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Medication Reconciliation (MedRec)
 
 
 
 
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Medication reconciliation is a formal process in which healthcare providers work together with patients, families and care providers to ensure accurate and comprehensive medication information is communicated consistently across transitions of care. Medication reconciliation requires a systematic and comprehensive review of all the medications a patient is taking (known as a BPMH) to ensure that medications being added, changed or discontinued are carefully evaluated. It is a component of medication management and will inform and enable prescribers to make the most appropriate prescribing decisions for the patient.
"[Medication Reconciliation] is definitely the right thing to do. We have certainly caught errors that could have caused harm to patients, which helps staff and physicians better understand the importance of MedRec."
Winnipeg Regional Health Authority, MB

A Best Possible Medication History (BPMH) is a history created using 1) a systematic process of interviewing the patient/family; and 2) a review of at least one other reliable source of information to obtain and verify all of a patient's medication use (prescribed and non-prescribed). Complete documentation includes drug name, dosage, route and frequency. The BPMH is more comprehensive than a routine primary medication history which is often a quick preliminary medication history which may not include multiple sources of information.


The BPMH is a 'snapshot' of the patient's actual medication use, which may be different from what is contained in their records. This is why the patient involvement is vital.


ISMP Canada supports Medication Reconciliation provincially, nationally and internationally

ISMP Canada created Getting Started Kits for Medication Reconciliation in Acute Care, Long Term Care, Home Care for the Canadian Safer Healthcare Now! campaign and for the World Health Organization High 5's initiative and provides ongoing support to teams around the world.


Best Possible Medication History (BPMH) training is available. Read More …


Knowledge is the best medicine - Tools to Help Patients Keep Track of Their Medications - MyMedRec iPhone app and website


Paper to Electronic MedRec Implementation Toolkit (English)



Experienced a MedRec failure? Report the medication incident to ISMP Canada.


Paper to Electronic MedRec Implementation Toolkit (English)


Medication Reconciliation in Canada: Raising the Bar (English) (Français)


A Snapshot of Medication Reconciliation in Canada (English)


Medication Communication Failures Impact EVERYONE! Poster and consensus statement from Canadian Healthcare leaders (English) (Français)


National Survey: Identifying Practice Leaders for Medication Reconciliation in Canada (English) (Français)


ISMP Canada is co-leading, with CPSI, the National Medication Reconciliation Strategy and is pleased to support the Canada Health Infoway ImagineNation Outcomes Challenge.


National Summit: Optimizing Medication Safety at Care Transitions (English) (Français)


Safer Healthcare Now!



Find out more …

ISMP Canada is the Protocol Lead for the World Health Organization (WHO) High 5s Medication Reconciliation Program: 'Assuring Medication Accuracy at Transitions in Care'. High 5s Project Overview Fact Sheet (English) (Français)


Standardized Operating Protocols (SOPs)



Find out more …

Provincial
 
 


Linking MedsCheck to MedRec - June 2009


With the support of the Ontario Ministry of Health and Long-Term Care (MOHLTC) and the Ontario Pharmacy Council, the Institute for Safe Medication Practices Canada (ISMP Canada) developed and delivered a pilot program to link the community-based MedsCheck program with medication reconciliation programs in hospitals. The goal of this collaborative initiative between hospitals and community pharmacists was to obtain the Best Possible Medication History (BPMH) for patients preparing to be admitted to hospital for surgery.


Linking MedsCheck to MedRec Report (PDF)


Optimizing Communication about Medications at Transitions of Care in Ontario - September, 2010


In the spring of 2010, ISMP Canada, in collaboration with the Canadian Society of Hospital Pharmacists Ontario Branch, hosted two invitational roundtable sessions. The overall goal of the sessions was to discuss opportunities and create recommendations to fully understand and utilize the drivers and resources that exist in Ontario to facilitate communication of medication information at transitions of care.


Optimizing Communication about Medications at Transitions of Care in Ontario Report (PDF)


Medication reconciliation at all interfaces of care - Pilot Project 2011/2012


Will provide a model for other institutions to adapt.

