Medication Reconciliation on Discharge at Upper River Valley Hospital Factors for Success
Medication reconciliation is an important aspect of medication management that is patient-centred. Health care providers work together with patients, families and other care providers to ensure accurate and comprehensive medication information is communicated consistently across transitions of care (admission, transfers and discharge). Background Horizon’s Upper River Valley Hospital (URVH) was not meeting the organization’s target of 75 per cent in Medication Reconciliation on Discharge (Med Rec on Discharge); for first quarter (April to June) of the 2017-18 fiscal year the hospital’s Med Rec on Discharge was at 46.9 per cent. Having an incomplete Med Rec on Discharge puts patients at risk for medication incidents such as omissions and inconsistencies (wrong medication or dosage). The overall objective was to increase Med Rec on Discharge compliance by 30 per cent within a year to reach the Horizon target. The project used a Process Improvement methodology called Lean Six Sigma (Green Belt) to systematically evaluate the current process issues, validate root causes and eliminate causes of poor quality or non-value added activities. An important aspect of performing a Green Belt project is the partnership with experienced staff who can identify root causes of why Med Rec on Discharge was not being completed. Improvement Strategies Baseline data analysis showed Med Rec on Discharge completion varied across units, medical specialities and physicians. Since Med Rec involves an interdisciplinary team, improvements focused on nursing and physician engagment tools and processes, such as visual aids, Information Service requests to alphabetize medications in Med Rec forms for ease of reconciliation and education strategies. Physician ownership was a key factor to drive the project. Dr. John Dornan, Horizon’s Regional Chief of Staff and previously Chief of Staff for Saint John and Upper River Valley, was instrumental in reducing process barriers by opening lines of communication through monthly Medical Staff meetings and addressing individual physician concerns. Showcasing medication incidents to staff where Med Rec was a contributing factor to patient safety incidents emphasised the importance of why URVH needed a standardised Med Rec process and built the case for completing Med Rec on Discharge. An audit tool used during the control phase of the project helped the team track their improvements and recognize barriers early on to sustain the positive change over time.
Key Facts • Medication Reconciliation on Discharge improved by 52.5 per cent at Horizon’s Upper River Valley Hospital • Improved compliance to an Accreditation Canada’s Required Organizational Practice (Med Rec Discharge) to 70.8 per cent (24.4 percentage point increase) improved the communication and internal coordination of care across the continuum (family physicians, community pharmacies) which improved the overall patient experience and ensured patient- and family-centred care. Discharge. This increase improved patient safety at URVH by reducing medication errors and the potential for patient harm. Additionally, implementation of Med Rec on Discharge helped maintain Horizon’s Accreditation status, as it is a Required Organizational Practice. In summary, standardizing the Med Rec process
A clear mandate from Horizon’s Executive Leadership Team for the implementation of Med Rec across Horizon as an organizational priority paved the way to the project’s success. Additional collaboration with a regional project, the Horizon Regional Med Rec Project, helped reinforce weekly tracking and achieving compliance to completion of Med Rec. During the implementation of the improvements, there was a brief period of time where the project did not have a process owner to provide leadership and support. Despite leadership challenges, the Green Belt project team carried out the responsibilities for the project. In particular, the nurse managers involved in the project ensured staff were adhering to the weekly audits and supporting the completion of Med Rec within physician groups. A new process owner was assigned to the project; this person held staff accountable, provided much-needed leadership and removed additional barriers. Benefits At the end of this project there was an improvement of 52 per cent in Med Rec on
Active Offer Every Day: What’s next?
Horizon is committed to providing safe patient- and family-centered care that is respectful and inclusive.
We are giving the patient the choice — a choice that must be respected and communicated throughout the continuum of care.
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That means making the Active Offer part of how we work, every day. It is part of providing exceptional care. As such, the Active Offer Every Day initiative began in winter 2017. The Active Offer ensures members of the public know they have the right to use the official language of their choice when receiving care or service from any government employee.
The Active Offer is a legal requirement.
The simplest way to provide an Active Offer is “Hello / Bonjour.”
Our team is extremely thankful for your contributions. This project is a great Horizon-wide example of exceptional teamwork. Together, we can find the keys to providing the Active Offer to our patients, clients and visitors.
• Increased quality and patient safety
• 256 Active Offer Every Day dialogue sessions have been provided throughout Horizon. • 3,413 employees have participated, and 90 per cent of attendees provided feedback • 1,464 comments have been shared • 3,604 ideas and suggestions for the future have been submitted • 1,166 six-word stories have been told
Active Offer Every Day in Numbers
A New Chapter: The Active Offer Relaunch in 2019
• Learning Horizon needs to improve learning options. • Translation Horizon needs to optimize translation and interpreting solutions. • Employment Horizon needs to manage the impact Official Languages have on recruitment. Within each category, different actions will be suggested to move towards continuous improvement with the Active Offer Every Day. We look forward to working hand-in-hand with patients and staff to develop the linguistic solutions of tomorrow.
Do not hesitate to contact the Official Languages Advisor of your sector for any additional information. We are here to help. Miramichi: Pauline Durelle Pauline.Durelle@HorizonNB.ca (506) 623-6258 Moncton Jason MacKenzie Jason.MacKenzie@HorizonNB.ca (506) 870 2574 Saint John Gary Selway Gary.Selway@HorizonNB.ca (506) 648-6956
In addition to ongoing sessions that will allow all units to meet attendance expectations, Horizon’s Official Languages team will be concentrating on several specific and achievable targets. Your feedback has been analyzed, categorized and will be considered for future implementation. Five main categories have been identified: • Organization Horizon has a solution; implementation can be improved. • Communication Horizon needs to share information more effectively.
Fredericton Gary Selway (Temporary assignment)
From left: Lyzandra Pereira, Quality Consultant, Fredericton and Upper River Valley area; Susan McCarron, URVH Emergency Department nurse manager; Charlotte Everett, nowwith the New Brunswick Extra Mural Program, Perth unit; and Teena McCarthy, e-documentation clinical specialist in Nursing Practice were some of the member of the Med Rec on Discharge Green Belt project.
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