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Measurement is essential to monitoring success and helps guide your team towards your specific intervention goal. Measurement also tells us what's working and what's not, and provides evidence to inspire other healthcare providers to improve the quality of patient safety. 

The measurement methodology and recommendations regarding sampling size referenced in this GSK, is based on The Model for Improvement and is designed to accelerate the pace of improvement using the PDSA cycle;  a "trial and learn" approach to improvement  based on the scientific method. Langley, G., Nolan, K., Nolan, T., Norman, C., Provost, L. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. San Francisco, Second Edition, CA. Jossey-Bass Publishers. 2009.

It is not intended to provide the same rigor that might be applied in a research study, but rather offers an efficient way to help a team understand how a system is performing. When choosing a sample size for your intervention, it is important to consider the purposes and uses of the data and to acknowledge when reporting that the findings are based on an "x" sample as determined by the team.

The scope or scale (amount of sampling, testing, or time required) of a test should be decided according to:

  1. The team's degree of belief that the change will result in improvement
  2. The risks from a failed test
  3. Readiness of those who will have to make the change

Provost, Lloyd P; Murray, Sandra (2011-08-26). The Health Care Data Guide: Learning from Data for Improvement (Kindle Locations 1906-1909). Wiley. Kindle Edition.

Please refer to the Improvement Frameworks GSK (2015) for additional information.

Measurement Worksheets (Measures) and Data Collection Forms (DCF)

Measures DCFs
Aggregate data (monthly)De-identified Patient-level data (daily)
Numerator and DenominatorMultiple data elements
Roll-up to Measurement Worksheets

 

MedRec Quality Audit

The MedRec Quality Audit tool can be used by acute care and long term care organizations to measure the quality of the basic elements of their MedRec process on admission.  These data will be helpful in identifying specific elements in need of process improvement and potentially reducing the occurrence of preventable drug events.

MedRec (Acute Care and Long Term Care) Quality Audit

DCF (Audit) Question Roll-up to ACUTE Measures Roll-up to LTC Measures
A. Admitted viaN/AN/A
B. Was MedRec Performed?MedRec-Acute 5MedRec-LTC 4
C. BPMH based on >1 sourceMedRec-Acute 11, 12MedRec-LTC 6, 7
D. Actual medication use verified by pt./caregiver interviewMedRec-Acute 11, 12MedRec-LTC 6, 7
E. Each medication has drug name, dose +/- strength, route, frequency on BPMH and Admission OrdersMedRec-Acute 11, 12MedRec-LTC 6, 7
F. Every medication in the BPMH is accounted for in the admission ordersMedRec-Acute 7, 11, 12MedRec-LTC 5, 6, 7
G. Prescriber has documented rationale for 'holds' and 'discontinued' medicationsMedRec-Acute 11, 12MedRec-LTC 6, 7
H. Discrepancy is communicated, resolved and documentedN/AN/A

 

MedRec Quality Audit Tools

MedRec-Acute Home Care Long Term Care
MedRec-Acute DCF - [PDF] MedRec-HC DCF - [PDF] MedRec-LTC DCF - [PDF]
MedRec-Acute Instructions - [PDF] MedRec-HC Score Template - [Excel] MedRec-LTC Instructions - [PDF]
MedRec-Acute Score Template - [Excel]  MedRec-LTC Score Template - [Excel]

 

MedRec (Acute Care) Measures

Measure Goal Type
MedRec-Acute 1 - Mean Number of Undocumented Intentional Discrepancies per PatientDecrease 75%Outcome
MedRec-Acute 2 - Mean Number of Unintentional Discrepancies per PatientDecrease 75%Outcome
MedRec-Acute 3 - Medication Reconciliation Success Index (Optional Measure)Set %Process
MedRec-Acute 4 - Percentage of Patients Reconciled at Discharge100%Process
MedRec-Acute 5 - Percentage of Patients Reconciled at Admission100%Process
MedRec-Acute 6 - Percentage of Patients Reconciled at Transfer100%Process
MedRec-Acute 7 - Percentage of Patients with One or More Discrepancy at AdmissionNo goalOutcome
MedRec-Acute 8 - Percentage of Patients Discharged with a BPMDP Distributed to ALL Eligible Care ProvidersNo goalProcess
MedRec-Acute 9 - Percentage of Patients with a Medication Calendar

No goal

 