  • Customization of tools and processes to meet the needs of the target unit / institution
  • Plan-Do-Study-Act (PDSA) methodology will be used to implement and test intervention
  • Develop a Policy and Procedure to support the intervention
  • Develop a plan for spreading the intervention across the institution
  • Develop a research plan to collect and measure data on the potential impact of the improvement initiative and report on these findings



Medication Reconciliation at discharge - Pilot Project 2011/2012


Will provide a model for other institutions to adapt.

  • Customization of tools and processes to meet the needs of the target unit / institution
  • Plan-Do-Study-Act (PDSA) methodology will be used to implement and test intervention
  • Develop a Policy and Procedure to support the intervention
  • Develop a plan for spreading the intervention across the institution
  • Collect and measure data on the impact of the improvement initiative in accordance with the research plan and report on the findings
  • Provide tools for discharge medication reconciliation and report on validation results, 2011/2012



Potential Medication Reconciliation Indicators for Public Reporting - 2012





Tools for Discharge Medication Reconciliation:




National
 
 

NATIONAL MEDICATION RECONCILIATION STRATEGY

Co-lead by ISMP Canada and CPSI.




Paper to Electronic MedRec Implementation Toolkit


This toolkit was prepared by researchers from the University of Victoria, in collaboration with AE Informatics Inc., ISMP Canada and CPSI thanks to funding from Canada Health Infoway. It explores current electronic MedRec (eMedRec) practices in Canada and provides guidance for organizations to migrate from a paper-based system to an electronic system for MedRec.


Tell us what you think about the toolkit. Send your comments and feedback to medrec@ismp-canada.org



Medication Reconciliation in Canada: Raising the Bar


Communicating effectively about medications is a critical component of delivering safe care. Without it, patients are at risk. By identifying and resolving medication discrepancies, the likelihood of adverse events occurring within health care organizations across the continuum of care will be reduced. In this report, four national health care organizations - Accreditation Canada, the Canadian Institute for Health Information, the Canadian Patient Safety Institute, and the Institute for Safe Medication Practices Canada - share information about medication reconciliation in Canada, thus painting a comprehensive picture of the situation.




A Snapshot of Medication Reconciliation in Canada


Communicating effectively about medications is a critical component of delivering safe care across all sectors of the Canadian health care system. Without it, patients are at risk. This communication must involve clinicians working with patients, families, and other health care providers to collect and share comprehensive medication information.




A Year in Review


This 2011 year end review reports on the progress of the National Medication Reconciliation (MedRec) Strategy. The accomplishments to date are significant, but we clearly acknowledge there is much work left to do. Improving communications about medications is a critical aspect of providing safer care and involves healthcare leaders, practitioners, and the public we serve. Your continued involvement will help ensure MedRec is a standard practice across the Canadian healthcare system.




Medication Communication Failures Impact EVERYONE! Poster Medication Safety: We all have a role to play.


The poster defines the impact of the Patient and Family, Healthcare System and Society in the communication of medications and includes an inter-professional joint statement, endorsed by 11 Canadian Healthcare organizations. This statement reflects the unique inter-professional ownership of this complex process, positioning Canada as a leader in this collaborative approach to professional engagement in support of medication reconciliation.



Identifying Practice Leaders for Medication Reconciliation in Canada


To facilitate understanding of the current landscape of medication reconciliation (MedRec) in Canada a survey of healthcare organizations was conducted between July and November of 2011. The purpose of the survey was to identify challenges and success factors in implementation of this key aspect of patient safety and to collect an inventory of tools and resources that contributed to this success.




National Summit: Optimizing Medication Safety at Care Transitions - February 10, 2011


On February 10, 2011 healthcare leaders from across the country gathered in Toronto to carve out strategies and identify solutions/ best practices for improving communication to reduce preventable medication errors during transitions of care, one of the country's biggest patient safety issues. ISMP Canada and CPSI will together create a national steering committee to ensure the recommendations identified at the summit are implemented.



ISMP Canada Safety Bulletins:



SafeMedicationUse Newsletter:



Ontario Critical Incident Learning Bulletins:




Safer Healthcare Now!


