At Horizon Health Network (Horizon), the Patient Safety Consultants: Diane Beaulieu (Saint John), John Glidden (Miramichi), Paula Pickard (Fredericton), and Melissa Stark (Moncton) are ambassadors for patient safety in their respective areas. They are passionate in assisting staff and teams with the implementation of medication reconciliation (MedRec). As a means to maintain the momentum for MedRec, they acknowledge and commend the staff for their hard work and dedication with this patient safety initiative. They recognize that quality MedRec can be unsuccessful if it is not kept at the forefront. However through persistence and use of a quality improvement framework which includes conducting small tests of change, constant monitoring, and evaluation - MedRec processes are becoming established and embedded in Horizon's organizational culture.
When the five New Brunswick Regional Health Authorities came together to form Horizon in 2008, each of the areas were at different stages of MedRec implementation. In January 2011, Horizon established a Regional Medication Reconciliation Committee to ensure that cross-regional collaboration occurred. This facilitated the planned organization-wide implementation and ongoing evaluation of MedRec. Due to Horizon's size and complexity, it was necessary that each area established a local multidisciplinary MedRec Committee with the goal of improving local MedRec processes and compliance results. These committees are accountable to the Regional MedRec Committee.
|As means to communicate MedRec compliance results across the organization, quantitative data for MedRec on Admission is provided to the Regional MedRec Committee and distributed to the senior leadership team, clinical networks, nurse managers and frontline staff on a quarterly basis. "This accountability framework has proven to be a very effective way of maintaining the momentum for MedRec," says John Glidden. "It reinforces the importance of MedRec, increases the visibility of compliance rates and the reason why we are doing audits".
Horizon's MedRec on admission process is well-established in Horizon's Acute Care, Home Care, and Community Mental Health services. As a means to further evaluate the quality of MedRec on Admission, Horizon began to use the
Safer Healthcare Now! Patient Safety Metrics MedRec quality audit tool in 2012. Sample MedRec audits are performed monthly. In many areas, the audit results are colorfully displayed on each nursing unit to highlight results to staff. This is a quick, visual means of letting everyone know how well they are doing, and helps identify areas for improvement. The quality audit tool is helpful in evaluating if the required steps of the MedRec process have been completed, such as it helps to identify if staff are using more than one source to create the Best Possible Medication History (BPMH). "Using the Patient Safety Metrics tools and resources enable us to do sample audits, and get our audit results back very quickly," adds John. "This allows us to provide real-time analysis and feedback which helps to keep the momentum going and the enthusiasm up."
Horizon was one of 173 sites that participated in the Canadian MedRec Quality Audit in February 2015, using the
Safer Healthcare Now! Patient Safety Metrics audit tool. Horizon volunteered to partake in this national audit for several reasons: to help raise staff's awareness for MedRec, to benchmark against other healthcare organizations, and to evaluate the quality of their MedRec on Admission processes. Having a thorough and 'quality' MedRec on Admission process is imperative since this information is used at each care transition throughout the hospital stay.
The following are MedRec results from the February 2015 Canadian MedRec Quality Audit:
% Patients Reconciled at Admission
Average MedRec Quality Score
February 2015 – Patient Safety Metrics
|"Lessons learned from successful implementation of MedRec within Horizon include ensuring MedRec processes are simple and embedding them into existing practices," says Diane Beaulieu. "If your processes are too cumbersome, they can fall off the radar. There have been challenges in some areas, however by doing Plan-Do-Study-Act (PDSA) rapid improvement cycles we have been able to identify areas of improvement and move forward."
"It is important to involve all stakeholders – physicians, pharmacy and nursing in developing your MedRec processes," says Paula Pickard. "In our local area, initially we did not have a lot of physician engagement. Our MedRec Committee felt physician involvement was a priority for moving MedRec forward. The MedRec Chairs met with several physician groups to address barriers and encourage their engagement with MedRec. This has resulted in physician involvement on the local MedRec Committee."
Ultimately MedRec is about improving patient safety. "Across Horizon any MedRec-related patient safety incidents are captured and trended, using the Hospital Incident Management System," says Melissa Stark. "This information is then used to make improvements. For example, when MedRec at Discharge was implemented, the number of incident reports increased substantially. This was great to see, because it meant Med Rec was becoming a normal part of practice; staff were identifying issues around the processes, they were able to discuss the issues with the team and physicians, and identify areas for improvements. Ultimately, this is an indicator that MedRec is making a difference and improving patient safety."
Work is now underway at Horizon on refining processes for MedRec at Transfer and Discharge. Area MedRec Committees and clinical network teams are also focusing efforts on meeting Accreditation Canada's test of compliance for Medication Reconciliation at Care Transitions. Processes to measure the compliance and the quality of MedRec at Transfer and Discharge are in development, including a quantitative dashboard indicator and quality audits. Implementing Med Rec is a continuous quality improvement journey; a journey that is well underway at Horizon due to the ongoing commitment and dedication of physicians and staff for patient safety.