Objectives: 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. Click the link to read more http://bit.ly/10LqxjQ

1. Medication Reconciliation
Recent changes introduced by Accreditation Canada
Safer Healthcare Now! National Call
March 5 2013
Heather Howley
Health Services Research Specialist, Accreditation Canada
Accredited by
Agréé par
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2. Required Organizational Practices
for 2013
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3. Why Med Rec?
 Prevent adverse drug events
 Recognized by:
 WHO = five patient safety challenges
 CPSI = core objective
 Canadian Health Jurisdictions = key patient safety
priority
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4. What is Med Rec?
Med Rec is a three-step process:
 COLLECT the Best Possible Medication
History
 COMPARE what the client is actually taken
with what is prescribed to identify
discrepancies
 COMMUNICATE and resolve medication
discrepancies
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5. History of MedRec
 2006 = Med Rec ROP became part of the
program
 2008 = Med Rec ROP requirements scaled
back due to challenges
 2010 – 2012 = customization and clarity to the
service level ROPs
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6. Improved performance
ROP Compliance (%)
2009 2010 2011
Medication reconciliation as an organizational priority ---- 61 77
Medication reconciliation at admission 46 47 60
Medication reconciliation at transfer/discharge 44 36 50
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7. Why Change MedRec
 Performance has improved
 More support and resources available
 Broader scope
 Higher expectations = patient safety
 Clarification and realignment of expectations
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8. Consultation and Development
 Extensive consultation during the development
of MedRec revisions(Mar-Nov 2012)
 Drafts of the revised ROPs sent out for national
consultation (Nov – Dec 2012)
 Changes were implemented as a result of
excellent feedback
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9. Overview of changes:
 Increased expectations for implementation
 Broader definition of “service”
 A two-phased approach:
 Phase 1: 2014-2017, in one service area
 Phase 2: 2018 and beyond, in all service area
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10. Overview of changes - ROP Structure
OLD REVISED
 Med Rec as an organizational  Med Rec as a strategic priority
priority (Leadership Standards)
 2 ROPs: Med Rec at admission and  1 single ROP Med Rec at Care
Med Rec at transfer/discharge transitions
(service-based standards)
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11. Medication Reconciliation as a
Strategic Priority
 The organization has a strategy to partner with
clients to collect accurate and complete
information about client medications and utilize
this information during transitions of care.
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12. Med Rec as a Strategic Priority:
Tests for Compliance
1. The organization has a medication reconciliation
policy and process to collect and utilize accurate
and complete information about client medication
at transitions of care. (Major)
2. The organization defines roles and
responsibilities for completing medication
reconciliation. (Minor)
3. The organization has a plan to implement and
sustain medication reconciliation that specifies
services/programs, locations and timelines.
(Major)
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13. Med Rec as a Strategic Priority:
Tests for Compliance (continued)
4. The organizational plan is led and sustained
by an interdisciplinary coordination team.
(Minor)
5. There is documented evidence that the
organization educates staff and physicians
responsible for medication reconciliation.
(Major)
6. The organization monitors compliance with
the medication reconciliation process, and
makes improvements when required. (Minor)
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14. Medication Reconciliation at Care
Transitions
 With the involvement of the client, family, or
caregiver (as appropriate), the team generates a
Best Possible Medication History (BPMH) and
uses it to reconcile client medications ....