ISMP Canada is the Intervention Lead for medication reconciliation in the successful Safer Healthcare Now! network. ISMP Canada supports Canadian teams in acute care, long term care, and home care implement medication reconciliation and optimize communication about medications across transitions of care.


Getting Started Kits for Medication Reconciliation have been created for Acute Care, Long Term Care and Home Care. These kits provide guidance to implement medication reconciliation.


The Community of Practice for Medication Reconciliation facilitates sharing and learning among practitioners across Canada. Activities include posting the latest articles, website links and tools contributed by individuals and teams participating in SHN. If you wish to sign up for SHN or participate in the Community of Practice for Medication Reconciliation, please go to the Safer Healthcare Now! website at www.saferhealthcarenow.ca.



Safer Healthcare Now! Progress Reports:




Medication Reconciliation in Acute Care


Hundreds of Canadian teams are implementing medication reconciliation in acute care. Although this began as a response to Accreditation Canada Required Organizational Practices (ROP's) teams that are successful would never return to previous practices.



Success Stories:




Medication Reconciliation in Long-Term Care


ISMP Canada identifies the proactive medication reconciliation model as being the most desirable in Long-Term Care.



Success Stories:




Medication Reconciliation in Home Care


The Home Care Getting Started Kit is the result of a partnership between VON Canada, CPSI and ISMP Canada. A pilot project including 20 teams from across Canada identified that more than 40% of clients had one or more discrepancies among various sources of information.



Videos:




Additional Posters and Guides:



International - WHO High 5s Medication Reconciliation Program: Assuring Medication Accuracy at Transitions in Care
 
 

ISMP Canada is honoured to be the Protocol Lead for the World Health Organization (WHO) High 5s Medication Reconciliation Program: 'Assuring Medication Accuracy at Transitions in Care'.



What is the High 5s Project?


The High 5s Project was launched by the World Health Organization (WHO) in 2006 to address continuing major concerns about patient safety around the world. The High 5s name derives from the Project's original intent to significantly reduce the frequency of 5 challenging patient safety problems in 5 countries over 5 years.


The Mission of the High 5s Project is to facilitate implementation and evaluation of standardized patient safety solutions within a global learning community to achieve measurable, significant and sustainable reductions in challenging patient safety problems.


The High 5s Project is a patient safety collaboration among a group of countries and the WHO Collaborating Centre for Patient Safety in support of the WHO Patient Safety Programme.


High 5s Project Overview Fact Sheet (English) (Français)




Scope of the High 5s


The major components of the High 5s Project include the development and implementation of problem-specific Standardized Operating Protocols (SOPs); creation of a comprehensive Impact Evaluation Strategy; collection of data, reporting and analysis; and the establishment of an electronic collaborative learning community. The Medication Reconciliation Protocol was developed by the Institute for Safe Medication Practices in Canada (ISMP Canada) and the Canadian Patient Safety Institute (CPSI).


The High 5s Project is designed to generate learning that will permit the continuous refinement and improvement of the SOPs, as well as assessment of the feasibility and success of implementing standardized approaches to specific patient safety problems across multiple countries and cultures. Achievement of the Project goals is expected to provide valuable lessons and new knowledge to support the advancement of patient safety around the world.


Education & Training
 
 


 

National MedRec Webinars


 

Upcoming Webinars



The next Safer Healthcare Now! webinar will take place in September 2014. Details to follow.


Past Safer Healthcare Now! 2014 Webinars



May 6th, 2014 - Safety, Sleuthing and Students: A Novel Collaborative MedRec Even


Dr. Arun Verma, Dr. Judith Soon, and Dr.Nick Petropolis, from the University of British Columbia will:

1. Describe the process of developing an undergraduate MedRec IPE Event involving > 480 senior Medicine, Pharmacy and Nursing students;
2. Explain the logistics of conducting the event in multiple venues and urban/remote locations;
3. Discuss the successes and challenges of communicating MedRec patient safety concepts through this process; and 4. Describe future opportunities for enhancing undergraduate MedRec training in an interprofessional environment.


April 8th, 2014- Making a PDiF-ference - Results of the Pharmacy Discharge Facilitator Initiative for high-risk medical inpatients.


