Lakeridge Health, a network of five community hospitals in Durham Region, has successfully implemented a pharmacy-led model to obtain Best Possible Medication Histories (BPMHs) from admitted patients and improve medication reconciliation (MedRec) rates.
Health Quality Ontario had a chance to speak with the team at Lakeridge Health including Leslie Motz, Vice President, Clinical and CNE, Annette Down, Director of Quality and Risk and Wilson Kwong, Director of Pharmacy about the success of the pharmacy-led model at the Oshawa Hospital, one facility within the five-hospital network.
How did you decide to use a pharmacy-led model in your organization?
At Lakeridge Health, we believe MedRec is instrumental to patient safety. We are committed to implementing a fulsome MedRec process to enhance the patient experience and care journey.
Prior to the implementation of the pharmacy-led model, nurses completed BPMHs. Very quickly we learned that nurses already had many tasks embedded into their daily routines. Obtaining BPMHs was time consuming and not always a priority.
Realizing the importance MedRec plays in patient safety, we saw this as an opportunity. With the support from the senior leadership team, we shifted to a pharmacy-led model from a nursing-led model. This change leveraged and built on the skill sets of our clinical pharmacists and regulated pharmacy technicians. Involving our regulated pharmacy technicians was also a tremendous staff engagement opportunity to maximize their role and scope of practice.
In this photo: Jaime Le (Pharmacist), Joseline Perciballi (Pharmacy Technician), Wilson Kwong (Director, Pharmacy Services), Dr. Allan Yan (Internist), members of the Pharmacy-Led Model Team
We have also worked tirelessly with Decision Support and IT to create a system that electronically monitors the progress of MedRec throughout the patient journey.
What have been your results so far?
With this pharmacy-led model, MedRec compliance rates are now consistently at 87% for admitted patients.
What were some challenges the team faced during implementation?
As with any implementation there are challenges and obstacles. For the team, some of the largest challenges were:
- Obtaining additional resources (hiring more pharmacy technicians);
- Training and orientating pharmacy technicians about their new role and increased scope of practice;
- Shifting from paper to electronic documentation, auditing and reporting;
- Standardizing the process throughout our multi-site organization, while customizing the process when needed to address the unique needs of various sites/units.
How did the team address some of these challenges?
The presence of senior leaders and interprofessional front-line champions on a committee dedicated to MedRec helped to drive this work forward. This initiative aligned with the strategic priorities of our organization. There was also consensus from front-line staff regarding the importance of the role that pharmacy technicians play in ensuring patient safety.
As a multi-site organization, our team needed a clear understanding of the current state regarding MedRec, especially at the start of the model change. During implementation we also considered the future state of the pharmacy-led model.
Using PDSA (plan, do, study, act) cycles, we engaged in continuous quality improvement. Through this phase we engaged staff and evaluated the process for safety and efficiency. Though this work proved challenging and time consuming, it was fundamental to successful implementation.
What is next?
Going forward we will continue to engage staff, physicians, patients and families to improve current processes. Next, Lakeridge Health will focus on driving the MedRec at Admission process to all five sites this year and will also begin piloting MedRec on Discharge on one unit using the PDSA approach.
Do you work to improve medication safety in your organization? Share your comments and questions by clicking on “Add a Comment” below.