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

1. www.saferhealthcarenow.ca
Safety, Sleuthing and Students: A
Novel Collaborative MedRec Event
Dr. Arun Verma, UBC Faculty of Pharmaceutical Sciences Faculty member
Dr. Judith Soon, UBC Faculty of Pharmaceutical Sciences Faculty member
Dr. Nick Petropolis, BC Fraser Health Authority physician
May 2014

2. www.saferhealthcarenow.ca
Safer Healthcare Now! MedRec
2014-2015 Year-at-a-glance
• 2nd MedRec Quality Audit Month (Fall-
Winter)
– 2 associated national call/webinars
• 6 national calls/webinars (webinars to
resume in Sept. 2014)
• Updates to Home Care Getting Started Kit
• Updates to MedRec Cross Canada
Check Up Map
• Developing MedRec FAQ documents
2

3. www.saferhealthcarenow.ca3
ISMP Canada MedRec Projects
2014-2015
• Doc Mike Evans YouTube video- MedRec
• MyMedRec app- soon available for
Android and Blackberry devices

4. www.saferhealthcarenow.ca
Safer Healthcare Now! website
http://www.saferhealthcarenow.ca/EN/events/
NationalCalls/2014Webinars/Pages/default.aspx
ISMP Canada website
http://www.ismp-canada.org/medrec/#webinars
Safer Healthcare Now! MedRec Community of Practice
http://tools.patientsafetyinstitute.ca/Communities
/MedRec/default.aspx
For real time notification of content posting, “like” the
Medication Reconciliation Network on Facebook
www.facebook.com/MedicationReconciliation
All Safer Healthcare Now! webinars are posted within the
week to the following locations:

5. Safety, Sleuthing and Students:
A Novel Collaborative MedRec Event
Arun Verma, B.Sc. Pharm, RPh, ACPR, PhD
Judith Soon, BSc Pharm, RPh, ACPR, PhD, FCSHP
Nick Petropolis, MD, BSc (Hon)
May 6, 2014

6. MedRec Team in Action!

7. Acknowledgements
Pharmaceutical Sciences Medicine Nursing
Anita Lo Lesley Bainbridge Kathy O’Flynn-Magee
Wayne Riggs Linlea Armstrong Elsie Tan
Lynda Eccott Keri Closson Suzanne Campbell
Shelley Novak Fraser Black Tarnia Taverner
Allison Kirkwood Karen Joughin Noreen Frisch
Melissa Lo Jessica Hartley Martha MacLeod
Vivian Leung Deborah Phillips Lisa Viik
Dan Martinusen Anne Worthington Lela Zimmer
Aleisha Thornhill Remare Ettarh Maren Akyürek
Mark Collins Stan Bardai Diana Choi
Jamal Kurtu John Cheng Myitzu Shwe

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

9. Overview
 Medication reconciliation ideally involves the
healthcare team in the clinical practice setting
 Opportunities for engaging interprofessional
undergraduate interactions in meaningful problem-
solving settings are rare
 A novel approach was taken to explore patient safety
issues in a 3rd year Pharmacy course that utilizes
case studies to integrate scientific and clinical
concepts

10. Background
 During new case development for Pharmacy 498, this
recently published paper was reviewed:
 It was recognized that MedRec was not being taught in
the undergrad healthcare curriculum at UBC
 Only some students observed in clinical care rotations

11. Aim
 To design and implement user-friendly interactive
activities to teach senior undergraduate healthcare
students about the importance of medication
reconciliation at transition points of care
Acute Care Hospital Home Residential Care

12. Definition of Medication Reconciliation
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.
http://www.ismp-canada.org/medrec/

13. Definition of Medication Reconciliation cont’d
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.
http://www.ismp-canada.org/medrec/

14. Best Possible Medication History (BPMH)
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/family involvement is vital.
http://www.ismp-canada.org/medrec/

15. Why Teach MedRec?
 Common error1
 Easily improved with systematic approach
 Accreditation standard across Canada2
 Standard of care in hospital2
 Excellent opportunity to teach collaboration
1Kwan JL et al. Medication Reconciliation During Transitions of Care as a Patient Safety
Strategy. Ann Intern Med. 2013;158(5.2):397-403
2 Mitchell JI et al. Medication Reconciliation: A Prescription for Safer Care. Healthcare
Quarterly. 2013:16(4): 10 – 13.

