ROP Handbook En

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RequiredOrganizationalPractices2012

ROPsROPs


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Required

Organizational

Practices

Rquird Orgaizaioal Prai

Published by: Accreditation Canada

All rights reserved.

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any

means, electronic, mechanical, photocopying, recording, or otherwise, without the proper written permission of the

publisher.

Accreditation Canada, 2012

www.accreditation.ca


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cOntents

Ardiaio caada, 2012

Overview.......................................................................................1

About the ROP handbook ............................................................2

Major and minor tests for compliance ..........................................3

SAFETY CULTURE

Adverse events disclosure ...........................................................4

Adverse events reporting .............................................................5

Client safety as a strategic priority ...............................................6

Client safety quarterly reports ......................................................7

Client safety-related prospective analysis ....................................8

COMMUNICATION

Client and family role in safety .....................................................9

Dangerous abbreviations ...........................................................10

Information transfer ....................................................................11

Medication reconciliation as an organizational priority

For Leadership Standards .................................................... 12

Medication reconciliation at admission

For Ambulatory Care Services and Ambulatory SystemicCancer Therapy Services .....................................................13

For Emergency Department Standards ................................ 15

For Acquired Brain Injury Services, Cancer Care andOncology Services, Critical Care, Hospice, Paliative, and

End-of-Life Services, Long-Term Care Services, Medicine

Services, Mental Health Services, Obstetrics Services,Rehabilitation Services, Residential Homes for Seniors,

Substance Abuse and Problem Gambling Services, and

Surgical Care Services. ........................................................17

For Case Management Services, Community-BasedMental Health Services and Supports, and Home Care

Services ................................................................................19

Medication Reconciliation at Transfer or Discharge

For teams using Ambulatory Care Services and AmbulatorySystemic Cancer Therapy Services ...................................... 21

For teams using Acquired Brain Injury Services, CancerCare and Oncology Services, Critical Care Services,

Emergency Departments, Hospice, Palliative, End-of-LifeCare Services, Medicine Services, Mental Health Services,

Obstetrics Services, Rehabilitation Services, Substance

Abuse and Problem Gambling Services, and Surgical

Care Services .......................................................................23

For teams using Home Care Services, Case ManagementServices, and Community Based Mental Health Services

and Supports. .......................................................................26

For teams using Long Term Care Services and ResidentialHomes for Seniors. ...............................................................28

Safe surgery checklist ................................................................30

Two client identifiers

For Managing Medications Standards .................................. 31

For teams using standards other than ManagingMedications ...........................................................................32

Verification processes for high-risk activities ..............................33

MEDICATION USE

Antimicrobial Stewardship ......................................................34

Concentrated electrolytes ...........................................................36

Heparin safety ............................................................................37

Infusion pumps training ..............................................................38

Medication concentrations ..........................................................39

Narcotics safety ..........................................................................40

WORKLIFE/WORKFORCE

Client safety: education and training ..........................................41

Client safety plan ........................................................................42

Client safety: roles and responsibilities ......................................43

Preventive maintenance program ..............................................44

Workplace violence prevention ..................................................45

INFECTION CONTROL

Hand-hygiene audit ....................................................................47

Hand-hygiene education and training .........................................48Infection control guidelines .........................................................49

Infection rates .............................................................................50

Influenza vaccine ........................................................................51

Pneumococcal vaccine ...............................................................52

Sterilization processes ...............................................................53

RISK ASSESSMENT

Falls prevention strategy ............................................................54

Home safety risk assessment ....................................................55

Pressure ulcer prevention .......................................................56

Suicide prevention ......................................................................58

Venous thromboembolism (VTE) prophylaxis ............................59

Chart of Required Organizational Practices ...............................60

Index ..........................................................................................61

New in 2013

New in 2013 for select acute care standard sets


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1


Accreditation Canada defines a Required Organizational Practice (ROP) as an essential practice that organizations must have

in place to enhance patient/client safety and minimize risk.

In the Qmentum accreditation program, ROPs are vital components of patient safety and quality improvement.

ROPs are reviewed annually and updated as required. New ROPs are developed as recommended by expert advisory commit-

tees and field-specific consultation.

ROPs are categorized into six patient safety areas, each with its own goal

SAFETY CULTURE:Create a culture of safety within the organization

COMMUNICATION:Improve the effectiveness and coordination of communication among care and service providers

and with the recipients of care and service across the continuum

MEDICATION USE: Ensure the safe use of high-risk medications

WORKLIFE/WORKFORCE: Create a worklife and physical environment that supports the safe delivery of care and

service

INFECTION CONTROL:Reduce the risk of health care-associated infections and their impact across the continuum of

care/service

RISK ASSESSMENT:Identify safety risks inherent in the client population

Accreditation Canada began developing ROPs in 2004 under the leadership of its Patient Safety Advisory Committee. Initial

work includes national and international literature reviews to identify major patient safety risk areas and best practices, analysis

of patient safety-related accreditation on-site survey results and compliance issues, and research into related activities in other

international accrediting bodies. Before being released to the field, each ROP is then subject to extensive testing, consultation,

and feedback from expert advisory committees, client organizations, surveyors, and other stakeholders such as governments

and content experts.

For more information on ROPs, Accreditation Canada, or the Qmentum accreditation program, visit www.accreditation.ca.

OVeRVIeW


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ABOUt tHe

ROP HAnDBOOK

For convenience and ease of use, all ROPs that appear in the standards have been collected into this handbook.

Most ROPs are applicable to more than one set of standards, and some of them, such as medication reconciliation, are custom-

ized for a specific service or f ield.

Each ROP in this handbook is presented as follows:

The ROP

.g. Advr ev Dilour

th orgaizaio implm a formal ad op poliy ad pro for dilour of advr v o li ad

famili, iludig uppor mhaim for li, family, aff, ad rvi providr ivolvd i advr v.

Guidelines

The guidelines provide context and rationale on why the ROP is important to patient safety and risk management, supporting

evidence, and information about meeting the tests for compliance.

Tests for Compliance

The tests for compliance show the specific requirements that are assessed to establish compliance with the ROP. Even oneunmet test for compliance results in an unmet rating for that ROP.

Reference Material

This section shows sources of supporting evidence used to develop the ROP, as well as tools and resources to assist

organizations in meeting requirements.


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MAJOR AnD MInOR tests

FOR cOMPLIAnce

ROPs are evidence-based practices that mitigate risk and contribute to improving the quality and safety of health services.

These practices address high priority areas that have been identified as central to quality and safety.

Beginning in January 2012, all ROP tests for compliance have been given a designation of major or minor. In order to be rated

compliant for an ROP, organizations must meet all tests for compliance, both major and minor.

Major tests for compliance have an immediate impact on safety. For unmet major tests for compliance, organizations will have

5 months to submit required follow-ups. Minor tests for compliance support safety culture and quality improvement, yet may

require additional time to be fully developed and/or evaluated. For unmet minor tests for compliance, organizations will have

11 months to submit required follow-ups. In some cases, time to submit required follow-ups may vary based on associated

levels of risk, surveyor observations, and an organizations accreditation status.