 Five versions:
 Acute care
 Ambulatory care
 Home and Community care
 Long-term care
 Substance misuse (unchanged)
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15. STANDARDS SET Version
Aboriginal Integrated Primary Care Services Ambulatory
Aboriginal Substance Misuse Services Standards Substance Misuse
Acquired Brain Injury Services Acute
Ambulatory Care Ambulatory
Ambulatory Systemic Cancer Therapy Services Ambulatory
Cancer Care and Oncology Services Acute
Case Management Services Home and Community
Community-Based Mental Health Services and Supports Standards Home and Community
Correctional Service of Canada Health Services Standards Acute
Critical Care Acute
Emergency Department Acute
Home Care Services Home and Community
Hospice, Palliative, and End-of-Life Services Acute
Long Term Care Services Long-term care
Medicine Services Acute
Mental Health Services Acute
Obstetrics Services Acute
Provincial Correctional Health Services Standards Acute
Rehabilitation Services Acute
Residential Homes for Seniors Long-term care
Spinal Cord Injury Acute Services Acute
Spinal Cord Injury Rehabilitation Services Acute
Substance Abuse and Problem Gambling Services Substance Misuse
Surgical Care Services Acute
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16. Acute care version:
Tests for Compliance
1. Upon or prior to admission, the team generates and documents a Best
Possible Medication History (BPMH), with the involvement of the client,
family, or caregiver (and others, as appropriate). (Major)
2. The team uses the BPMH to generate admission medication orders OR
compares the Best Possible Medication History (BPMH) with current
medication orders and identifies, resolves, and documents any medication
discrepancies. (Major)
3. A current medication list is retained in the client record. (Major)
4. The prescriber uses the Best Possible Medication History (BPMH) and the
current medication orders to generate transfer or discharge medication
orders. (Major)
5. The team provides the client, community-based health care provider, and
community pharmacy (as appropriate) with a complete list of medications
the client should be taking following discharge. (Major)
*Special consideration in emergency departments
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17. Ambulatory care version:
Tests for Compliance
1. The organization identifies and documents the type of ambulatory care visits where
medication reconciliation is required. (Major)
2. For ambulatory care visits where medication reconciliation is required, the
organization identifies and documents how frequently medication reconciliation
should occur. (Major)
3. During or prior to the initial ambulatory care visit, the team generates and
documents the Best Possible Medication History (BPMH), with the involvement of
the client, family, caregiver (as appropriate). (Major)
4. During or prior to subsequent ambulatory care visits, the team compares the Best
Possible Medication History (BPMH) with the current medication list and identifies
and documents any medication discrepancies. This is done as per the frequency
documented by the organization. (Major)
5. The team works with the client to resolve medication discrepancies OR
communicates medication discrepancies to the client’s most responsible prescriber
and documents actions taken to resolve medication discrepancies. (Major)
6. When medication discrepancies are resolved, the team updates the current
medication list and retains it in the client record. (Major)
7. The team provides the client and the next care provider (e.g., primary care provider,
community pharmacist, home care services) with a complete list of medications the
client should be taking following the end of service. (Major)
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18. Home and community care version:
Tests for Compliance
1. The organization identifies and documents the types of clients who
require medication reconciliation. (Major)
2. At the beginning of service the team generates and documents a
Best Possible Medication History (BPMH), with the involvement of
the client, family, health care providers, and caregivers (as
appropriate). (Major)
3. The team works with the client to resolve medication discrepancies
OR communicates medication discrepancies to the client’s most
responsible prescriber and documents actions taken to resolve
medication discrepancies. (Major)
4. When medication discrepancies are resolved, the team updates
the current medication list and provides this to the client or family
(or primary care provider, as appropriate) along with clear
information about the changes. (Minor)
5. The team educates the client and family to share the complete
medication list when encountering health care providers within the
client’s circle of care. (Major)
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19. Long-term care version:
Tests for compliance
1. Upon or prior to admission, the team generates and documents a Best
Possible Medication History (BPMH), in consultation with the resident,
family, health care providers, and caregivers (as appropriate).
2. The team compares the Best Possible Medication History (BPMH) with the
admission orders and identifies, resolves, and documents any medication
discrepancies.
3. The team uses the reconciled admission orders to generate a current
medication list that is kept in the resident record.
4. Upon or prior to re-admission from another service environment (e.g.,
acute care), the team compares the discharge medication orders with the
current medication list and identifies, resolves, and documents any
medication discrepancies.
5. Upon transfer out of long-term care, the team provides the resident and
next care provider (e.g., another long-term care facility or community-
based health care provider), as appropriate, with a complete list of
medications the resident should be taking.
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20. Implementation
 Revised ROPs apply to on-site surveys beginning
in 2014
 Implementation in one service (broadly defined) is
expected for on-site surveys between 2014 and
2017.
 For services that use standards that contain an
applicable MedRec ROP
 Implementation in all services is expected for on-
site surveys in 2018 and beyond
 For services that use standards that contain an
applicable MedRec ROP
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21. Resources
 Accreditation Canada
 Backgrounder
 FAQ
 Webcast
 Webinar Series
 Accreditation Specialist
 MedRec@accreditation.ca
 Safer Healthcare Now! Getting Started kits
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22. Proud to be a
Top 25 Employer
in 2010, 2011, and 2012.
Fier de faire partie des
25 meilleurs employeurs
en 2010, 2011 et 2012.
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