​​Holland Bloorview Kids Rehabilitation Hospital has created an all-encompassing approach to medication management for children and youth with disabilities and complex medical needs attending camps and programs that the hospital offers.

Each year, the Participation and Inclusion program provides community-based and on-site recreational, life skills and creative arts programs to more than 400 children and youth between the ages of seven and 18. The programs are offered at the rehabilitation hospital, as well as at college and university residences and residential camps at various locations throughout the greater Toronto area.

“The underlying philosophy of the program is to include experiential learning and calculated risk-taking to help our clients experience life in a community setting, while providing skills to transition to adulthood and gain as much independence as possible,” says C.J. Curran, Operations Manager, Participation and Inclusion.  “We had to be creative and take a collaborative approach in developing and customizing safe medication practices in these non-medical environments.”

Following a medication incident in one of the programs, a working group was created with teams from each program area to look at their medication practices. Together, they created and adopted a common intake form to collect medication history and then developed a new medication administration record (MAR) with photo identification.

Wrist bands are used to identify participants taking medications and two patient identifiers have been implemented when giving medications. Other safety precautions include same name and look alike/sound alike name flagging; having two staff members verify the MAR, which the family also verify and sign-off; and a physician-signed letter to verify the medications.

A registration form is used to collect the initial medication information from program participants. A standardized MAR is then created by a nurse on the first day the participant attends the program; that information is then shared across portfolios to ensure safe handover of information between staff administering medications.  A number of safety features have been built into the MAR, including information on allergies and over-the-counter and herbal remedies so that all medical information on each participant is in a centralized location.

The programs are run by non-medical staff, therefore, an education session is held annually with staff from each camp and program to review and gather feedback on the medication management process. In addition, an orientation program has been developed for all new staff, where they are introduced to the integrated practices and standardized processes. “We strive to provide best practices for medications across the entire portfolio and review medication principles and practices so that the frontline staff is comfortable with the processes,” says Nick Joachimides, Manager, Patient Safety.

The Working Group used a Failure Mode and Effect Analysis (FMEA) approach to look at four areas of the medication management process: pre-program and the first day; applying best practices for storage of medications; administration of medications; and documentation and handover (currently in process). They also used stretch benchmarking – going beyond healthcare to look for ideas and best practices. Parks and recreation departments, school boards and camping associations were consulted to look at strategies that could be applied in this environment.

“We had a lot of challenges on how to store the medications safely and securely in a community setting,” says Nick Joachimides. “In a camp situation, our participants will travel throughout the city and our challenge was how to store medications securely in those environments. We looked at all of the program needs and standardized storage containers in backpacks based on each program requirement, as well as ways to accommodate refrigeration of medications.”

The medication management program was developed in collaboration with clients and families, members of the Holland Bloorview Youth Advisory Committee, front-line staff and with full support of the leadership team. Holland Bloorview attributes the success of their medication management program to being able to involve frontline staff from the beginning and the engagement of both frontline staff and families.

“Family members and clients have also provided feedback on the program and processes and we also reached out to the Youth Advisory Council to provide input on ways to improve medication administration,” says Nathan Ho, Pharmacy Manager.

A creative “Dragon’s Den” style approach was used where frontline staff came up with ideas on how to close gaps and look at what to put in place to streamline processes that were then implemented into daily practice across the portfolio. “Staff were encouraged that they could share their ideas and appreciated that we were coming to them for their input,” says Nick Joachimides. “We were humbled by how eager the staff were to contribute to any learning to be had, their openness to new processes, and their commitment to enhancing patient safety and mitigating risk.”

 “We have found a balance between preserving the nature of our programs while ensuring the safe management of medications,” says C.J. Curran.

Holland Bloorview has shared their learnings nationally and internationally and have been recognized by the Institute for Healthcare Improvement (IHI) and Accreditation Canada for medication best practices. To learn more about the Participation and Inclusion safe medication management program, contact  cjcurran@hollandbloorview.ca  /or nho@hollandbloorview.ca