In the ROP handbook, major/minor designations will be displayed beside each test for compliance as follows:

Major At least one prospective analysis has been completed within the past year.

Minor The organization uses information from the analysis to make improvements.


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SAFETY CULTURE

Create a culture of safety within the organization

Required

Organizational

Practices

ADVERSE EVENTS DISCLOSURE

The organization implements a formal and open policy and process for disclosure of adverse events to clients

and families, including support mechanisms for clients, family, staff, and service providers involved in adverseevents.

GUIDELINES

Research shows a positive relationship between client satisfaction with how an adverse event is handled by an organization

and formal open disclosure. Disclosing adverse events in an open and timely manner may maintain the clients relationship

with the health service organization, staff and service providers, and reduce the risk of litigation.

Core elements of disclosure include discussing the event with the client, family, and relevant staff or service providers;

acknowledging or apologizing for the event; reviewing the actions taken to mitigate the circumstances surrounding the event;

discussing corrective action to prevent further similar adverse events; responding to client, family and staff or service providerquestions; and offering counselling to staff, service providers, and clients involved.

The Canadian Disclosure Guidelines, published by the Canadian Patient Safety Institute (CPSI) is a resource intended

to encourage and support healthcare providers, interdisciplinary teams, organizations and regulators in developing and

implementing disclosure policies, practices and training methods. They can be accessed on the CPSI website.

The disclosure policy and process is in compliance with any applicable legislation and within any protection afforded by

legislation.

TESTS FOR COMPLIANCE

Major There is a written policy for disclosure of adverse events to clients and families.

Major The disclosure policy includes support mechanisms for clients, families, staff, and service providers.

Major There is evidence of a process for disclosure of adverse events to clients, families, staff, and services providers.

REFERENCE MATERIAL

Chafe, R., Levinson, W., & Sullivan, T. (2009). Disclosing errors that affect multiple patients. CMAJ., 180,1125-1127.

Conway J, Federico F, Stewart K, & Campbell MJ (2011). Respectful Management of Serious Clinical Adverse Events (Second

Edition). IHI Innovation Series white paper [On-line]. Available: www.ihi.org/knowledge/Knowledge%20Center%20Assets/

IHIWhitePapers%20-%20RespectfulManagementofSeriousClinicalAdverseEvents_490ab9fb-d691-43e8-af97-6d39638cedec/

IHIRespectfulManagementofSeriousClinicalAdverseEventsOct11.pdf

Iedema, R., Sorensen, R., Manias, E., Tuckett, A., Piper, D., Mallock, N. et al. (2008). Patients and family members experiences of opendisclosure following adverse events. Int.J.Qual.Health Care, 20, 421-432.

Iedema, R., Jorm, C., Wakefield, J., Ryan, C., & Sorensen, R. (2009). A New Structure of Attention? Open Disclosure of Adverse Events toPatients and Their Families. Journal of Language and Social Psychology, 28, 139-157.

Institut canadien pour la scurit des patients. (2011). Lignes directrices nationales relatives la divulgation des vnements indsirables: parlerouvertement aux patients et aux proches. Institut canadien pour la scurit des patients [On-line]. Available:www.patientsafetyinstitute.ca/French/toolsresources/disclosure/Documents/CPSI%20Canadian%20Disclosure%20Guidelines%20FR.pdf

Institute for Healthcare Improvement. (2007). Disclosure Toolkit and Disclosure Culture Assessment Tool. Institute for Healthcare Improvement[On-line]. Available:www.ihi.org/knowledge/Pages/Tools/DisclosureToolkitandDisclosureCultureAssessmentTool.aspx

Kraman, S. S. & Hamm, G. (1999). Risk management: extreme honesty may be the best policy.Ann.Intern.Med., 131, 963-967.


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SAFETY CULTURE


Required

Organizational

Practices

ADVERSE EVENTS REPORTING

The organization establishes a reporting system for adverse events, sentinel events, and near misses,

including appropriate follow-up. The reporting system is in compliance with any applicable legislation, andwithin any protection afforded by legislation.

GUIDELINES

An adverse event is an unexpected and undesirable incident directly associated with the care or services provided to the

client. The incident occurs during the process of receiving health services. The adverse event is an adverse outcome, injury or

complication for the client.

A sentinel event is an adverse event that leads to death or major and enduring loss of function for a recipient of healthcare

services. Major and enduring loss of function refers to sensory, motor, physiological, or psychological impairment not present

at the time services were sought or began, i.e. a client dies or is seriously harmed by a medication error.

A near miss is an event or situation that could have resulted in an accident, injury or illness to a client but did not, either by

chance or through timely intervention.

The reporting system for adverse events, sentinel events and near misses may be part of a larger incident reporting system.

The goal of the reporting system for adverse events, sentinel events and near misses is to learn from the event, prevent

recurrences, and strengthen the culture of safety.


Major There is a reporting policy and process to report adverse events, sentinel events, and near misses.

Minor Improvements are made following investigation and follow-up.

REFERENCE MATERIAL

Baker, G. R., Norton, P. G., Flintoft, V., Blais, R., Brown, A., Cox, J. et al. (2004). The Canadian Adverse Events Study: the incidence of adverseevents among hospital patients in Canada. CMAJ., 170, 1678-1686.

Canadian Patient Safety Institute. (2008). Building a Safer System: The Canadian Adverse Event Reporting and Learning System ConsultationPaper. Canadian Patient Safety Institute [On-line]. Available: http://signup.patientsafetyinstitute.ca/English/toolsResources/ReportingAndLearning/CanadianAdverseEventsReportingAndLearningSystem/Documents/CAERLS%20Consultation%20Paper.pdf

Griffin FA & Resar RK (2009). IHI Global Trigger Tool for Measuring Adverse Events (2nd Edition). Institute for Healthcare Improvement [On-line].

Available:www.ihi.org/knowledge/Knowledge%20Center%20Assets/Tools%20-%20IHIGlobalTriggerToolforMeasuringAdverseEvents_df8a18b6-52cc-4674-8258-030941832115/IHIGlobalTriggerToolWhitePaper2009.pdf

World Alliance for Patient Safety. (2005). WHO Draft Guidelines for Adverse Event Reporting and Learning Systems. World Health Organization[On-line]. Available: www.who.int/patientsafety/events/05/Reporting_Guidelines.pdf

World Health Organization. (2009). Conceptual Framework for the International Classification for Patient Safety (Version 1.1). World HealthOrganization [On-line]. Available: www.who.int/patientsafety/implementation/taxonomy/icps_technical_report_en.pdf


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SAFETY CULTURE


Required

Organizational

Practices

CLIENT SAFETY AS A STRATEGIC PRIORITY

The organization adopts client safety as a written, strategic priority or goal.

