Joseph Brant Hospital (JBH) is using technology to significantly increase the number of medication reconciliations (MedRecs) being completed at their hospital.
Health Quality Ontario had a chance to catch up with Jessy Samuel, Director of Clinical Support Services (Pharmacy, Laboratory Medicine and Diagnostic Imaging), Dr. Frank Fornasier, Lead Hospitalist and Co-Chair of Health Records, and Hala Basheer, Manager of Pharmacy to learn how they implemented this initiative.
When did you first decide to use a technology solution to improve MedRec at your hospital?
In 2014 a decision was made to focus on improving MedRec throughout the organization since it was a quality issue that we felt required improvement. A MedRec Advisory Committee was struck, and after thorough research, a new medication reconciliation software program called MedsTracker® (by First Data Bank) was purchased.
Technology is often an enabler to quality improvement work, and the implementation of MedsTracker® was seen as an opportunity to make significant strides in MedRec at our hospital.
How did you go about implementing the MedsTracker® software?
With carefully thought out planning, a MedsTracker® pilot went live on a medical ward in June 2017. Since then, the MedsTracker® tool has been implemented in all inpatient programs and units with plans to expand to outpatient programs and clinics.
Key players in this project included our vendor, who customizes the software to meet our unique needs, our IT department who helped iron out kinks and set up the training environment, and our MedRec champions who provided support, coaching and continuously advocated for change.
We had a team that was very dedicated to the success of this project and we applaud everyone for working through the challenges, frustration and times of uncertainly.
What were the biggest challenges of this initiative?
Reflecting back, I don’t think we fully understood the scope of the project that we were undertaking! We found that the biggest challenges we faced included:
- Getting buy-in from frontline staff and shifting attention to MedRec as an organizational priority
- Managing competing program/department priorities
- Understanding differing unit processes, including the roles and responsibilities of team members
- Troubleshooting process issues that the software did not compensate for
- Working on this project during organizational re-development (i.e. moving physical sites)
How did you manage some of these challenges?
Having a strategic focus on MedRec was essential to allow us to navigate through competing priorities.
Staff buy-in was also important to us, and we encouraged this buy-in by sharing the positive results obtained from the pilot project. This motivated staff to continue the effort.
Being conscious of unit space and computer availability made a big difference in staff being able to complete the MedRecs. Finally, selecting a strong team with a passion for MedRec, including a physician champion, was key to success. Our champions worked tirelessly with different hospital areas to ensure successful rollout, policy compliance and clear processes.
As with any QI process, we continuously evaluated the implementation of this project and customized changes to fit our unique environments and provider needs.
What results have you seen so far?
In the first six months of implementing MedsTracker®, we realized a 70% MedRec completion rate!
Feedback from nurses, physicians, patients and community pharmacies has been very positive. Patients now receive a printed list of medications, with clear instructions about which medications to continue, stop or change. When patients present back to hospital, providers are now able to see the last best possible medication history (BPMH), which is very helpful.
What’s next?
We continue to show programs and units weekly results on compliance and disseminate success stories from providers and patients. Weekly senior leadership quality reports, which include a MedRec parameter, keep senior leadership engaged and identify areas that need increased support or resources.
We will be implementing “quality boards” on every unit with a focus on MedRec, which will display data for frontline staff to see.
Going forward, we are getting ready to roll out MedsTracker® to our outpatient programs and will continue to work on improving our current compliance and processes.
Do you work to improve MedRec in your organization? Share your comments and questions by clicking on “Add a Comment” below.