CANADIAN MEDREC QUALITY AUDIT MONTH 2015: RESULTS

Facilitator: Maryanne D’Arpino CPSI Presenter: Jennifer Turple, ISMP Canada

March 31st, 2015

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Jennifer graduated from Dalhousie University's College of Pharmacy in 2001. In 2002 she went on to pursue a hospital pharmacy residency at Capital District Health Authority (CDHA) in Halifax, NS. She then worked as a clinical pharmacist in a general cardiology unit for several years before taking on the role of Medication Safety Pharmacist for CDHA in 2007. Jennifer gained experience conducting research in a pediatric emergency department just prior to joining ISMP Canada in the fall of 2011. Since joining the ISMP Canada team, Jennifer has worked as part of the Safer Healthcare Now! Medication Reconciliation intervention lead team and with the consumer medication safety program, SafeMedicationUse.ca. She is currently enrolled in part time study in a Masters of Health Informatics program and resides in Halifax, NS.

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Today’s Speaker Jennifer Turple, BScPsych, BScPharm, ACPR

Canadian MedRec Quality Audit Month 2015: Results

Outline

Background – MedRec Quality Audit Tool – MedRec Quality Audit Month

Audit Month Results – Participation – Aggregated results by audit tool “column” – Calculated results – Relationships between variables

Discussion & Next steps

Background MedRec Quality Audit (MRQA) Tool

MRQA tool launched in June 2013 Collects data on the quality completion of

admission MedRec in acute and long term care settings

Completed through chart audit post-completion of admission MedRec processes

Organization specific tools are generated through Patient Safety Metrics System (PSMS)

Completed tools are faxed, and data is presented in PSMS

Across Canada, there are ongoing challenges related to the effective and reliable completion of MedRec processes.

Measurement of MedRec processes can help to identify areas of excellence and areas for improvement 1st MedRec Quality Audit Month- October 2013 2nd MedRec Quality Audit Month- February 2015

Background Canadian MedRec Quality Audit Month

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MedRec Quality Audit Month webpage was created with: – Detailed instructions to participate – Frequently asked questions/answers

Organizations were invited to register to participate in Audit Month in November 2014.

Each registered org. was contacted by the Central Measurement team to facilitate creation of MRQA tools.

Call to action national call/webinar on January 6th, 2015.

All data submitted to PSMS (for Feb 2015 audits) was included in the analysis.

Background Quality Audit Month Methodology

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Audit Month Results

• Audit participation

• Aggregated results by audit tool “column”

• Calculated results

• Relationships between variables

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Audit Month Results Audit Month Participation- # of sites/charts

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Oct. 2013 Feb. 2015

Sites 103 173

Patients / Residents 2340 5201

Audit Month Results 2015 Audit Month Participation by Jurisdiction

Sites (n) = 173 Records (n) = 5201

Audit Month Results 2015 vs. 2013 Audit Month Participation by Jurisdiction

2013 2015 Sites (n) 103 173

Record (n) 2,340 5,201

Audit Month Results Audit Month Participation by Sector

79%

31%

Acute

LTC

Acute

LTC

Sites (n) = 173 Records (n) = 5201

What do you think the results will show?

We have a lot of work to do

We are doing alright We are doing

great

Audit Month Results

• Audit participation

• Aggregated results by audit tool “column”

• Calculated results

• Relationships between variables

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0

A. Admit via

60%

48%

n=4526+436

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B. MedRec Performed

80% 98%

n = 4745+443

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A review of published articles found that 10-67% of patients had at least 1 prescription medication history error – when non-prescription medications were included the

frequency of errors was 25-83% Authors suggest: “should be a comprehensive medication

history that includes an interview, inspection of medication vials or lists, or both and contact with community pharmacies, or family physicians.”

CMAJ, 2005 http://www.cmaj.ca/content/173/5/510.full.pdf+html

Studies suggests…..

Studies suggests…

66% of Canadians have sometimes used non-prescription medication in the past six months.

57% sometimes took vitamins and minerals, while 34% sometimes took herbal and natural products.

2004 Survey of Canadians’ Use of OTC Medications http://www.bemedwise.ca/english/usagesurvey.html

12% of patients don’t fill their prescription at all. 12% of patients don’t take medication at all after they

fill the prescription. 22% of patients take less of the medication than is

prescribed on the label. Adult Meducation http://www.adultmeducation.com/OverviewofMedicationAdherence_2.html

C. BPMH based on greater than one source

69%

n=3988+434

70%

D. Med Use Verified by Pt/Caregiver

66%

n=3979+434

54%

E. Each med w/name dose, route, etc.

88%

n=3981+435

83%

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Studies suggests….

