28 Focus
WOMEN’S HEALTH/MEN’S HEALTH/ACCREDITATION/PHARMACOLOGY
Strong relationships ensure
safe medication transitions By Lauren Peddle
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reventable, drug-related hospitalizations cost the Canadian health care system approximately $2.6 billion per year; according to a joint report from Accreditation Canada, the Canadian Institute for Health Information, the Canadian Patient Safety Institute and the Institute for Safe Medication Practices. Further, a critical analysis entitled Making Health Care Safer II and published in 2013 suggests that at least 40 per cent of patients experience unintentional medication discrepancies at admission, transfer or discharge – incidents that could be reduced with proper medication reconciliation. Runnymede Healthcare Centre is addressing these serious issues by managing medications before patients are admitted, during their stay, and after they return home. Communicating medication information consistently across health care providers can reduce adverse drug-related events and contribute to the safe, highquality care of patients. Runnymede focuses on developing strong relationships with referring hospitals, patients and families, and community health partners, to ensure that hospital staff receive the information necessary to provide exemplary care, that patients/families are informed and that they are supported by their communities.
Preventable, drug-related hospitalizations cost the Canadian health care system approximately $2.6 billion per year. Getting the facts
Medication reconciliation is a systematic and comprehensive review of all the medications a patient is taking to ensure that medications being added, changed or discontinued are carefully assessed and documented (Medication Reconciliation in Canada: Raising the Bar). The medication reconciliation process at Runnymede begins before admission and is a vital part of getting to know patients and what type of care they will need. The patient flow team receive an application from the referring hospital that often includes a medication administration record, discharge summary, Best Possible Medication History (BPMH) and Best Possible Medication Discharge Plan (BPMDP). Runnymede’s strong relationships with these organizations mean that along with reviewing those documents, hospital pharmacy staff can call, email or meet with organizations to learn more. Staff ask important questions about patients’ previous experiences – information that can’t always be reflected in a standard report. Much of this work is done ahead of patients arriving at Runnymede – another benefit of working closely with referring organizations and local pharmacies that appreciate the hospital’s role in transitioning patients to their next stage of care. HOSPITAL NEWS DECEMBER 2014
Before admission, the patient flow team speak with patients and their families to discuss the patient experience at the hospital, confirm the medication information provided, and ask about any new developments or needs. That information is shared with Runnymede’s pharmacy team so they can complete their own reconciliation which is then embedded into the plans that nurses and doctors use every day to get patients back on their feet.
Getting back into the community
Throughout a patient’s time at Runnymede, staff from across the hospital work together to provide excellent care. Dis-
charge planning begins upon admission to ensure that a thorough plan is in place for when patients are ready to return home. Runnymede staff members also sit down with patients and their family members to review the care they’ve received, how their medications have changed and what might need to happen when they go home. Patients and their family members are provided with a report that outlines their current medications versus what they were taking on admission. This helps patients manage new and old prescription bottles at home to assist them in determining what needs to be disposed of and what can be kept. The health care team also discuss the importance of family involvement and tips for a successful transition home. Runnymede maintains an open dialogue that encourages patients and family members to check in and ask questions. Patients trust Runnymede staff and feel a connection to them because of the relationships that are cultivated during their stay at the hospital. As staff work to ensure patients and families feel comfortable with their new medication(s), they also reach out to community health partners, such as lo-
cal pharmacists, family doctors and home care providers to make sure everyone is on the same page. With patient consent, staff have the same open dialogue with community partners that has been established with referring hospitals and pharmacies. From sharing information to consulting on best practices, our staff are a resource to community partners, working together to do everything possible to help patients. Of 452 admissions and 436 discharges last year, 100 per cent of patients had medication reconciliations completed at admission and discharge. Since medication reconciliation is an accreditation standard, Runnymede’s adherence to these practices helped the hospital to achieve a perfect score and, earn the highly coveted Accredited with Exemplary Standing award from Accreditation Canada, the highest distinction a health care organization can receive. More than that, Runnymede’s strong relationships demonstrate a commitment to clinical H excellence and puts patient safety first. ■ Lauren Peddle is a Communications Specialist at Runnymede Healthcare Centre.
Leading the patient experience By Sandra Morrison
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he operation was a success. You, your family, and your doctor are discussing your care plan. A physiotherapist steps in and makes recommendations. Later, after everyone has left, the nurse checks your vitals, gives you medication to ease the pain, and says goodnight. These people, along with other staff at the frontline, are the individuals the patient sees and comes into contact with during a hospital visit. What the patient likely doesn’t realize is that health care providers and teams, no matter how diligent and motivated, have a much harder time meeting patients’ needs and expectations without strong leadership. The leadership of any health care organization—from the executive, to directors and managers, to boards—plays a pivotal part in the patient experience. When Accreditation Canada recently strengthened and broadened the patient- and family-centred care content throughout its program, the Leadership and Governance standards were also enhanced to reflect and emphasize the essential role of the board and leadership in this area. It must start at the top, with an organizational structure and culture that supports the implementation, spread, and success of a patient-centred model. Accreditation Canada’s enhanced standards ask organizations to identify patient- and family-centred care as a guiding principle, include client and family representatives on advisory and planning groups,
establish partnerships with clients and families, share performance reports, and commit to co-designing services. There are many ways leadership can support teams in their efforts to partner with clients and families in all aspects of the care process. One way is establishing policies, such as unrestricted visiting hours, that encourage family presence, so that clients have the support they need from loved ones, when they need it.
Patients and families offer a unique perspective on quality improvement opportunities for organizations. Others include providing barrier-free opportunities for patients to access information in their health record and partnering with patients and families in team discussions concerning the patient’s care plan. It’s about communication. Sharing information. Getting a different perspective. Sliding into your patient’s slippers and walking around for a while. Hearing about quality and safety incidents directly from the people who experience them. This lends context that cannot be gleaned from statistics and provides valuable information on the next
steps for improvement and incident prevention. Patients and families offer a unique perspective on quality improvement opportunities for organizations. The standards address seeking their input on organizational decisions where patient involvement may not have been heard in the past, such as moving a facility, changing services, adjusting policies, designing new space, and determining optimal use of current space to best support comfort and recovery. Leadership can establish mechanisms to gather input from clients and families, such as Family and Client Advisory Councils, project-specific committees, focus groups, interviews, and feedback kiosks. A growing body of evidence demonstrates that improving the patient experience and developing partnerships with patients and families are linked to improved health outcomes. The support provided, the policies established, and the culture created by an organization’s leaders will ultimately determine the degree to which patients and families are involved during the care process. As the culture of patient- and familycentred care becomes more entrenched, patients and families will gain a greater appreciation and understanding of the contribution that strong, committed leaders make to improving the patient H experience. ■ Sandra Morrison is a Writer/Editor at Accreditation Canada. www.hospitalnews.com