WSLHD A Clinical Services Redesign Project Carrie Marr Executive - - PowerPoint PPT Presentation
Medication Reconciliation WSLHD A Clinical Services Redesign Project Carrie Marr Executive Director Organisational Effectiveness, WSLHD August 2015 eMEDs Executive Sponsor Margaret Macarthur Director of Pharmacy BMDH & Pharmacy
August 2015
Executive Director Organisational Effectiveness, WSLHD eMEDs Executive Sponsor
Director of Pharmacy BMDH & Pharmacy Directorate,WSLHD
eMEDs Pharmacist,WSLHD
4 teaching hospitals
– Westmead – Blacktown Mount Druitt (2 campuses) – Auburn – Cumberland
7 Community Health Centres > 876,500 local residents > 9000 employees 2000 beds Strategic Challenges:
– Population growth 2% per annum until 2021 (NSW average 1.2%) and 40% increase in people aged 65+ – 45% local residents speak a language
average 24%) – >50% adult population is overweight
– Diabetes rates higher than NSW average
Improving access to information through technology is a key component of the strategy to enable clinicians to respond to the increase in demand for services.
Western Sydney LHD
Blacktown Hospital rolled out online clinical documentation in 2014; Why?
– to provide secure, real time access to medical records for all staff at all locations; – new Clinical Services building designed without paper records storage; – preparing the ground for EMM.
We are “Paper-Lite”
Clinical Services Redesign Framework
Project Approach
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for how the District could implement solutions which would deliver benefits that are commensurate with the original EMM business case and represent best value for money.
Project Auburn Blacktown Cumberland Mount Druitt Westmead Antimicrobial stewardship Pharmacy foundation projects Medications reconciliation Full electronic medications management
5
6
WSLHD & Paper-Lite Project Approach Planning Scope & Governance Diagnostic & Solution Implementation Sustainability Results & Summary
Speaker change
Stakeholder mapping & Communication
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Primary Care Providers Targeted
clinician engagement Safe use of Medicines Committee District Drug Committee Clinical Leadership Forums Safety & Quality in Health Care Councils Medical Staff Councils Patients (Focus Groups) Departmental & Specialty meetings
Meetings & Workshops One-to-one engagement Emails Corridor conversations
8 25 3 3 39 5 10 15 20 25 30 35 40
Medical Nursing Pharmacy Other Total
Objective: identify the key challenges in taking a BPMH and ensuring the accuracy of patient’s medications across the patient journey.
week period with 39 Blacktown Hospital staff across medical, nursing, and pharmacy staff.
patient journey, with particular emphasis on the admission and discharge process and the roles and responsibilities of clinical staff in medication management.
Staff Interviewed
Review best practice literature and findings from the CEC Blacktown medication audit Informal interviews with medical, nursing, and pharmacy staff to identify key issues Workshop to validate findings and receive feedback Interviews with GPs, community pharmacies and patient focus groups Solution Design Phase
1. Interviews with GPs and Community Pharmacists 2. Patient focus group
Impact Influence
Low High Low High
1
Roles and Responsibilities Systematic Process Admitting Team Rework
2 3
Transfer of Medication
4
Pharmacy Cover
5
Discharge Documentation
6
Day of discharge delays
7
Patient Education
8
1 2 3 4 5 6 7 8 9
Blacktown clinical staff ranked the key 9 findings based on: 1. Impact – the impact of the problem on the recording of accurate medications information. 2. Influence – the ability of clinicians and the
each of the problem areas.
34 38 32 3
107
20 40 60 80 100
Medical Nursing Pharmacy Other Total
The problems identified and prioritised during the diagnostic were used to structure the solution design phase.
February and was attended by 30 clinicians.
solutions to each of the problems. Clinicians were divided into 2 project work streams to focus on their area of expertise: 1. ED / Admission 2. Discharge
period for one hour and actions were completed in between meetings.
