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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



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


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.



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.




Canada Health Infoway ImagineNation Outcomes Challenge


Canada Health Infoway seeks to accelerate the use and spread of innovative solutions in healthcare information and communication technologies. They have selected four key areas with the potential to improve health care quality and the patient experience in Canada.


1. e-Scheduling

2. Patient access to health information

3. Medication reconciliation

4. Clinical synoptic reporting


Up to $1 million in awards are being offered through this team-based Challenge to demonstrate the use and growth of e-solutions. ISMP Canada is a supporting organization for the ImagineNation Outcomes Challenge, providing expertise related to medication reconciliation.


More information is available from: www.imaginenationchallenge.ca


ISMP Canada Safety Bulletins:



SafeMedicationUse Newsletter:




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:



Success Stories:




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




Past Webinars



WEBINAR:
MedRec - A Panel Discussion with Physicians


Dr. Robin Walker, Dr. Hilary Adams, Dr. Clint Torok-Both will discuss:

  • Strategies to engage physicians in medication reconciliation
  • The benefits of medication reconciliation from the perspective of physicians
  • Physician roles in the medication reconciliation process




WEBINAR:
Medication Reconciliation - Recent changes introduced by Accreditation Canada


Heather Howley a Health Services Research Specialist in Program Development from Accreditation Canada will:


1. Review the changes in Accreditation Canada expectations for implementing MedRec beginning in 2014.
2. Overview of changes to the ROP structure, for Medication Reconciliation ROPs in the leadership and service-based standards.
3. Direct organizations to additional information, resources, and support.




WEBINAR:
Making a Case for Medication Reconciliation in Primary Care - February 12, 2013


Dr. Karen Hall Barber, Sherri Elms, and Danyal Martin from the Department of Family Medicine at Queen's University discussed how they were able to:


  • Raise awareness about medication safety issues - specifically medication reconciliation - in primary care.
  • Highlight the need for better communication and connectivity between hospitals, pharmacies, and primary care. (And how we can help each other.)
  • Suggest that primary care take on a leadership role in medication safety - we can (and should!) "own" the list.
  • Stress the importance of medication reconciliation as a continuous, interdisciplinary, and collaborative activity.




WEBINAR:
The Stepping Stones to MedRec Success - January 22, 2013


Learn how to London Health Sciences Centre (LHSC) staff Sandy Jensen, Nadia Facca and Pam Andress described:


1. The challenging elements of MedRec implementation in one of Canada's largest, acute care teaching hospitals
2. How LHSC overcame these challenges by focusing on interdisciplinary collaboration
3. How LHSC is evaluating and sustaining the process



Download LHSC tools and forms:




WEBINAR:
Engaging Physicians in Medication Reconciliation


Learn how Dr. Nathan Neufeld and Dr. Kayode Williams from the Johns Hopkins Blaustein Pain Treatment Center were able to:

  • Change culture and engage physicians using positive reinforcement
  • Successfully introduce models on increasing compliance, and
  • Sustain results of change implementation


Although this presentation focuses on experience in an ambulatory care setting; the concept used is universal and can be incorporated into any unit, in any type of healthcare facility/agency.




WEBINAR:
Sharing Ontario's Central Community Care and Access Centre's Success Story


Learn how Mary Burello from Central CCAC and Lisa Sever from Community York Central Hospital, were able to develop a Medication Management Support Services in Ontario's Central CCAC for medication reconciliation. This session objectives include

  • Understand what Medication Management Support Services is in Central CCAC and who is eligible
  • Define and quantify medication issues that occur between the hospital and home environment
  • Define and quantify medication issues that occur between the hospital and home environment
  • Share key processes that drive success


The webinar is based on experience from Ontario's Central LHIN




 

ISMP Canada MedRec Education/Training


 

BPMH Training for Pharmacy Technicians
Understanding the hospital pharmacy technician's role in the medication reconciliation process.



This one-day workshop is designed to provide hospital pharmacy technicians with an overview of medication reconciliation. There will be a specific focus on the importance of the Best Possible Medication History (BPMH) within the medication reconciliation process and participants will learn how to conduct a BPMH interview and document the necessary components of a BPMH.


At the completion of this workshop, participants will be able to:

  • Explain the role of medication reconciliation as it effects patient care
  • Understand where and how medication reconciliation takes place
  • Understand the role of the BPMH at all care transitions
  • Describe the process of completing a BPMH
  • Understand the benefits and limitations to the various sources of a patient's medication information.


Location:ISMP Canada Medication Learning Centre
4711 Yonge Street, Toronto, ON
Cost:$400 + HST (enrolment is limited to 8 attendees)
Time:9 am to 5 pm
Course Level:Novice
Audience:Pharmacy technicians working in acute care


Session Dates and Registration:

May 15, 2013
Toronto, ON
Registration
June 11, 2013
Toronto, ON
Registration
September 18, 2013
Toronto, ON
Registration


Further Information:

If you would like to arrange a BPMH Training for Pharmacy Technicians workshop in your organization, please email education@ismp-canada.org




Jump into MedRec - BPMH training for clinical staff



Learning Objectives:

The Best Possible Medication History (BPMH) is the cornerstone of medication reconciliation.


At the end of the session, participants will have:

  • learned how to obtain a BPMH using a systematic process;
  • learned how to identify and document discrepancies;
  • practiced their skills in obtaining an efficient and accurate BPMH, using real-life exercises; and
  • gained sufficient knowledge, tools and resources to be able to apply the process in their own healthcare environments.


The content of the workshop is tailored to meet the needs of the participants and their respective healthcare sectors.


Who should attend?

Physicians, Pharmacists, Pharmacy Technicians, Registered Nurses, and Registered Practical Nurses


Length: 3 hours


This program has been approved by the Ontario College of Pharmacists and awarded 3 CEUs


Further Information:

If you would like to arrange a BPMH Training session in your organization, please email education@ismp-canada.org




 

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.

Contact Us
 
 


Provincial

 

Kimindra Tiwana - KTiwana@ismp-canada.org



National

 

Marg Colquhoun - mcolquhoun@ismp-canada.org
Jennifer Turple - jturple@ismp-canada.org
Brenda Carthy - bcarthy@ismp-canada.org



International

 

Marg Colquhoun - mcolquhoun@ismp-canada.org
Brenda Carthy - bcarthy@ismp-canada.org