To implement a solution, you have to sell a problem. Located in Eastern Ontario, patients at the 63-bed Winchester District Memorial Hospital (WDMH) are known to be older, sicker, poorer, and die earlier. Increased medication errors, length of stay and readmissions provided the opportunity and the solution was to implement a Discharge Care Plan for medication reconciliation that would follow the patient from admission through to discharge.
“When we first spoke about introducing medication reconciliation, we received a lot of push back from the staff, as they viewed this as yet another task in their busy day, so we called it a Discharge Care Plan,” says Lynn Hall, Senior Vice-President Clinical Services/Chief Nurse Executive and Professional Practice Leader, WDMH. “We had always carried out medication reconciliation, however it was not systematic and there was not a process in place to ensure consistency.”
“To start the process, we asked our staff to anonymously tell us what they do,” says Hall. “We compiled the feedback from about 70 physicians, nurses, pharmacists and other team members and then met as a group to walk through the medication reconciliation process step by step. The dialogue was very interesting; about 50 percent of the team admitted to forgetting various steps of the medication reconciliation process. We then identified steps that were duplicate, unnecessary or redundant. From that, a streamlined, consistent, patient-centered and user-friendly process for medication reconciliation was introduced.”
Hall reinforces that you have to know what is important to your staff. The new medication reconciliation process was first rolled out in Emergency and word travelled fast as it was not long before other units wanted to get on board. “When we reduced some of the paperwork, we received buy-in from the staff,” says Hall.
This creative approach by WDMH utilized existing resources and Hall emphasizes that a strong leadership voice supporting the initiative is a must. “I am a cheerleader and can open doors, but it is the staff who are doing all of the work.” Involving both internal and external stakeholders ensured physician engagement and an opportunity for the local pharmacist to contribute to the process. An educational component focused on understanding medication reconciliation and the benefits to patients and staff. And, making people feel appreciated is part of the culture and WDMH celebrates everything. For example, during Nursing Week, nurses were presented with a carnation and a laminated card listing steps to obtain a best possible medication history.
The Discharge Care Plan has decreased length of stay from 8.4 to 5.8 days; readmissions within seven days from 1.6 to .4; and increased staff satisfaction and patient engagement. WDMH is now moving from a paper-based to an electronic medication reconciliation and computerized physician order entry systems.
For more information, click on the link to view Lynn’s presentation at Canada’s Virtual Forum on Patient Safety and Quality Improvement , Medication Reconciliation: Success Story at a Rural Community Hospital, or download a PDF copy of the slide presentation.