GUIDELINES

There is an important connection between organization excellence and safety. Ensuring safety in the provision and delivery

of services is among an organizations primary responsibilities to clients, staff and providers. Accordingly, safety should be a

formally written component of the organizations strategic objectives. This may be in the form of the strategic plan, the annual

report, or list of organizational goals.


Major Client safety appears as a written, strategic priority or goal.

Minor Resources are allocated to support the organizations implementation of the client safety strategic priority or goal.

REFERENCE MATERIAL

Baldrige Performance Excellence Program. (2012). Health Care Criteria for Performance Excellence. National Institute of Standards andTechnology [On-line]. Available: www.nist.gov/baldrige/publications/upload/2011_2012_Health_Care_Criteria.pdf

Canadian Patient Safety Institute. (2012). Effective Governance for Quality and Patient Safety. Canadian Patient Safety Institute [On-line].Available: www.patientsafetyinstitute.ca/English/toolsResources/GovernancePatientSafety/Pages/default.aspx

Thomas R.Krause, John Hidley, & Diane C.Pinakiewicz (Foreword by) (2008). Taking the Lead in Patient Safety: How Healthcare LeadersInfluence Behaviour and Create Culture. Wiley.


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SAFETY CULTURE


Required

Organizational

Practices

CLIENT SAFETY QUARTERLY REPORTS

The organizations leaders provide the governing body with quarterly reports on client safety, and include

recommendations arising out of adverse incident investigation and follow-up, and improvements made.

GUIDELINES

The board or governing body for each organization is ultimately accountable for the quality and safety of health services.

Literature supports the important role of a governing body to enable an organizational culture that enhances client safety. An

organization is more likely to make safety and quality improvement a central feature of health services if the governing body is

aware of client safety issues and adverse events, and leads in the quality improvement efforts of the organization. In addition,

the governing body needs to be informed about and have input into follow-up actions or improvement initiatives resulting from

adverse events. Evidence is emerging that organizations with active board engagement in client safety are able to achieve

improved outcomes and processes of care.


Major Quarterly client safety reports have been provided to the governing body.

Minor The reports outline specific organizational activities and accomplishments in support of client safety goals andobjectives.

Minor There is evidence of the governing bodys involvement in supporting the activities and accomplishments, andacting on the recommendations in the quarterly reports.

REFERENCE MATERIAL

Institute for Healthcare Improvement. (2008). Getting Started Kit: Governance Leadership Boards on Board How-to Guide. www.ihi.org [On-line].Available: www.ihi.org/knowledge/Pages/Tools/HowtoGuideGovernanceLeadership.aspx

Jiang, H. J., Lockee, C., Bass, K., & Fraser, I. (2009). Board oversight of quality: any differences in process of care and mortality? J.Healthc.Manag.,54, 15-29.

Reinertsen JL, Bisognano M, & Pugh MD (2008). Seven Leadership Leverage Points for Organization-Level Improvement in HealthCare (Second Edition). IHI Innovation Series white paper [On-line]. Available: www.ihi.org/knowledge/Pages/IHIWhitePapers/SevenLeadershipLeveragePointsWhitePaper.aspx


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SAFETY CULTURE


Required

Organizational

Practices

CLIENT SAFETYRELATED PROSPECTIVE ANALYSIS

The organization carries out at least one client safety-related prospective analysis and implements

appropriate improvements.

GUIDELINES

Evidence shows that conducting systematic prospective analyses of potential adverse events is an effective method to prevent

or reduce errors. The principle behind the reduction of such events is the elimination of unsafe actions and conditions that can

lead to potentially serious events. A study by Nickerson applied Failure Modes and Effects Analysis (FMEA) to two high-risk

situations, transcription of medication errors for inpatients, and overcrowding in the emergency department. Results showed a

significant improvement.

There are numerous tools and techniques available to conduct a prospective analysis. One tool is FMEA, a team-based,

systematic, and proactive approach that identifies the ways a process or design might fail, why it might fail, the effects of thatfailure, and how it can be made safer. Other methods to proactively analyze key processes include fault tree analysis, hazard

analysis, simulations, and Reasons Errors of Omissions model.


Major At least one prospective analysis has been completed within the past year.

Minor The organization uses information from the analysis to make improvements.

REFERENCE MATERIAL Chiozza, M. L. & Ponzetti, C. (2009). FMEA: a model for reducing medical errors. Clin.Chim.Acta, 404, 75-78.

Grout, J. (2007). Mistake-Proofing the Design of Healthcare Processes. www.ahrq.gov [On-line]. Available:www.ahrq.gov/qual/mistakeproof/mistakeproofing.pdf

Nickerson, T., Jenkins, M., & Greenall, J. (2008). Using ISMP Canadas framework for failure mode and effects analysis: a tale of two FMEAs.Healthc.Q., 11, 40-46.

Spath, P. L. (2003). Using failure mode and effects analysis to improve patient safety. AORN J., 78, 16-37.

Tezak, B., Anderson, C., Down, A., Gibson, H., Lynn, B., McKinney, S. et al. (2009). Looking ahead: the use of prospective analysis to improve thequality and safety of care. Healthc.Q., 12Spec No Patient, 80-84.


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COMMUNICATION

Improve the effectiveness and coordination of communicationamong care and service providers and with the recipients ofcare and service across the continuum

Required

Organizational

Practices

CLIENT AND FAMILY ROLE IN SAFETY

The team informs and educates clients and families in writing and verbally about the client and familys role in

promoting safety.

GUIDELINES

Clients and families play an important role in preventing adverse events. Their questions and comments are often a good

source of information about potential risks, errors, or safety issues. Clients and families are able to fulfill this role when they are

included and actively involved in the process of care.

Many organizations have developed materials that relate to client safety-related issues and provide guidance and direction for

questions and topics to address during care. Examples of client safety educational materials include the Manitoba Institute of

Patient Safetys Its Safe to Ask, and the Ontario Hospital Associations Your Healthcare Be Involved.


Major The team develops written and verbal information for clients and families about their role in promoting safety.

Major The team provides written and verbal information to clients and families about their role in promoting safety.

REFERENCE MATERIAL

Alberta Health Services. (2012). Patient Engagement. Alberta Health Services [On-line]. Available:www.albertahealthservices.ca/patientengagement.asp

Center for Advancing Health. (2010). A New Definition of Patient Engagement: What is Engagement and Why is it Important? Center forAdvancing Health [On-line]. Available: www.cfah.org/pdfs/CFAH_Engagement_Behavior_Framework_current.pdf

Entwistle, V. A., Mello, M. M., & Brennan, T. A. (2005). Advising patients about patient safety: current initiatives risk shifting responsibility.Jt.Comm J.Qual.Patient.Saf,31, 483-494.

