The Saskatoon Health Region (SHR) was one of the pioneers of medication reconciliation (MedRec) in home care, beginning its journey to implement MedRec in 2007. It took three years of work before a medication reconciliation strategy for home care was ready for implementation, as the standard definitions from acute care did not apply.
The key to making the process sustainable has been to streamline processes, reduce duplication, conduct audits and provide ongoing feedback to participants and clients. The MedRec in Home Care on admission process has been adopted and/or adapted by all 13 health regions across Saskatchewan. Between 80 to 100 per cent of home care clients now have their medications reconciled on admission.
Medication information is gathered from the client and their family and input is obtained from the community pharmacy. The client’s family physician then verifies the client’s medications. It is interesting to note that physicians often discontinue at least one in seven medications after the review. One of the side benefits of implementing a best possible medication history (BPMH) is that the home care nurse now knows when their client self-selects not to take or discontinue certain medications.
The MedRec team initially interviewed a number of physicians to determine whether over-the-counter medications and nutritional/herbal supplements should be included in the client’s medication history, along with the list of prescription drugs they are taking. It was determined that it would be good to have all information included on the medication record.
When MedRec was first implemented, audits became an integral part of the process. A Pharmacist and Clinical Nurse Educator audit charts monthly, at 5:30 am, when all charts are available. This comprehensive data is invaluable in providing timely feedback to staff on what needs to change and where they can improve.
The Medication Reconciliation in Home Care team is now tackling MedRec on transfer and discharge and determining how to audit that process. The challenge with MedRec at transfer points is ensuring effective communication amongst physicians. It is the system that fails the client when the information is not known or well understood throughout the transitions of care.
Myra Parcher, Manager of Operations, Saskatoon Health Region - Home Care is an inaugural faculty member of the Safer Healthcare Now! Medication Reconciliation in Home Care intervention. Myra worked closely with Safer Healthcare Now! and the Institute for Safe Mediation Practices Canada (ISMP Canada) in developing the SHR’s MedRec on admission process for Home Care. “As Faculty, we learned from one another and it was that collective thinking that helped move the process along in developing the Medication Reconciliation in Home Care Getting Started Kit,” says Myra.
While MedRec won’t fix everything, Myra says that there is a quality of life value that you can’t even begin to measure. Her advice is to stay with it and find your champions to implement medication reconciliation. If at all possible, have a pharmacist involved as it helps improve MedRec, particularly at discharge.