Medication discrepancy was defined as a difference between the medication use history (BPMH) and the admission medication orders.

In the sample of patients admitted to general medicine unit: – 54% of patients had at least one unintentional discrepancy

identified (most common type was omission of a regularly used medication)

– 38% of these discrepancies were judged to have the potential to cause moderate to severe discomfort or clinical deterioration

F. Meds on BPMH are accounted for

80%

n=3976+432

81%

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G. Prescriber documented rationale

69%

n=3951+435

76%

Audit Month Results

• Audit participation

• Aggregated results by audit tool “column”

• Calculated results

• Relationships between variables

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To calculate a MedRec Quality Score, each “Yes” (or “Unable to Perform”) is

assigned 1 point for each of the highlighted columns

Average MedRec Quality Score 2013 vs. 2015 by Sector

2013 (n) = 1945 2015 (n) = 4825

Average MedRec Quality Score By Province and Sector

n=4825

Percentage of Patients by Score 2013

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29%

n=1937

55%

Scores

Percentage of Patients by Score 2015

35%

n=4825

30%

Audit Month Results

• Audit participation

• Aggregated results by audit tool “column”

• Calculated results

• Relationships between variables

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Percentage of MedRec Performed x Score

30%

40%

n=4210

Percentage of MedRec Not Performed x Score

3% 11%

n=615

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Compliance w/ BPMH elements by “Admit via”

n=2393

Results Summary

Good overall pan-Canadian participation in the 2nd MRQA month – 173 participating sites & over 5000 charts audited

There MAY be a disconnect between assessment of MedRec performed measure and actual quality admission MedRec completion

The 3 key “components” that define a BPMH were found in approximately 70%, 65% and 85% of charts audited respectively.

Results Summary

Despite having an established MedRec process, outstanding discrepancies between the BPMH and admission orders/documentation (a key step in the MedRec process) was found in 20% of the charts audited.

32% of charts audited had all 5 key quality dimensions present.

This “snapshot” suggests that there remains many potential opportunities for MedRec quality improvement – Use your own organizational data to drive your quality

improvement efforts!

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These results are:

Shocking Expected

Discussion/ Questions

Next Steps

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Of those 120* sites who participated in the 2013 MedRec Quality Audit Month: – 106 sites (88%) have continued to submit

data to Patient Safety Metrics using the MRQA tool through to Feb 2015

*includes 17 late submissions

Using Your Data for Improvement

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Using Your Data for Improvement

53 * Of those who participated in MRQA month 2013

1-9 Data Submissions

53%

10-17 Data Submissions

47%

Data Submissions since MRQA Month 2013*

Audits are used to increase awareness of the need to measure your medrec processes consistently over time

Measurement data will signal medrec processes which require attention

Measurement is the key to understanding if the changes you implement are improving your medrec processes

Using Your Data for Improvement

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Supporting Quality Improvement in MedRec

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Call for Action

MedRec Quality Audit Month

National Results

QI in MedRec

Upcoming MedRec Webinar

May, 2015 Noon Eastern Time

“Beyond the Audit: Measuring MedRec Processes for Quality Improvement”

What you can expect: 1. Recap of aggregated MedRec audit month data that identify

potential opportunities for improvement

2. Review of concepts as it relates to measuring for quality improvement

3. Review how to enter data into the Patient Safety Metrics System and create run charts

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Medrec Getting Started Kits • Acute

http://www.saferhealthcarenow.ca/EN/Interventions/medrec/Documents/Acute%20Care/MedRec%20(Acute%20Care)%20Getting%20Started%20Kit.pdf

• Long Term Care http://www.saferhealthcarenow.ca/EN/Interventions/medrec/Documents/Long%20Term%20Care/Med%20Rec%20(Long%20Term%20Care%20)%20Getting%20Started%20Kit.pdf

• Home Care http://www.saferhealthcarenow.ca/EN/Interventions/medrec/Documents/Home/Medication%20Reconcillation%20in%20Home%20Care%20Getting%20Started%20Kit.pdf

Improvement Guide GSK http://www.patientsafetyinstitute.ca/English/toolsResources/ImprovementFramework/Documents/Improvement%20Frameworks%20GSK%20EN.PDF

Resources

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We are here to help!

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For Audit forms and Data Questions CPSI Central Measurement Team metrics@saferhealthcarenow.ca Virginia Flintoft - 416-946-8350 Alexandru Titeu - 416-946-3103

For MedRec Content (MedRec Intervention Lead) Institute for Safe Medication Practices Canada (ISMP

Canada) medrec@ismp-canada.org CPSI Patient Safety Intervention Lead

Maryanne D’Arpino MDArpino@cpsi-icsp.ca