Moving From Paper To Electronic Medication Reconciliation
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- 1. Moving from Paper to Electronic Medication Reconciliation November 12, 2013www.saferhealthcarenow.ca
2. Welcome to our francophone attendees Bienvenue nos participants francophones Hlne Riverin Conseillre en scurit et en amlioration Safety Improvement Advisor www.saferhealthcarenow.ca 3. Pour nos participants francophones.. Pour accder aux diapositives franais: -Cliquez sur l'onglet "FRENCH" OU -Envoyer un courriel email@example.com Suivre la bote Chat pour les commentaires du confrencire traduit en franaiswww.saferhealthcarenow.ca 4. Next Webinar: December 10, 2013 at 12 noon ETMedRec Quality Audit Month Results2235 patientsOrganizations28% Met all 5 quality criteria40%99 1906 Acute Care 329 Long Term Care 3 - 4 met quality criteriaJoin us to hear about the results and how your organization should be involved. www.saferhealthcarenow.ca 5. Call Overview Introduce the toolkit to support healthcare providers in making a safe and effective transition from paper MedRec to eMedRec. 1.Discuss the results of the pan-Canadian survey of existing practices with respect to the use of technology to support Medication Reconciliation (MedRec)2.Describe the steps and considerations for transitioning to electronic MedRec (eMedRec)3.Identify factors that support and impede successful migration of paper MedRec to eMedRec.4.Discuss the lessons learned from research and other organizations.www.saferhealthcarenow.ca 6. Todays Speakers Dr. Elizabeth Borycki Dr. Borycki is an Associate Professor at the University of Victoria, Victoria, British Columbia Canada. Dr. Borycki has worked in numerous roles among them as a Clinical Informatics Specialist, Disease Management Specialist, Consultant and Researcher. Elizabeth teaches organizational behaviour and change management, systems evaluation, quality improvement, information/information technology management and research methods in the undergraduate and graduate programs in the School of Health Information Science. Elizabeth has co-authored many health informatics articles. More recently, she has edited two books: The Human, Social and Organizational Aspects of Health Information Systems and Comprehensive Management of Chronic Obstructive Pulmonary Disease. She was the Academic Representative for Canadas Health Informatics Association (COACH) to the International Medical Informatics Association (IMIA).www.saferhealthcarenow.ca 7. Todays Speakers Dr. Andre Kushniruk Dr. Kushniruk is a Professor of the School of Health Information Science at the University of Victoria and he previously served as the Director of the School of Health Information Science at the University of Victoria. Dr. Kushniruk conducts research in a number of areas including evaluation of the effects of technology, human-computer interaction in health care and other domains as well as usability engineering. His work is known internationally and he has published widely in the area of health informatics and testing of healthcare IT (including work in the area of decision support for medication reconciliation). He focuses on developing new methods for the design and evaluation of information technology and studying human-computer interaction in health care and he has been a key researcher on a number of national and international collaborative projects. His work includes the development of novel methods for conducting video analysis of computer users. Dr. Kushniruk has held academic positions at a number of Canadian universities. He was elected as a Fellow of the American Medical Information Association (FACMI) in 2009 and also served on the COACH (Canada's Organization for Health Informatics) board of directors. He holds undergraduate degrees in Psychology and Biology, as well as a M.Sc. in Computer Science from McMaster University and a Ph.D. in Cognitive Psychology from McGill University.www.saferhealthcarenow.ca 8. Please complete our poll8www.saferhealthcarenow.ca 9. Moving from Paper to Electronic Medication Reconciliation (eMedRec)9www.saferhealthcarenow.ca 10. Moving from Paper to Electronic Medication Reconciliation (eMedRec) Andre Kushniruk Elizabeth Borycki Helen Monkman Alex Kuo University of Victoria Margaret Colquhoun Alice Watt ISMP Canada Marie Owen CPSI www.saferhealthcarenow.ca 11. Medication Reconciliation (MedRec) A process in which providers work with patients and other providers to ensure accurate medication information is communicated across transitions of care Admission, transfer, discharge Intended to prevent harm from ineffective communication Is challenging! www.saferhealthcarenow.ca 12. What is eMedRec? Electronic MedRec (eMedRec) uses Health Information Systems (HIS) to access and integrate electronically stored patient medication data To support the development of the electronic Best Possible Medication History (eBPMH) and the detection and