Canadian MedRec Quality Audit Month Results Show Room for Improvement

Canadian MedRec Quality Audit Month:
Results and Future Direction
Marg Colquhoun, Virginia Flintoft and Alex Titeu
December 2013

www.saferhealthcarenow.ca

Where to find our webinars…
www.ismp-canada.org/medrec
See “Education and Training”

http://www.saferhealthcare
now.ca/EN/events/National
Calls/Pages/default.aspx


Outline
•
•
•
•

Background
Audit Month results
Interactive discussion
Accessing your results in the Patient
Safety Metrics System


Background
MedRec Quality Audit 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


Background
Canadian MedRec Quality Audit Month

• 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
improvements
MedRec Quality Audit Month
– October 2013

5


Background
Audit Month Methodology
• Call to action national call/webinar on October 1st, 2013.
• Sites registered to participate
– Central Measurement Team (CMT) facilitated the creation of
audit/data collection forms
• MedRec Audit Month Workbook published
• Sites submitted data to the Patient Metrics System throughout the
month of October
– CMT corrected any data submission error reports and
resubmitted
• Preliminary results (e.g. numbers of participating sites) were
presented October 30th, during Canada’s Virtual Forum
on Patient Safety and Quality Improvement
6


Audit Month Results


Audit Month Results
• Audit participation
• Results by column
• Calculated results
• Relationships between variables

8


Audit “Participants”

Sites = 103
Patient/Resident Charts
= 2,340
9


“Participants” by Province/Territory
103 sites
2,340 patients

Number of Patients

Provinces/Territories

10


“Participants” by Sector
2,340 patients

103 sites

15%
N=348

23%
N=24
LTC

LTC

Acute Care

Acute Care
85%
N=1,992

11

77%
N=79



12


0

13


A. ‘Admission via’
N=2,298

57%
50%

14


=

15


B. ‘Med Rec Performed’
N = 2,328

95%
75%

16


Literature suggests…..
• 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


C. ‘BPMH -greater than one source’
N=2,040

74%

60%

19


Literature 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

• Adherence- “the extent to which a person’s behavior [in] taking
medication…corresponds with agreed recommendations from a
health care provider”
(World Health Organization, 2003).
• 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


D.‘Med Use Verified by Pt/Caregiver’
N=2,044

63%
57%

22


E.‘Each med w/ name dose, route, etc.’
N=1982
77%
92%

25


Literature 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+Admin Order’
N=2,006
87%
73%

28


G.‘Prescriber documented rationale’
N=1,946
84%

64%

30


Audit Month Results
• Relationships between variable

31


To calculate a MedRec Quality Score,
each “Yes” (or “Unable to Perform”) is
assigned 1 point for each of the highlighted
columns

32


Percentage of Patients by Score
N=1,937

55%

29%

33

Scores


Audit Month Results

34


% Med Rec Performed by Score
55%
29%

7%

36

0%


Compliance w/ 1st 3 elements
by “Admit via”

38


Results Summary Comments
• Because this is the first audit using these criteria, we do
not have historical data to compare our progress it is
likely that we have collectively improved
• However, audit tool results demonstrate need for ongoing
and specific improvements
• Many people believe they are doing MedRec but they may
not be doing it well
– The foundation of the process – the BPMH needs work
• Validity of the BPMH –results are disappointing
– It will be useful to use the scores and correlations in
future audits to measure improvement


Results Summary Comments
• Need to critically evaluate admission
processes to ensure quality of MedRec
processes at other transitions
• Sites will need to understand the need
for training people to use the audit tool –
materials are available to support this
process

40


Discussion


Accessing Your Data in
the Patient Safety Metrics
System
Virginia Flintoft & Alex Titeu

42


Data Collection (Audit) Form

46


Contact Patient Safety Metrics team at:
metrics@saferhealthcarenow.ca
Contact ISMP Canada MedRec team at:
medrec@ismp-canada.org

55


Upcoming MedRec Webinars
Jan 14, 2014

The MARQUIS Project Dr. Jeffrey
Schnipper

Feb 11, 2014

Engaging Patients in MedRec

March 25, 2014 MedRec in Home Care

56


On behalf of the ISMP Canada MedRec
Team, CPSI and the Patient Safety
Metrics Team
All the best in 2014!

Canadian MedRec Quality Audit Month Results Show Room for Improvement

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Canadian MedRec Quality Audit Month Results Show Room for Improvement