 
MedRec-Acute 10 - Average Number of Discrepancies Identified per Patient at DischargeNo goalOutcome
MedRec-Acute 11 - Average MedRec Quality Score at Admission100%Outcome
MedRec-Acute 12 - Quality Audit Bundle Compliance at Admission100%Process
MedRec-Acute 13 - Percentage of Patients using more than one source for BPMH100%Process
MedRec-Acute 14 - Percentage of Patients for whom actual med use was verified by pt/caregiver100%Process
MedRec-Acute 15 - Percentage of Patients for whom BPMH and Admission Orders has drug name, dose, route, and frequency for each medication100%Process
MedRec-Acute 16 - Percentage of Patients for whom every medication in BPMH is accounted for in Admission Orders100%Process
MedRec-Acute 17 - Percentage of Patients for whom the prescriber has documented the rationale for Holds and Discontinued medications100%Process
MedRec-Acute 18 - Percentage of Patients for whom a Best Possible Medication History (BPMH) was Completed100%Process

MedRec (Home Care) Measures

Measure Goal Type
MedRec-HC 1 - Percentage of eligible Home Care clients with a Best Possible Medication History (BPMH)95%Process
MedRec-HC 2 - The average time to complete a Best Possible Medication History (BPMH)SetBalancing
MedRec-HC 3 - Percentage of eligible Home Care clients with at least one discrepancySet %Process
MedRec-HC 4 - Percentage of Medication Discrepancies Identified by Type100%Information
MedRec-HC 5 - Percentage of Home Care Clients for whom MedRec was initiated95%Process
MedRec-HC 6 - Percentage of  Home Care Clients for whom the BPMH was based on more than one source for BPMH100%Process
MedRec-HC 7 - Percentage of Home Care Clients for whom actual medication use was verified by the client/caregiver100%Process
MedRec-HC 8 - Percentage of Home Care Clients for whom BPMH and Admission Orders has drug name, dose, route, and frequency for each medication100%Process
MedRec-HC 9 - Percentage of Home Care Clients for whom every medication in BPMH is accounted for in Admission Orders95%Process
MedRec-HC 10 - Percentage of Home Care Clients for whom Discrepancies were Resolved, and/or Communicated to the Most Responsible Provider, and Actions Documented95%Process
MedRec-HC 11 - Percentage of Home Care Clients for whom the reconciled medication list has been communicated to the client/caregiver and others in the client circle of care.95%Process
MedRec-HC 12 - Average MedRec Quality Score at Admission100%Outcome
MedRec-HC 13 - Home Care MedRec Quality Bundle Compliance at Admission100%Process

MedRec (Long Term Care) Measures

Measure Goal Type
MedRec-LTC 1 - Mean Number of Undocumented Intentional Discrepancies per Resident in Long-Term CareDecrease 75%Information
MedRec-LTC 2 - Mean Number of Unintentional Discrepancies per Resident in Long-Term CareDecrease 75%Outcome
MedRec-LTC 3 - Percentage of Long-Term Care Residents Reconciled100%Process
MedRec-LTC 4 - Percentage of Residents Reconciled at Admission100%Process
MedRec-LTC 5 - Percentage of Residents with One or More Discrepancy at AdmissionNo goalOutcome
MedRec-LTC 6 - Average MedRec Quality Score at Admission100%Outcome
MedRec-LTC 7 - Quality Assessment Bundle Compliance at Admission100%Process
MedRec-LTC 8 - Percentage of Residents using more than one source for BPMH100%Process
MedRec-LTC 9 - Percentage of Residents for whom actual medication use was verified by the resident/caregiver100%Process
MedRec-LTC 10 - Percentage of Residents for whom BPMH and Admission Orders has drug name, dose, route, and frequency for each medication100%Process
MedRec-LTC 11 - Percentage of Residents for whom every medication in BPMH is accounted for in Admission Orders100%Process
MedRec-LTC 12 - Percentage of Residents for whom the prescriber has documented the rationale for Holds and Discontinued meds100%Process
MedRec-LTC 13 - Percentage of Patients for whom a Best Possible Medication History (BPMH) was Completed100%Process

Types of Measures

Safer Healthcare Now! (SHN) has two types of measures for each of the interventions: process measures and outcome measures. Some interventions also have balancing measures and information measures. Below are examples of each.

Outcome measures - answers whether the team is achieving what it is trying to accomplish and articulates the picture of success. For example, if the team wants to reduce falls it should measure the number of falls.

Process measures - Processes which directly affect the outcome are measured to ensure that all key changes are being implemented to impact the outcome measure. For example, the delivery of timely prophylactic antibiotics to reduce surgical site infection.

Balancing measures - answer the question whether improvements in one part of the system were made at the expense of other processes in other parts of the system. For example, in a project to reduce the average length of stay for a group of patients, the team should also monitor the percent of readmissions within 30 days for the same group.

Information measures - collect general details relative to the intervention.