13. www.saferhealthcarenow.ca
STEP 2‐ Compare
• The process of comparing the BPMH to
admission orders generally occurs in one of
two ways/through two models:
• This comparison takes place to identify
differences (or discrepancies)
Decision to admit
BPMH Collected
TIME
Admission Orders
Written
Admission Orders
Written
BPMH Collected
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Challenges
• Proactive model
– Embeds the “compare” step
into the process of writing
admission orders
– This allows for explicit
ordering (communication) of
each medication in the BPMH
• Retroactive model
– Perceived as “extra work” as
it is not embedded into a pre‐
existing workflow
– The “compare” step is more
challenging in that the
prescribers intentions may
not be obviously stated in the
admission orders/chart
ECASA 325 mg po daily
Metoprolol 50 mg po bid
Bradycardia
Admission Orders BPMH
ECASA 325 mg po daily Metoprolol 50 mg po bid
ECASA 325 mg po daily
?? Simvastatin 40 mg daily
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Use of the Tool
• Ideally an auditor(s) should:
– be someone familiar with the admission MedRec
process(es), forms used and overall chart layout
– not audit their own work
– have some training or guidance provided (to
ensure consistency in application of org‐specific
criteria)
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Medication Info Source (C)
• “YES” when auditor identifies use of any one of the
following sources:
• Electronic provincial medication/community pharmacy record
• Medication vials or pill‐packs/community pharmacy records
• Patient’s own medication list (hand‐written or electronic)
• Home care reconciled medication list
• Previous admission records/discharge summary
• Prescriber referral/consultation notes
• Ambulatory clinic medication records
For patients admitted directly from a setting where medications have been
administered directly to the patient:
• Most current Medication Administration Record (MAR)
• Best Possible Medication Discharge Plan (BPMDP)
• “No” when auditor does not identify use of any of these
• “Unclear” if the chart documentation does not allow the
auditor to respond confidently “yes/no”
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Compare (F)
• “YES” if in the previously conducted process of comparing
admission orders to BPMH (as collected), all medications are
accounted for
• “NO” if there are any differences that are unaccounted for
between the BPMH (as collected) and the admission orders
An “unaccounted‐for” difference could include the lack of:
‐an explicit admission order to either discontinue/
hold/change/continue a medication listed in the BPMH
OR
‐a clear* clinical reason/documentation for the difference (e.g.
stopping warfarin in a patient admitted with an acute bleed).
* The definition of “clear” is at the discretion of end users and should
incorporate some clinical judgement.
No reference to unintentional or intentional.
Quantity or type of difference is not captured.
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• Patient Safety Metrics - Introduction
– Features
– Worksheets vs. Data Collection Forms (DCF)
• MedRec Quality Assessment DCF
– Contact Information, Unit and Patient Sample, Date
– How to fill-out the information and fax the form
• Patient Safety Metrics - Demo
– How to enroll in MedRec-Acute and MedRec-LTC Intervention
– How to add and generate the forms
– How to view data and run reports
Agenda
33. www.saferhealthcarenow.ca
Features:
• Cloud-based data collection and reporting tool
• Available in English and French
• User friendly and simple to navigate
• Accessible from website with login details
• Tracks >100 process and outcome measures over 14 interventions
• Provides real time reporting.
• Reduces burden of data collection, entry and analysis
• Roll Up or Drill Down Reports (i.e. Unit National) with
automated Run Charts
• Capacity to customize measures and reports
Patient Safety Metrics - Introduction
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• Measurement Worksheets
– Aggregate data - monthly
– Numerator and Denominator
• Data Collection Forms (DCF)
– Patient-level data (de-identified) - daily
– Multiple data elements
– Print form Collect data Fax form
– Automatic roll-up to Measurement Worksheets
Worksheets vs Data Collection Forms
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• Fill in bubble completely (Sharpie is best)
• Do not colour outside the line
• Do not fold the form
• Fax form in FINE RESOLUTION (setting on fax machine)
• Do NOT use a cover sheet
• No extra markings on form
• To void fill in the VOID bubble
• Do not spill anything on the form
Data Collection Forms - BEWARE!
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• DCF - MedRec-Acute QA - Patient Data (Form Format)
– Report by individual patients (No QA score)
• DCF - MedRec-Acute QA - Patient QA Score
– Report by individual patients
• DCF - MedRec-Acute QA - Monthly Form QA Score
– Aggregate report by patient population
• DCF - MedRec-Acute QA - Monthly Overall QA Score
– Overall organization score
Data Collection Forms - Reports
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