Staff Working Group Attendance
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December January February March April
Planning
Diagnostic Solution Design Implementation
Work Stream Meetings Interviews
12
Pre-arrival Emergency Department Inpatient Discharge
The solutions generated in the Working Groups are designed to improve the accuracy and handover of medication information between all clinicians involved in a patient’s management. This includes the communication of information between community and hospital based clinicians.
Medication Information Flow
Handling
Responsibilities
Summary
Solutions
GP Lists D/S Patient Initial Medication History Best Possible Medication History Discharge Summary Patient Friendly Medication List INBOUND INFORMATION OUTBOUND INFORMATION
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My MEDS TAKE CONTROL OF YOUR MEDICATIONS
Medication name & strength How much to take When to take Reason (if known) 8. 9. 10. 11. 12. 13. 14. 15.
Why should I use it?
Have an up to date medications
record on you at all times that you can easily share with your care team, including during emergencies.
Scan
the barcode
your medication to upload details to the app.
Record
vital health information, e.g. allergies.
Set alarms to remind you to take
your medication.
MedicineList+ is an app that helps you manage medications for yourself and the people you care for. Is there a smarter way to take control of my medications?
YES!
Download for free at
www.medicinelistplus.com.au
My MEDS
Show this list to your Doctor
My name is My Contact Information is Emergency Contact Name Phone
Fold Here
ground support
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A key theme of the project was medications being everyone’s business, so all health clinicians involved with patient’s medication management will be accountable
Result & Dashboards
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Summary: Enablers & Barriers of the project
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Barriers Enablers
Introducing a paper tool when already Paper-Lite Interim solution Not everyone was aware Engaged staff early Certain critics of change Recognition of champions Extra workload beliefs Tailoring training material More accountability Engagement by own profession Lower uptake to start Clinical Lead Misunderstanding eMEDs team role progression Dedicated support by eMEDs team to facilitate Implementing at other sites My MEDS leaflet tool
Activities
and roles
initiative
− Establish project objectives and KPIs − Request and receipt of data − Status and risk reporting
− Stakeholder mapping − Communication plan − Plan patient engagement strategies − Capability training for Planning and Diagnostics
− Workflow characteristics − Performance (incidents; compliance; quality) − Activity / volume − Target segmentation / risk stratification − Manual data collection (where required)
− Pharmacists − Doctors (Consultants; Registrars; Residents − Patient stories − Nursing
Design
ACSQHC; CEC; exemplar sites; existing LHD projects to provide input into design workshops
workshops: − Strengths based development: defining the vision, outlining the path, building the components − Develop standard ‘principles’ for medication reconciliation across WSLHD − Identify areas for local adaption of these principles in processes at each hospital (e.g. who performs a task dependent on staffing) − Outline process changes (‘to-be’ process − Outline behaviour changes (who are we expecting to act and do differently)
Implementation
− Components of solution developed: process, tools, education and communication materials, reporting, policy/procedure − Confirm KPI definition, baseline, targets, collection and reporting plan − Pilot implementation work plan finalised (cohort/speciality/ward etc.)
− Change teams and champions identified and resources allocated − Training on process, roles, accountabilities and reporting conducted
− Operationalise medication reconciliation process − Begin KPI monitoring and reporting − Real time feedback and revision
Implementation management
site:
compliance, communicate benefits to staff and patients
corrective responses
(reporting across LHD to promote competition to be considered)
incorporated into formal structures: policy, procedures, Position Descriptions
using the NHS sustainability framework Benefits
responsibilities
project governance
about who will be impacted, what the approach is and what the aims are
engaging with patients and staff
(qualitative and quantitative data)
medication reconciliation for local site
for change
impact of medication reconciliation processes
and innovation explored
promote ownership of improvements (potential to involve patients as best practice)
LHD standardisation through principles, with flexibility to achieve local implementation
performance measures for solutions
champions to lead, own and direct the change
feedback mechanisms, messaging and reporting
process
implementation
Outputs
Phase 1: Planning Phase 2: Diagnostics Phase 3: Solutions Design Phase 4: Implementation Phase 5: Sustain
1 2 3 4 5