Colleen Cameron, Clinical Pharmacist at Grand River Hospital in Kitchener, Ontario will:


1. Provide background information about the PDiF initiative, outcomes and key lessons learned.
2. Identify how one organization addressed the obstacles patients face with respect to safe medication management after they are discharged from hospital
3. Challenge all health care providers to incorporate discharge medication reconciliation into their assessment from the day of admission throughout the patients' hospital stay.
4. Challenge pharmacists to expand their role in discharge medication reconciliation.



March 25th, 2014 - Continuing the circle of care: MedRec in the Community


Ann Nickerson (Pharmacist) and Michelle Anglehart (Clinical Nurse Specialist) Moncton NB AND Colleen Stoecklein (Clinical Educator) and Liz Moran- Murray (Pharmacist) Saskatoon, SK will:


1. Demonstrate the timeline for the development of a provincial bilingual medication reconciliation form and process
2. Identify how technology provided an avenue for a multi-site team collaboration
3. Distinguish the key elements in a provincial bilingual medication reconciliation form


AND

1. Share how they developed a nurse driven, paper-based MedRec program to support home care clients in medication management.
2. Outline their current MedRec process
3. Showcase their current Med Rec/BPMH form and data collection form for the audit process.



February 11th, 2014 - Partnering with our patients - Engaging patients, families and caregivers in MedRec to achieve the best and safest care


Teams from Saskatchewan Sunrise Health Region's Champion Your Health Team, Ontario North Bay Regional Health Centre and Alberta Health Services Provincial MedRec Team discussed:
  • successful strategies and approaches to engage patients and caregivers in MedRec
  • how teams effectively dialogue with patients and their caregivers on the benefits of having an accurate medication list
  • the development of paper and electronic tools and resources created for patients and their caregivers to create and maintain their medication lists.



January 14th, 2014 - Got Med Wreck? Targeted Repairs from the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS)


Listen to Dr. Jeffrey Schnipper:

  • Provide an overview of the MARQUIS toolkit components, informed by medication reconciliation best practices, designed to help hospitals improve the quality of their medication reconciliation processes
  • Preview the preliminary results of the MARQUIS study in order to understand the effects of a mentored quality improvement intervention on medication reconciliation errors
  • Discuss lessons learned from study sites that have implemented the MARQUIS program and how they might be applied to Canadian hospitals, including an exploration of barriers to implementation and how to overcome them
  • Make the case for provinces, health systems, and hospitals to invest in medication reconciliation quality improvement efforts, and why physicians need to play a major role in these efforts




Past 2006-2013 Webinars


To access a searchable list of all Safer Healthcare Now! MedRec webinars from 2006-2013, please click here.




 

ISMP Canada MedRec Education/Training


 

ISMP Canada offers workshops and training related to Medication Reconciliation including training specific to BPMH collection. More details on the educational opportunities.




 

Open Access Web-Based MedRec Learning Modules


 


Queens University's Medication Reconciliation: A Learning Guide



Medication Reconciliation: A Learning Guide an online eLearning module created by Queens University to provide healthcare providers with the basic knowledge and understanding to successfully incorporate medication reconciliation in your daily practice as a team.



Sunnybrook Health Sciences Centre's e-BPMH Training Package



This Sunnybrook created BPMH eLearning Training Package! facilitates the training of personnel involved in the collection of BPMHs and educates trainees on the importance of medication reconciliation in advancing patient safety.



Medication Reconciliation: Doing It Because It Is The Right Thing To Do



Medication Reconciliation: Doing It Because It Is The Right Thing To Do is an online CCCEP accredited eLearning module developed by ISMP Canada. This program provides pharmacists with practical information to understand medication reconciliation (MedRec) in the acute care setting and the role of patients and other healthcare providers in the process. (registration required - complimentary).



MedRec Pharmacy Technicians: simply indispensable



MedRec Pharmacy Technicians: simply indispensable is a CE accredited continuing education program developed by ISMP Canada. This program defines the pharmacy technician.s scope of practice and role as it relates to MedRec.




 

Presentations


 
Contact Us
 
 


To contact the ISMP Canada MedRec team please email medrec@ismp-canada.org