Concordia Hospital in Winnipeg, Manitoba, has embraced medication reconciliation (MedRec) and is looking to implement it in its full capacity – admissions, transfer and discharge, across all units by 2020.

Concordia participated in the Canadian MedRec Quality Audit Month in February 2015, to obtain a snapshot of where they were at from a Canadian perspective. "We brought in a pharmacist who did a couple of extra shifts to complete the Family Medicine/Surgery audits," says Linda Mumtaz, Director Program and Patient Services, Family Medicine/Oncology/Lab/Pharmacy. "Having someone who understood what needed to be looked at, where to look for it, and how to answer the questions made the process a lot easier.  It was not that difficult to do; it just takes time to do it. We also had assistance from the Clinical Manager from Critical Care to complete the audit."

Mumtaz has four Family Medicine units reporting to her (114 beds), other units audited included a 28- bed surgery unit, seven-bed Critical Care Unit, and the emergency department. "Some programs have embraced MedRec and are further along," says Mumtaz. "We keep tweaking our processes and improving them.  It takes a lot of teamwork and we are seeing steady improvement."

Emergency room physicians initiate MedRec for patients being admitted to the family medicine unit(s). Tools have been put in place to collect information on what medications they are on at home and what medications have been changed in ER. When the family medicine physician takes on the patient, it makes it much easier for them to change or agree with the medication protocol.

Concordia has a well-designed process for doing MedRec on transfer to a Personal Care Home (PCH) from N1N (one of the Family Medicine Units). The majority of patients on the Family Medicine Sub-Acute Unit go to a PCH; the staff worked with the Regional Pharmacy and MedRec representatives and created a process that is now well-known throughout the region.

When family medicine unit patients are discharged home, they are armed with a copy of current medications that they are on. A copy is faxed to the patient's family physician for follow-up.  Approximately 10- 12 patients are discharged each day, so the work involved behind the scenes can at times be onerous.

"We have set up a mechanism whereby if the physician and the team identify that a patient is ready for discharge, the day prior we will have the MedRec paperwork ready for the physician to review and document any changes required," says Mumtaz. "We have made the mechanism come together so that it is a smooth process. In the case of a complicated patient going home on 10 to 15 medications, we will ask the pharmacist to review the medications to flag any interactions and make any recommendations prior to the physician completing the MedRec."

Concordia also has a number of pharmacists allocated to cover the family medicine unit(s).  The pharmacists attend discharge planning rounds and will make recommendations along the way. 

Mumtaz emphasizes the importance of engaging your stakeholders upfront, being patient and being consistent. The Management Team shares expectations of Accreditation Canada required organizational practice and MedRec audit results by summarizing information so that is not too overwhelming.  One of the quality staff also does chart reviews to look for markers that physicians are expected to deliver on and then works one-on-one with the individual physicians to get them where they need to be. 

"You need to help people learn how to do MedRec," says Mumtaz. "Our Chief Medical Officer and Chief Nursing Officer have been very proactive and that leadership has been invaluable from a physician and nursing perspective. We have trained the clinical managers, nurses and clerks on the floor how to print and use the MedRec documents. This has been a long process, and the building blocks are in place to get to where we need to be by 2020."