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Vital to quality improvement is measurement, and this applies specifically to implementation of interventions. The chosen measures will help to determine whether an impact is being made (primary outcome), whether the intervention is actually being carried out (process measures), and whether any unintended consequences ensue (balancing measures).

Below are some recommended measures to use, as appropriate, to track your progress. In selecting your measures, consider the following:

  • Whenever possible, use measures you are already collecting for other programs.
  • Evaluate your choice of measures in terms of the usefulness of the final results and the resources required to obtain them; try to maximize the former while minimizing the latter.
  • Try to include both process and outcome measures in your measurement scheme.
  • You may use different measures or modify the measures described below to make them more appropriate and/or useful to your particular setting. However, be aware that modifying measures may limit the comparability of your results to others.
  • Posting your measure results within your hospital is a great way to keep your teams motivated and aware of progress. Try to include measures that your team will find meaningful and exciting (IHI, 2012).

For more information on measuring for improvement, contact the Canadian Patient Safety Institute Central Measurement Team at measurement@cpsi-icsp.ca

Outcome – Medication Reconciliation

  1. Per cent of Patients Reconciled on Admission
  2. Per cent of Patients Reconciled on Transfer
  3. Per cent of Patients Reconciled at Discharge
  4. Per cent of Patients Undergoing Medication Review on Admission

Outcome – High Alert Medications

  1. Adverse Drug Events Related to Narcotic per 100 Admissions with Narcotic Administered
  2. Adverse Drug Events Related to Anticoagulant per 100 Admissions with Anticoagulant Administered
  3. Adverse Drug Events Related to Insulin per 100 Admissions with Insulin Administered
  4. Adverse Drug Events Related to Sedative per 100 Admissions with Sedative Administered
  5. Per cent of Patients Receiving Warfarin with INR Outside Protocol Limits
  6. Per cent of Patients Receiving Heparin with a PPT Outside Protocol Limits
  7. Per cent of Patients Receiving Insulin with Blood Glucose Level Outside Protocol Limits
  8. Per cent of Patients Receiving Narcotic Who Require Subsequent Treatment with Naloxone
  9. Per cent of Patients Receiving Sedative Who Require Subsequent Treatment with Flumazenil

Process – Medication Reconciliation

  1. Percentage of Patients Using More Than One Source for BPMH
  2. Percentage of Patients For Whom Actual Medication Use Was Verified by Patient/Caregiver
  3. Percentage of Patients For Whom BPMH And Admission Orders has Drug Name, Dose, Route, And Frequency for Each Medication
  4. Percentage of Patients For Whom Every Med in BPMH is Accounted For in Admission Orders
  5. Percentage of Patients For Whom Prescriber Has Documented Rationale For Holds and Discontinued Meds

Process – High Alert Medications

  1. Per cent of Narcotic Administrations Appropriately Managed According to Protocol
  2. Per cent of Anticoagulant Administrations Appropriately Managed According to Protocol
  3. Per cent of Insulin Administrations Appropriately Managed According to Protocol
  4. Per cent of Sedative Administrations Appropriately Managed According to Protocol
  5. Per cent of Unreconciled Medications
  6. Unreconciled Medications per 100 Admissions

In addition to the above measures you may need to create your own process improvement measures based on the results of your clinical and system review and the focus of your improvement efforts.