Manitoba Institute for Patient Safety. (2012). Its Safe to Ask. Manitoba Institute for Patient Safety [On-line]. Available: www.safetoask.ca/

Ontario Hospital Association. (2012). Your Health Care - Be Involved. Ontario Hospital Association [On-line]. Available:www.oha.com/KnowledgeCentre/Library/PatientSafety/Pages/YourHealthCareBeInvolved.aspx

Weingart, S. N., Zhu, J., Chiappetta, L., Stuver, S. O., Schneider, E. C., Epstein, A. M. et al. (2011). Hospitalized patients participation and itsimpact on quality of care and patient safety. Int.J.Qual.Health Care, 23, 269-277.


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COMMUNICATION


Required

Organizational

Practices

DANGEROUS ABBREVIATIONS

The organization has identified and implemented a list of abbreviations, symbols, and dose designations that

are not to be used in the organization.

GUIDELINES

Medication errors are the largest identified source of preventable hospital medical error. From 2004-2006, a total of 643,151

medication errors were reported to the United States Pharmacopeia (USP) MEDMARX program, with a total annual cost of

$3.5 billion. 5% of those errors were attributed to abbreviation use. Misinterpreted abbreviations can result in omission errors,

extra or improper doses, administering the wrong drug, or giving a drug in the wrong manner. In return this can lead to an

increase in the length of stay, more diagnostic tests and changes in drug treatment.


Major The list is inclusive of the abbreviations, symbols, and dose designations, as identified of the Institute of SafeMedication Practices (ISMP) Canadas Do Not Use List, available athttp://www.ismp-canada.org/dangerousabbreviations.htm.

Major The organization implements the Do Not Use List and applies this to all medication-related documentation whenhand written or entered as free text into a computer.

Major The organizations preprinted forms, related to medication-use, do not include any abbreviations, symbols, anddose designations identified on the Do Not Use List.

Major The dangerous abbreviations, symbols, and dose designations are not used on any pharmacy-generated labelsand forms.

Minor The organization educates staff about the list at orientation and when changes are made to the list.

Minor The organization updates the list and implements necessary changes to the organizations processes.

Minor The organization audits compliance with the Do Not Use List and implements process changes based onidentified issues.

REFERENCE MATERIAL

Medication safety issue brief. Eliminating dangerous abbreviations, acronyms and symbols (2005). Hosp.Health Netw., 79, 41-42.

Institute for Safe Medication Practices Canada. (2006). Eliminate Use of Dangerous Abbreviations, Symbols, and Dose Designations. ISMPCanada Safety Bulletin [On-line]. Available: ismp-canada.org/download/safetyBulletins/ISMPCSB2006-04Abbr.pdf

Institute for Safe Medication Practices Canada. (2012). Do Not Use: List of Dangerous Abbreviations, Symbols, and Dose Designations. Institutefor Safe Medication Practices Canada [On-line]. Available: www.ismp-canada.org/dangerousabbreviations.htm

Koczmara, C., Jelincic, V., & Dueck, C. (2005). Dangerous abbreviations: U can make a difference! Dynamics., 16, 11-15.


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COMMUNICATION


Required

Organizational

Practices

INFORMATION TRANSFER

The team transfers information effectively among service providers at transition points.

GUIDELINES

Effective communication has been identified as a critical element in improving client safety, particularly with regard to transition

points such as shift changes, end of service, and client movement to other health services or community-based providers.

Effective communication includes transfer of information within the organization, between staff and service providers, with the

client and family, and to other services outside the organization, such as primary care providers. Examples of mechanisms to

ensure accurate transfer of information may include transfer forms and checklists.


Major The team has established mechanisms for timely and accurate transfer of information at transition points.

Major The team uses the established mechanisms to transfer information.

REFERENCE MATERIAL

Alvarado, K., Lee, R., Christoffersen, E., Fram, N., Boblin, S., Poole, N., et al. (2006). Transfer of accountability: transforming shift handover toenhance patient safety. Healthc.Q., 9Spec No, 75-79.

Avoidable Hospitalization Advisory Panel. (2011). Enhancing the Continuum of Care. Ontario Ministry of Health and Long-Term Care [On-line].Available: www.health.gov.on.ca/en/public/publications/ministry_reports/baker_2011/baker_2011.pdf

Kripalani, S., Jackson, A. T., Schnipper, J. L., & Coleman, E. A. (2007). Promoting effective transitions of care at hospital discharge: a review of

key issues for hospitalists. J.Hosp.Med., 2, 314-323.

Kripalani, S., LeFevre, F., Phillips, C. O., Williams, M. V., Basaviah, P., & Baker, D. W. (2007). Deficits in communication and information transferbetween hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA, 297,831-841.

Naylor, M. D., Aiken, L. H., Kurtzman, E. T., Olds, D. M., & Hirschman, K. B. (2011). The care span: The importance of transitional care inachieving health reform. Health Aff.(Millwood.), 30, 746-754.

Patterson, E. S. & Wears, R. L. (2009). Beyond communication failure. Ann.Emerg.Med., 53, 711-712.

Trachtenberg, M. & Ryvicker, M. (2011). Research on transitional care: from hospital to home. Home.Healthc.Nurse, 29, 645-651.

World Health Organization. (2009). Human Factors in Patient Safety Review of Topics and Tools. World Health Organization [On-line]. Available:www.who.int/patientsafety/research/methods_measures/human_factors/human_factors_review.pdf


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COMMUNICATION


Required

Organizational

Practices

MEDICATION RECONCILIATION AS AN ORGANIZATIONALPRIORITY

For Leadership Standards

The organization reconciles clients medications at admission, and transfer or discharge.

GUIDELINES

Medication reconciliation is a structured process in which healthcare professionals partner with clients, families and caregivers

for accurate and complete transfer of medication information at transitions of care. Medication reconciliation is complex and

requires support from all levels of an organization, and many disciplines within the system.

Medication reconciliation is widely recognized as an important safety initiative. Research suggests that over 50% of patients

have at least one medication discrepancy upon admission to hospital, with many discrepancies carrying the potential to cause

adverse health effects. Evidence shows that medication reconciliation reduces the potential for medication discrepancies such

as omissions, duplications, and dosing errors, while cost-effectiveness analyses have also demonstrated that medication

reconciliation is an extremely cost-effective strategy for preventing medication errors. Additional research highlights that

successful medication reconciliation can also reduce workload and rework associated with patient medication management.

In Canada, Safer Healthcare Now! identifies medication reconciliation as a safety priority. The World Health Organization

(WHO) has also developed a Standard Operating Protocol for medication reconciliation as one of its interventions designed to

enhance patient safety.


Major Medication reconciliation is implemented in one client service area at admission.

Major Medication reconciliation is implemented in one client service area at transfer or discharge.

Major There is a documented plan to implement medication reconciliation throughout the organization.

Major The plan includes locations and timelines for implementing medication reconciliation throughout the organization.

REFERENCE MATERIAL

Avoidable Hospitalization Advisory Panel. (2011). Enhancing the Continuum of Care. Ontario Ministry of Health and Long-Term Care [On-line].Available: www.health.gov.on.ca/en/public/publications/ministry_reports/baker_2011/baker_2011.pdf

Greenwald, J. L., Halasyamani, L., Greene, J., LaCivita, C., Stucky, E., Benjamin, B., et al. (2010). Making inpatient medication reconciliation patientcentered, clinically relevant and implementable: a consensus statement on key principles and necessary first steps. J.Hosp.Med., 5, 477-485.