resolution of discrepancies Can be integrated with other systems such as computerized provider order entry (CPOE)www.saferhealthcarenow.ca 13. eMedRec: Two Unreconciled Medication Lists for Comparisonwww.saferhealthcarenow.ca (adapted from Markowitz, 2011) 14. eMedRec: Matching Two Medication Listswww.saferhealthcarenow.ca (adapted from Markowitz, 2011) 15. eMedRec: Final Reconciled Medication Recordwww.saferhealthcarenow.ca (adapted from Markowitz, 2011) 16. eMedRec Process Flow Mapwww.saferhealthcarenow.ca 17. Idealized Overview of eMedRecwww.saferhealthcarenow.ca 18. What is the Current State of eMedRec?www.saferhealthcarenow.ca 19. eMedRec: A Review of the Literature Conducted a literature review searched PubMed and CINAHL for the term medication reconciliation. 218 unique articles, published between 2003 and October 2012 reviewed by title, abstract (where possible) and/or full article to exclude studies that did not include original research (e.g., editorials) or that lacked reference to MedRec. 139 articles remained that met the inclusion criteria The following characteristics were also recorded: Type of MedRec Points of care Outcome Measureswww.saferhealthcarenow.ca 20. Type of MedRec Processes ranged from: Entirely paper-based hybrid (i.e. combination of paper and electronic) entirely electronic MedRec (eMedRec). The numbers of studies for each type of medication reconciliation were similar: paper (35 studies) hybrid (40 studies) electronic (44 studies) some of the papers did not explicitly state or describe what type of MedRec was used and therefore could not be included.www.saferhealthcarenow.ca 21. Key Findings: Points of Care The articles collected dealt with MedRec as it occurs at different points of care. most of the articles focused on hybrid processes few articles looked at eMedRec processes across different points of carewww.saferhealthcarenow.ca 22. Key Findings: MedRec Investigations at Different Points of CareQuantitative Measures of Medication Reconciliationwww.saferhealthcarenow.ca 23. Key Findings: Information Technology (IT) and eMedRec Information technology has been used in the eMedRec process to do the following: Generate the best possible medication lists (BPMHs) Electronically support human MedRec processes providing electronic sources of data providing electronic tools for comparing lists and detecting and resolving medication discrepancieswww.saferhealthcarenow.ca 24. Examples of eMedRec Studies Boockvar et. al (2011). Medication Reconciliation: Barriers and Facilitators from Perspectives of Resident Physicians and Pharmacists (J. of Hospital Medicine) Focus groups and observation of VA eMedRec tool Participants agreed about central goal of eMedRec to prevent errors, but disagreed if it achieved goal Participants varied in how they sequenced the task using the tool When time was limited, physicians considered other responsibilities higher priority Barriers included: competing tasks, unreliable sources of information and need for educationwww.saferhealthcarenow.ca 25. Schnipper et al. (2009). Effect of an Electronic Medication Reconciliation Application and Process Redesign on Potential Adverse Drug Events (Arch Int Med) Performed a controlled randomized trial Intervention was an eMedRec tool and process redesign involving physicians, nurses and pharmacists Main outcome was unintended discrepancies between preadmission meds and admission or discharge meds that had potential for harm (PADEs) Found that the eMedRec tool and process redesign was associated with a significant decrease in PADEswww.saferhealthcarenow.ca 26. Kushniruk et al. (2011). Cognitive Analysis of a Medication Reconciliation Tool conducted think aloud usability tests and clinical simulations of use of an eMedRec tool Both artificial cases and real cases observed Found Pharmacists and physicians approached cognitive process of using eMedRec tool differently Significant differences found in accuracy of task and time spent by pharmacists as compared to physicians Led to implications for redesign, customization and trainingwww.saferhealthcarenow.ca 27. What is the Current State of eMedRec in Canada?www.saferhealthcarenow.ca 28. eMedRec in Canada There is a move from paper to eMedRec to improve efficiency and safety to integrate MedRec with information systems Paper Based MedRecHybrid MedReceMedRec+www.saferhealthcarenow.ca 29. eMedRec in Canada We conducted an online survey of eMedRec practices in Canada to assess the current state of eMedRec Method: online survey conducted in spring 2013 Participants: 2799 people were invited to participate 212 people responded included physicians, nurses, pharmacists, administrators, QI professionals, and health IT professionalswww.saferhealthcarenow.ca 30. Where is eMedRec Implemented in Canada?www.saferhealthcarenow.ca 31. Type of eMedRec in Canadawww.saferhealthcarenow.ca 32. Perceived Success of eMedRec in Canadawww.saferhealthcarenow.ca 33.