MedRec Details to follow. 52 www.saferhealthcarenow.ca

All Safer Healthcare Now! webinars are posted within the week to the following locations: Safer Healthcare Now! website http://www.saferhealthcarenow.ca/en/events/ NationalCalls/2014Webinars/Pages/default.aspx ISMP Canada website http://www.ismp-canada.org/medrec/#webinars Safer Healthcare Now! MedRec Community of Practice http://tools.patientsafetyinstitute.ca/communities /MedRec/default.aspx For real time notification of content posting, like the Medication Reconciliation Network on Facebook www.facebook.com/medicationreconciliation www.saferhealthcarenow.ca

We encourage you to report medication incidents Practitioner Reporting https://www.ismp-canada.org/err_report.htm Consumer Reporting www.safemedicationuse.ca/ www.ismp-canada.org www.saferhealthcarenow.ca 54

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 www.ismp-canada.org/mssa or email mssa@ismp-canada.org www.ismp-canada.org www.saferhealthcarenow.ca