Institute for Safe Medication Practices Canada. (2011). Optimizing Medication Safety at Care Transitions - Creating a National Challenge.Institute for Safe Medication Practices - Canada [On-line]. Available:www.ismp-canada.org/download/MedRec/MedRec_National_summitreport_Feb_2011_EN.pdf

Institute for Safe Medication Practices Canada. (2012). Medication Reconciliation (MedRec). Institute for Safe Medication Practices - Canada[On-line]. Available: www.ismp-canada.org/medrec/

Karapinar-Carkit, F., Borgsteede, S. D., Zoer, J., Egberts, T. C., van den Bemt, P. M., & van, T. M. (2012). Effect of medication reconciliation onmedication costs after hospital discharge in relation to hospital pharmacy labor costs.Ann.Pharmacother., 46, 329-338.

Karnon, J., Campbell, F., & Czoski-Murray, C. (2009). Model-based cost-effectiveness analysis of interventions aimed at preventing medicationerror at hospital admission (medicines reconciliation). J.Eval.Clin Pract.,15, 299-306.


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13


COMMUNICATION


Required

Organizational

Practices

MEDICATION RECONCILIATION AT ADMISSION

For Ambulatory Care Services and Ambulatory Systemic Cancer Therapy Services

The team reconciles the clients medications with the involvement of the client, family, or caregiver at thebeginning of service when medication therapy is a significant component of care. Reconciliation should berepeated periodically as appropriate for the client or population receiving services.

GUIDELINES

Medication reconciliation is a structured process in which health care professionals partner with clients, families and caregivers

for accurate and complete transfer of medication information at transitions of care.

The medication reconciliation process involves generating a comprehensive list of all medications the client has been taking

prior to a visit the Best Possible Medication History (BPMH). The BPMH is compiled using a number of different sources,and includes information about prescription medications, non-prescription medications, vitamins, and supplements, along with

detailed documentation of drug name, dose, frequency, and route of administration. Any discrepancies identified between what

the client is prescribed, and what they are actually taking, will be resolved at the clinic or referred to their provider of care (e.g.

family physician).

Medication reconciliation is widely recognized as an important safety initiative. Evidence shows medication reconciliation

reduces potential for medication discrepancies such as omissions, duplications, and dosing errors. In Canada, Safer

Healthcare Now! identifies medication reconciliation as a safety priority. The World Health Organization (WHO) has also

developed a Standard Operating Protocol for medication reconciliation as one of its interventions designed to enhance patient

safety.

Medication reconciliation is a shared responsibility which must involve the client or family. Liaison with the primary care

provider and community pharmacist may be required.

Due to the wide range of service offerings and client populations receiving care in ambulatory clinics, teams are encouraged

to establish appropriate target populations to receive formal medication reconciliation. Medication reconciliation should focus

on clients for whom medication therapy is a significant component of care. A screening or risk assessment approach may be

adopted, and should consider: i) the clients needs, ii) the type of clinic, and iii) the service offerings of the clinic.

NOTE: Documented rationale for the selection of target clients or populations, as well as the appropriate interval of

reconciliation for these clients or populations, must be provided.

(Contd on next page...)


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COMMUNICATION


Required

Organizational

Practices

Medication reconciliation at admission (contd)


Major The team provides documented rationale for the selection of target clients or populations to receive formalmedication reconciliation.

Major There is a demonstrated, formal process to reconcile client medications at the beginning of service, andperiodically as appropriate for the client or population receiving services.

Major The team generates or updates a comprehensive list of medications the client has been taking prior to thebeginning of services (Best Possible Medication History (BPMH)).

Major The team documents any changes to the medications list (i.e. medications that have been discontinued, altered, orprescribed).

Minor The team provides clients and their providers of care (e.g. family physician) with a copy of the BPMH and clearinformation about the changes.

Major An up-to-date medications list is retained in the client record.Minor The process is a shared responsibility involving the client and one or more health care practitioner(s), such as

nursing staff, medical staff, pharmacists, and pharmacy technicians, as appropriate.

REFERENCE MATERIAL

American Medical Association. (2007). The physicians role in medication reconciliation. American Medical Association[On-line]. Available: www.ama-assn.org/resources/doc/cqi/med-rec-monograph.pdf

Institute for Healthcare Improvement. (2012). How-to Guide: Prevent Adverse Drug Events (Medication Reconciliation). Institute for HealthcareImprovement [On-line]. Available: www.ihi.org/knowledge/Pages/Tools/HowtoGuidePreventAdverseDrugEvents.aspx

Institute for Safe Medication Practices Canada. (2012). Medication Reconciliation (MedRec). Institute for Safe Medication Practices Canada [On-line]. Available: www.ismp-canada.org/medrec/

Institute for Safe Medication Practices Canada. (2012). Cross Country Med Rec Check-Up. Institute for Safe Medication Practices Canada [On-line]. Available: www.ismp-canada.org/medrec/map/

Safer Healthcare Now!. (2012). Medication Reconciliation: Getting Started Kits. Safer Healthcare Now! [On-line]. Available:www.saferhealthcarenow.ca/EN/Interventions/medrec/Pages/default.aspx

World Health Organization. (2009). Assuring Medication Accuracy at Transitions in Care: Medication Reconciliation. High 5s: Action on PatientSafety Getting Started Kit [On-line]. Available: www.high5s.org/pub/Manual/TrainingMaterials/MR_Getting_Started_Kit.pdf


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COMMUNICATION


Required

Organizational

Practices


For Emergency Department Standards

The team reconciles medications for clients with a decision to admit, with the involvement of the client, familyor caregiver.

GUIDELINES




prior to admission the Best Possible Medication History (BPMH). The BPMH is compiled using a number of different

sources, and includes information about prescription medications, non-prescription medications, vitamins, and supplements,along with detailed documentation of drug name, dose, frequency, and route of administration.

Medication reconciliation at admission generally fits into two models - the proactive process, the retroactive process, or a

combination of the two:

In the proactive process, the prescriber uses the BPMH to create admission medication orders. This process includes

verification that every medication in the BPMH has been assessed by the prescriber.

In the retroactive process, the BPMH is generated after the admission medication orders are written. This process

requires a timely comparison of the BPMH against the admission medication orders, with any discrepancies identified

and resolved with the prescriber.



Healthcare Now!identifies medication reconciliation as a safety priority. The World Health Organization (WHO) has also


safety.





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COMMUNICATION


Required

Organizational

Practices



Major There is a demonstrated, formal process to reconcile client medications for clients with a decision to admit.

Major The team generates a Best Possible Medication History (BPMH) for clients with a decision to admit.

