Med Rec: Beginning With the End in Mind

Clara Ballantine, SIASHN Ontario NodeOntario Node Open Line CallOctober 29, 2007

What is Med Rec?

Making it Manageable• Two pieces of work:

The Best Possible Medication HistoryThe Reconciliation process

• Two pieces of advice:Move to designing the new process earlyDon’t get stuck on the BPMH tool (form)

What are we trying to accomplish?

How will we know that a change is an improvement?

What changes can we make that will result in improvement?

Act Plan

Study Do

AIM Statement

Measures

Change Ideas for PDSA

cycles

Model for Improvement

What is “The End”?• Whole Process

AdmissionTransferDischarge

• Whole organizationPilot unit All other clinical areas

• SustainabilityProcesses are embedded Targets met and maintained

What is “The Beginning”?

• Project charterSenior sponsorshipTeam leadershipPilot unitTargets

• Baseline dataMaybe before first team meetingDefinitely before tests

of change

What is “The Beginning”?

• Team formationLeadership vs ownershipMembership for pilot and toward spread

• First team meetingPicture, purpose, plan and place

• Communication

Pilot and Spread: What is “Spread”?

• “…learning which takes place in any part of an organization is actively shared and acted upon by all parts of the organization.”

-NHS Modernisation Agency

• “Spread is the result of the process of adoption”

- NHS Modernisation Agency

What is Sustainability?

• “…when new ways of working and improved outcomes become the norm.”

• “…means holding the gains and evolving as required, definitely not going back.

So, What to Do?• Engage concrete, visible senior leadership

support pre-charter• Write a strong, clear charter and use it• Consider team co leadership or an alternative to

pharmacist led (becoming pharmacist owned)• Consider pilot unit in terms of opportunity for

learning, ease of spread, impact• Decide between full three phase process in pilot

unit VS first phase full organization approach• Form team with spread in mind – leadership

support + front line champions• Design process with sustainability in mind

Words of Wisdom on Beginnings

• Beginnings are always messy- John Galsworthy, English

novelist

• Don’t ask me to be in on the landing if I wasn’t in on the takeoff.

- Lyndon B. Johnson

• Begin with the end in mind.- Stephen Covey, 7 Habits of

Highly Effective People

Contact Information

• Clara Ballantine, BSc(PT), MEd, CPHQ

SIA, Ontario Node

clara.ballantine@qhn.ca

Phone: (613) 736-9142