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CANADIAN MEDREC QUALITY AUDIT MONTH 2015: RESULTS
Facilitator: Maryanne D’Arpino CPSI Presenter: Jennifer Turple, ISMP Canada
March 31st, 2015
Welcome to our francophone attendees Bienvenue à nos participants francophones
Hélène Riverin Conseillère en sécurité et en amélioration Safety Improvement Advisor
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conférencière traduit en français
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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
52 Scores
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
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