Major Depending on the model, the prescriber uses the BPMH to create admission medication orders (proactive), OR, theteam makes a timely comparison of the BPMH against the admission medication orders (retroactive).

Major The team documents that the BPMH and admission medication orders have been reconciled; and appropriatemodifications to medications have been made where necessary.

Minor The process is a shared responsibility involving the client and one or more health care practitioner(s), such asnursing staff, medical staff, pharmacists, and pharmacy technicians, as appropriate.

REFERENCE MATERIAL

American Medical Association. (2007). The physicians role in medication reconciliation. American Medical Association[On-line]. Available: www.ama-assn.org/resources/doc/cqi/med-rec-monograph.pdf


Institute for Safe Medication Practices Canada. (2012). Medication Reconciliation (MedRec). Institute for Safe Medication Practices Canada. [On-line]. Available: www.ismp-canada.org/medrec/





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COMMUNICATION


Required

Organizational

Practices


For Acquired Brain Injury Services, Cancer Care and Oncology Services, Critical Care, Hospice, Paliative, and

End-of-Life Services, Long-Term Care Services, Medicine Services, Mental Health Services, Obstetrics Services,

Rehabilitation Services, Residential Homes for Seniors, Substance Abuse and Problem Gambling Services, and Surgical

Care Services.

The team reconciles the clients medications upon admission to the organization, with the involvement of theclient, family or caregiver.

GUIDELINES




prior to admission the Best Possible Medication History (BPMH). The BPMH is compiled using a number of different sources,

and includes information about prescription medications, non-prescription medications, vitamins, and supplements, along with

detailed documentation of drug name, dose, frequency, and route of administration.

Medication reconciliation at admission generally fits into two models - the proactive process, the retroactive process, or a

combination of the two:

In the proactive process, the prescriber uses the BPMH to create admission medication orders. This process includes

verification that every medication in the BPMH has been assessed by the prescriber.

In the retroactive process, the BPMH is generated after the admission medication orders are written. This process

requires a timely comparison of the BPMH against the admission medication orders, with any discrepancies identified

and resolved with the prescriber.





safety.





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COMMUNICATION


Required

Organizational

Practices



Major There is a demonstrated, formal process to reconcile client medications upon admission.

Major The team generates a Best Possible Medication History (BPMH) for the client upon admission.

Major Depending on the model, the prescriber uses the BPMH to create admission medication orders (proactive), OR, theteam makes a timely comparison of the BPMH against the admission medication orders (retroactive).

Major The team documents that the BPMH and admission medication orders have been reconciled; and appropriatemodifications to medications have been made where necessary.


REFERENCE MATERIAL

American Medical Association. (2007). The physicians role in medication reconciliation. American Medical Association[On-line]. Available:www.ama-assn.org/resources/doc/cqi/med-rec-monograph.pdf


Institute for Safe Medication Practices Canada. (2012). Medication Reconciliation (MedRec). Institute for Safe Medication Practices Canada. [On-line]. Available: www.ismp-canada.org/medrec/



World Health Organization. (2009). Assuring Medication Accuracy at Transitions in Care: Medication Reconciliation. High 5s: Action on Patient

Safety Getting Started Kit [On-line]. Available: www.high5s.org/pub/Manual/TrainingMaterials/MR_Getting_Started_Kit.pdf


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COMMUNICATION


Required

Organizational

Practices


For Case Management Services, Community-Based Mental Health Services and Supports, and Home Care Services

The team reconciles the clients medication at the beginning of service with the involvement of the client andfamily or caregiver when medication management is a component of care.

GUIDELINES




prior to the beginning of service the Best Possible Medication History (BPMH). The BPMH is compiled using a number

of different sources, and includes information about prescription medications, non-prescription medications, vitamins, andsupplements, along with detailed documentation of drug name, dose, frequency, and route of administration.





safety.




Major There is a demonstrated, formal process to reconcile client medications at each visit if medications have beendiscontinued, altered or changed.

Major The team generates a Best Possible Medication History (BPMH) at the beginning of service when medicationmanagement is a component of care.

Major The team conducts a timely comparison of the BPMH with medications prescribed, ordered, dispensed, oradministered during service.

Major The team communicates the BPMH and discrepancies requiring resolution to the appropriate health care provider,and documents actions taken in the client record.




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COMMUNICATION


Required

Organizational

Practices


REFERENCE MATERIAL American Medical Association. (2007). The physicians role in medication reconciliation. American Medical Association

[On-line]. Available: www.ama-assn.org/resources/doc/cqi/med-rec-monograph.pdf

Institute for Healthcare Improvement. (2012). How-to Guide: Prevent Adverse Drug Events (Medication Reconciliation). Institute for HealthcareImprovement [On-line]. Available:www.ihi.org/knowledge/Pages/Tools/HowtoGuidePreventAdverseDrugEvents.aspx

Institute for Safe Medication Practices Canada. (2012). Medication Reconciliation (MedRec). Institute for Safe Medication Practices Canada [On-line]. Available: www.ismp-canada.org/medrec/


Safer Healthcare Now!. (2012). Medication Reconciliation: Getting Started Kits. Safer Healthcare Now! [On-line]. Available: www.saferhealthcarenow.ca/EN/Interventions/medrec/Pages/default.aspx

World Health Organization. (2009). Assuring Medication Accuracy at Transitions in Care: Medication Reconciliation. High 5s: Action on Patient

Safety Getting Started Kit [On-line]. Available:www.high5s.org/pub/Manual/TrainingMaterials/MR_Getting_Started_Kit.pdf


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COMMUNICATION


Required

Organizational

Practices

MEDICATION RECONCILIATION AT TRANSFER OR DISCHARGE

For teams using Ambulatory Care Services and Ambulatory Systemic Cancer Therapy Services

The team reconciles the clients medications with the involvement of the client, family, or caregiver atinterfaces of care where the client is a risk of medication discrepancies (transfer, discharge), when medicationtherapy is a significant component of care. Reconciliation should be repeated periodically as appropriate forthe client or population receiving services.

GUIDELINES


for accurate and complete transfer of medication information at transitions of care. The Medication Reconciliation at Transfer

or Discharge ROP is designed to complement Accreditation Canadas Medication Reconciliation at Admission ROPs.


prior to the beginning of services the Best Possible Medication History (BPMH). The BPMH is compiled using a number of

different sources, and includes information about prescription medications, non-prescription medications, vitamins, herbal

remedies, and supplements, along with detailed documentation of drug name, dose, frequency, and route of administration.

Throughout a clients health care journey, the BPMH serves as an important reference for reconciling medications at interfaces

of care. In instances where a client has been receiving services for an extended period and did not receive a BPMH at

the beginning of services, the up-to-date, complete medication list may be used as a BPMH (the period of time should be

determined by organizational policy). In these instances, every effort should be made to account for medications the patient

may have been taking prior to the beginning of services that may not be included on the up-to-date medication list.

tRAnsFeR ad DIscHARGe

Transfer and discharge in ambulatory care settings are defined as critical interfaces of care where clients are at risk of

medication discrepancies as they transition from one clinic service to another, or when a clients services with a clinic come

to an end. Examples of transfer and discharge may include a client who is transferred between renal program sites (transfer),

external transfer from a renal program to a long term care facility (discharge), or external transfer of a client no longer in need

of chemotherapy to palliative care (discharge).

