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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. 

To make measurement easier, we’ll give you access to a web-based tool: Patient Safety Metrics. You can use this to generate your own reports and create charts from the data you enter. 

The Patient Safety Metrics system will allow you to collect monthly aggregate data using the indicator-specific Measurement Worksheets and audit level data using Data Collection (Audit) Forms.  The data from the Data Collection Forms are automatically rolled up into specific Measurement Worksheets.  See the table below for a comparison between the measurement worksheets and the data collection/audit forms.

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 DFCs​
​Aggregate data (monthly) ​De-identified Patient-level data (daily)
​Numerator and Denominator ​Multiple data elements
​Data submitted using online worksheets ​Data submitted by printed forms (Print form > Collect data > Fax form)
​Automatic roll-up to Measurement Worksheets (1 hour after faxing)
 

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 via ​N/A N/A​
​B. Was MedRec Performed? ​MedRec-Acute 5 ​MedRec-LTC 4
​C. BPMH based on >1 source ​MedRec-Acute 11, 12 ​MedRec-LTC 6, 7
​D. Actual medication use verified by pt./caregiver interview ​MedRec-Acute 11, 12 ​MedRec-LTC 6, 7
​E. Each medication has drug name, dose +/- strength, route, frequency on BPMH and Admission Orders ​MedRec-Acute 11, 12 ​MedRec-LTC 6, 7
​F. Every medication in the BPMH is accounted for in the admission orders ​MedRec-Acute 7, 11, 12 ​MedRec-LTC 5, 6, 7
​G. Prescriber has documented rationale for 'holds' and 'discontinued' medications ​MedRec-Acute 11, 12 ​MedRec-LTC 6, 7
​H. Discrepancy is communicated, resolved and documented ​N/A N/A​
 

MedRec (Acute Care) Measures

​Measure Goal​ Type​
​MedRec-Acute 1 - Mean Number of Undocumented Intentional Discrepancies per Patient ​Decrease 75% Outcome
​MedRec-Acute 2 - Mean Number of Unintentional Discrepancies per Patient ​Decrease 75% Outcome
​MedRec-Acute 3 - Medication Reconciliation Success Index (Optional Measure) ​Set % ​Process
​MedRec-Acute 4 - Percentage of Patients Reconciled at Discharge ​100% ​Process
​MedRec-Acute 5 - Percentage of Patients Reconciled at Admission ​100% ​Process
​MedRec-Acute 6 - Percentage of Patients Reconciled at Transfer ​100% ​Process
​MedRec-Acute 7 - Percentage of Patients with One or More Discrepancy at Admission ​Decrease Outcome
​MedRec-Acute 8 - Percentage of Patients Discharged with a BPMDP Distributed to ALL Eligible Care Providers ​100% ​Process
​MedRec-Acute 10 - Average Number of Discrepancies Identified per Patient at Discharge ​Decrease Outcome
​MedRec-Acute 11 - Average MedRec Quality Score at Admission ​100% Outcome
​MedRec-Acute 12 - Quality Audit Bundle Compliance at Admission ​100% ​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) ​Set ​Balancing
​MedRec-HC 3 - Percentage of eligible Home Care clients with at least one discrepancy ​Set % ​Process
​MedRec-HC 4 - Percentage of Medication Discrepancies Identified by Type ​100% ​Information

 

MedRec (Long Term Care) Measures

​Measure Goal​ Type​
​MedRec-LTC 1 - Mean Number of Undocumented Intentional Discrepancies per Resident in Long-Term Care ​Decrease 75% ​Information
​MedRec-LTC 2 - Mean Number of Unintentional Discrepancies per Resident in Long-Term Care ​Decrease 75% ​Outcome
​MedRec-LTC 3 - Percentage of Long-Term Care Residents Reconciled ​100% ​Process
​MedRec-LTC 4 - Percentage of Residents Reconciled at Admission ​100% ​Process
​MedRec-LTC 5 - Percentage of Residents with One or More Discrepancy at Admission ​Decrease ​Outcome
​MedRec-LTC 6 - Average MedRec Quality Score at Admission ​100% ​Outcome
​MedRec-LTC 7 - Quality Assessment Bundle Compliance at Admission ​100% ​Process

 

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

Please note that the Patient Safety Metrics system is no longer accepting data. Click here or email us at metrics@saferhealthcarenow.ca for more information.

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