Due to the wide range of service offerings and client populations receiving care in ambulatory clinics, teams are encouraged

to establish appropriate target populations to receive formal medication reconciliation. Medication reconciliation should focus

on clients for whom medication therapy is a significant component of care. A screening or risk assessment approach may be

adopted, and should consider: i) the clients needs, ii) the type of clinic, and iii) the service offerings of the clinic. Regarding

transfer and discharge, teams are also encouraged to identify the risk points during service delivery where medication

reconciliation is appropriate, and establish reconciliation processes at these junctures to mitigate the risk of medication errors.

NOTE: Documented rationale for the selection of target clients or populations, the appropriate interval of reconciliation for

these clients or populations, and the risk points where reconciliation will be conducted must be provided.



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COMMUNICATION


Required

Organizational

Practices

Medication Reconciliation at Transfer or Discharge (contd)

Medication reconciliation is widely recognized as an important safety initiative. In Canada, Safer Healthcare Now! identifies

medication reconciliation as a safety priority. The Institute for Safe Medication Practices Canada has developed a Standard

Operating Protocol for medication reconciliation which has been endorsed by the World Health Organization as one of its

interventions designed to enhance patient safety.




Major The team provides documented rationale for the selection of target clients or populations to receive formalmedication reconciliation, and the risk points during service delivery where reconciliation will be conducted.

Major There is a demonstrated, formal process to reconcile client medications at interfaces of care where the clientis at risk of medication discrepancies (transfer, discharge), and periodically as appropriate for the client orpopulation receiving services.

Major The team documents any changes to the medications list (i.e. medications that have been discontinued, altered,or prescribed).

Major Upon transfer or discharge, the team provides clients and their providers of care (e.g. family physician, nextprovider of care) with a copy of the up-to-date medications list and clear information about the changes.

Minor The process is a shared responsibility involving the client or family, and one or more health care practitioner(s),such as nursing staff, medical staff, and pharmacy staff, as appropriate.

REFERENCE MATERIAL

American Medical Association. (2007). The physicians role in medication reconciliation. American Medical Association [On-line]. Available:www.ama-assn.org/resources/doc/cqi/med-rec-monograph.pdf


Institute for Safe Medication Practices Canada. (2012). Medication Reconciliation (MedRec). Institute for Safe Medication Practices Canada[On-line]. Available:www.ismp-canada.org/medrec/

Institute for Safe Medication Practices Canada. (2012). Cross Country Med Rec Check-Up. Institute for Safe Medication Practices Canada[On-line]. Available: www.ismp-canada.org/medrec/map/




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COMMUNICATION


Required

Organizational

Practices


For teams using Acquired Brain Injury Services, Cancer Care and Oncology Services, Critical Care Services, Emergency

Departments, Hospice, Palliative, End-of-Life Care Services, Medicine Services, Mental Health Services, Obstetrics

Services, Rehabilitation Services, Substance Abuse and Problem Gambling Services, and Surgical Care Services

The team reconciles the clients medications with the involvement of the client, family or caregiver at transitionpoints where medication orders are changed or rewritten (i.e. internal transfer, and/or discharge).

GUIDELINES





prior to admission the Best Possible Medication History (BPMH). The BPMH is compiled using a number of different sources,

and includes information about prescription medications, non-prescription medications, vitamins, herbal remedies, and

supplements, along with detailed documentation of drug name, dose, frequency, and route of administration.

Throughout a clients health care journey, the BPMH serves as an important reference for reconciling medications at

transitions of care. In instances where a client has been in a service environment for an extended period and did not receive

a BPMH upon admission, the up-to-date, complete medication list may be used as a BPMH (the period of time should be


may have been taking prior to admission that may not be included on the up-to-date medication list.

InteRnAL tRAnsFeR

Internal transfer is defined as an interface of care within a facility where medication orders are changed or rewritten. Internal

transfers where medication reconciliation should occur include a change in responsible medical service, a change in level of

care, post-operatively, and/or transfer between units when one of the previous three conditions is present. Bed relocation or

transitions of care where the responsible health care provider does not change should not be considered an internal transfer

for the purpose of medication reconciliation.

The goal of medication reconciliation at internal transfer is to consider not only what the patient was receiving on the

transferring/sending unit, but also medications they were taking at home that may be appropriate to continue, restart,

discontinue, or modify.

DIscHARGe

Discharge is defined as a critical interface of care where clients are at risk of medication discrepancies as they transition out

of a facility. Discharge includes external transfers to another service environment or community-based service provider, or the

end of service. Examples may include but are not limited to acute care to long term care, acute care to home care, acute care

to rehab, and acute care to self-care.

The goal of discharge medication reconciliation is to reconcile the medications the patient was taking prior to admission, and

those initiated in hospital, with the medications they should be taking post-discharge. (Contd on next page...)


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COMMUNICATION


Required

Organizational

Practices


Medication reconciliation at internal transfer and discharge generally fits into two models the proactive process or the

retroactive process.

In the proactive process, the prescriber uses the BPMH and the active medication orders to generate transfer or

discharge medication orders. This process includes verification that every medication in the BPMH has been assessed

by the prescriber.

In the retroactive process, the team makes a timely comparison of the BPMH, the active medication orders, and the

transfer or discharge medication orders to identify discrepancies and resolve with the prescriber.

At discharge, this information should be used to generate a Best Possible Medication Discharge Plan (BPMDP). The BPMDP

includes all detailed medication information outlined in the BPMH description above, and should be communicated to the client

and/or caregiver, community-based physician or service, community pharmacy, and alternative care facility or service, as

appropriate.

NOTE: For emergency departments, medication reconciliation at internal transfer or discharge is only expected for patientswho have been admitted.

Medication reconciliation is widely recognized as an important safety initiative. In Canada, Safer Healthcare Now!identifies

medication reconciliation as a safety priority. The Institute for Safe Medication Practices Canadahas developed a Standard

Operating Protocol for medication reconciliation which has been endorsed by the World Health Organization as one of its





Major There is a demonstrated, formal process to reconcile client medications at transition points where medicationorders are changed or rewritten (i.e. internal transfer, and/or discharge).

Major Depending on the model, the prescriber uses the Best Possible Medication History (BPMH) and the activemedication orders to generate transfer or discharge medication orders (proactive),OR, the team makes atimely comparison of the BPMH, the active medication orders, and the transfer or discharge medication orders(retroactive).

Major The team documents that the BPMH, the active medication orders, and the transfer or discharge medicationorders have been reconciled; and appropriate modifications to medications have been made where necessary.

Major Depending on the transition point, an up-to-date medication list is retained in the client record (internal transfer),OR, the team generates a Best Possible Medication Discharge Plan (BPMDP) that is communicated to theclient, community-based physician or service provider, and community pharmacy, as appropriate (discharge).




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COMMUNICATION


Required

Organizational

Practices


REFERENCE MATERIAL American Medical Association. (2007). The physicians role in medication reconciliation. American Medical Association [On-line]. Available:

www.ama-assn.org/resources/doc/cqi/med-rec-monograph.pdf


Institute for Safe Medication Practices Canada. (2012). Medication Reconciliation (MedRec). Institute for Safe Medication Practices Canada[On-line]. Available:www.ismp-canada.org/medrec/





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COMMUNICATION


Required

Organizational

Practices


For teams using Home Care Services, Case Management Services, and Community Based Mental Health Services and

Supports.

The team reconciles the clients medications at interfaces of care where the client is at risk for medicationdiscrepancies (circle of care, discharge) with the involvement of the client and family or caregiver whenmedication management is a component of care, or as deemed appropriate through clinician assessment.

GUIDELINES





prior to the beginning of services the Best Possible Medication History (BPMH). The BPMH is compiled using a number of

different sources, and includes information about prescription medications, non-prescription medications, vitamins, herbal

remedies, and supplements, along with detailed documentation of drug name, dose, frequency, and route of administration.

Throughout a clients health care journey, the BPMH serves as an important reference for reconciling medications at interfaces

of care. In instances where a client has been receiving services for an extended period and did not receive a BPMH at

the beginning of services, the up-to-date, complete medication list may be used as a BPMH (the period of time should be


may have been taking prior to the beginning of services that may not be included on the up-to-date medication list.

cIRcLe OF cARe

The circle of care is defined as a group of individuals including the client and family who are involved in the clients care within

the health care setting. This includes health care providers, as well as formal and informal caregivers. Specifically, those who

are involved with the clients care within the community care setting. Examples of risk points for medication discrepancies

within a clients circle of care may include but are not limited to physician, nurse practitioner, or clinic appointments, a change

in client status, or transfers to an alternate level of care within the organization.

The goal of medication reconciliation within a clients circle of care is to maintain and communicate an up-to-date, complete,

and accurate medication list. The community care clinician should update the clients medication list following each

consultation or visit to a health care practitioner in the clients circle of care.

DIscHARGe

Discharge is defined as the discontinuation of service by the community care organization, and includes external transfers to

another service environment. Discharge is an interface of care where clients are at risk of medication discrepancies. Examples

may include but are not limited to discharge to acute care, long term care, palliative care, self-care, or the end of services.



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COMMUNICATION


Required

Organizational

Practices


The goal of medication reconciliation at discharge is to communicate an up-to-date, complete, and accurate medication

list to the next provider of care. If the client is being discharged to another health care setting, the community care clinician

should update and communicate the clients current reconciled medication list to the next provider of care. If the client is beingdischarged into self-care, the community care clinician should verify that the client or family understands any changes to their

medication regimen.

As care in the community is intermittent, the community care organization may not always be immediately aware that a client

has been transferred or discharged. Keeping the reconciled medication list up-to-date and accurate is the best way to be

prepared for transfer and discharge at any time.

Depending on a clients circumstances, community care providers may use a variety of methods to communicate the

medication list to the clients circle of care or next provider of care. Methods may include using the client or family as a carrier,

or face-to-face discussion, a telephone call, or facsimile between health care providers.

Medication reconciliation is widely recognized as an important safety initiative. In Canada, Safer Healthcare Now!identifies

medication reconciliation as a safety priority. The Institute for Safe Medication Practices Canada has developed a StandardOperating Protocol for medication reconciliation which has been endorsed by the World Health Organization as one of its





Major There is a demonstrated, formal process to reconcile client medications at interfaces of care where the client is atrisk of medication discrepancies (circle of care, discharge).

Major The team updates the clients medication list following each clinician consultation or visit to a health care

practitioner within the clients circle of care.Minor The team provides the client with a copy of the up-to-date medication list, clear information about the changes, and

educates the client to share the list when encountering providers in the clients circle of care.

Major Upon notification that a client has been transferred or discharged, the community care organization communicatesthe most recent medication list to the next provider of care.


REFERENCE MATERIAL

American Medical Association. (2007). The physicians role in medication reconciliation. American Medical Association. [On-line]. Available:www.ama-assn.org/resources/doc/cqi/med-rec-monograph.pdf


Institute for Safe Medication Practices Canada. (2012). Medication Reconciliation (MedRec). Institute for Safe Medication Practices Canada[On-line]. Available: www.ismp-canada.org/medrec/





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COMMUNICATION


Required

Organizational

Practices


For teams using Long Term Care Services and Residential Homes for Seniors.

The team reconciles the clients medications with the involvement of the client, family or caregiver at transitionpoints where medication orders are changed or rewritten (i.e. internal transfer, and/or discharge).

GUIDELINES





prior to admission the Best Possible Medication History (BPMH). The BPMH is compiled using a number of different sources,and includes information about prescription medications, non-prescription medications, vitamins, herbal remedies, and

supplements, along with detailed documentation of drug name, dose, frequency, and route of administration.

Throughout a clients health care journey, the BPMH serves as an important reference for reconciling medications at

transitions of care. For clients that have been in a service environment for an extended period of time, the up-to-date, complete

medication list will become the BPMH.

InteRnAL tRAnsFeR

Internal transfer is defined as an interface of care within a facility where medication orders are changed or rewritten. Internal

transfers where medication reconciliation should occur include a change in responsible medical service, a change in level of

care, and/or transfer between units when one of the previous two conditions is present. Bed relocation or transitions of care

where the responsible health care provider does not change should not be considered an internal transfer for the purpose of

medication reconciliation.

The goal of medication reconciliation at internal transfer is to ensure that all medication orders are completely and accurately

transferred with the client, and that any discrepancies with the medication list are intentional. The process should involve a

comparison of: i) the most current medication list; and ii) the new transfer orders, to identify and resolve discrepancies.

DIscHARGe

Discharge is defined as a critical interface of care where clients are at risk of medication discrepancies as they transition out

of a facility. Discharge includes external transfers to another service environment or community-based service provider, or

the end of service. Examples may include but are not limited to long term care to acute care, long term care to self-care, and

between long term care facilities.

The goal of medication reconciliation at discharge is to communicate a complete list of medications to the next provider of

care. The process should involve a comparison of: i) the BPMH/most current medication list; and ii) recent changes including

newly initiated medications, adjusted doses, and discontinued medications.

In long term care settings, medication reconciliation at internal transfer and discharge provides an opportunity to review the

treatment goal and expected duration of therapy for medications to ensure that continued use is appropriate.



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COMMUNICATION


Required

Organizational

Practices


Medication reconciliation is widely recognized as an important safety initiative. In Canada, Safer Healthcare Now! identifies

medication reconciliation as a safety

ROP Handbook En

Documents

Transcript of ROP Handbook En