16. Safety Issues
 Different types of errors
 Frequently non-Rx meds not accounted for
 Patient confusion at discharge
 Community care providers unaware of medication
changes
Tam VC et al. Frequency, type and clinical importance of medication history errors at
admission to hospital. CMAJ. 2005 Aug 30;173(5):510-5.

17. Why is Collaboration Important?
 Diverse sources of medication profile
 Various opportunities to do reconciliation
 Input from multiple disciplines

18. Timeline for Curriculum Development

19. Process of Developing MedRec IP Event
 Need to establish links to other professions
 Need to identify by healthcare profession:
 Level and number of students
 Appropriate course to host activity
 *** DATE *** of the activity
 Participation - mandatory or volunteer
 Assignment - individual or team
 Technology – Faculty-specific or University-wide platform
 Budget - e.g. facilitators, supplies

20. Participant Considerations
 Need to identify by healthcare profession:
 Which other course coordinators need to be consulted
 Responsibility for communication to students
 Consequences for the student if they do not participate
 Class list to be shared to develop IP group & room list

21. Urban/Remote Location Logistics
 Need to identify for each of the three academic sites:
 Number of IP participants
 Number, size and location of rooms required
 Faculty individual responsible for room bookings
 Availability of rooms on potential date and times
 IT technology to support the simultaneous activities
 Facilitators: Regional Health Authority MedRec Coordinators
 4 UBC site; 1 UNBC site; 1 UVIC site

22. Technology Specifications
 Need to identify by healthcare profession:
 Technology manager and support personnel
 On call individual prior to and during event
 Early booking for technology link between sites
 Preferred online platform and “shell” for courses
 Platform login for participants to be set-up prior to event
 Implications of high volume usage

23. Clinical Case Development
 Collaboration with acute care MedRec Coordinator
 Case: acute care geriatric patient with complex
medications and multiple errors identified during
routine MedRec
 Patient identifiers removed
 Lab values, medical and social history generated

24. Clinical Case Setting and Resources
 MedRec activity situated in a multidisciplinary
discharge planning meeting
 Patient, nurse, social worker, pharmacist, attending physician
 PharmaNet pre-admission form developed:
 diagnosis, age, medication history
 Acute care MedRec admission form
 Acute care Discharge form

25. Pre-Reading Materials
 Learning Objectives
 Background reference articles
 MedRec clinical case
 SBAR form
 Situation, Background, Assessment, Recommendation
 Map of the venues
 Request bring laptop or tablet
 Pack a lunch

26. Room Preparation
 Directional signage
 Sign-in sheets
 White boards
 Online connectivity
 Doors to rooms unlocked

27. Communications
 Need to identify by healthcare profession:
 Individual responsible for coordinating consistent messaging
 Press release – by individual profession or collaborative
 Signage – paper and/or digital
 Media – academic, professional and/or community

28. Curriculum Intervention 2013

29. Life Sciences Centre
Pharmaceutical Sciences
Lecture theatre
308 students
Seminar rooms
44 groups x 7 students

30. Small group sessionUndergrads
on the move
Debriefing session

31. Student Evaluation 2013
 “The interprofessional collaboration was most valuable. It provided a
platform to talk about the challenges of medication reconciliation and
the different expectations and different roles”. Pharmacy Student
 “I felt that setting up the groups with pharmacy and medical students
was an excellent idea. It was great to meet new people in such an
environment and to work with them. It helped to establish to us what
role pharmacists play in the community and hospital.” Medical Student
 “The case in the module was fantastic! It was very complex, and
brought together many topics that we’ve covered in a single patient.
Having a case for us to work up collaboratively in small groups was an
excellent idea.” Pharmacy Student

32. Curriculum Intervention 2014
January 6, 2013 Pre-reading posted online – MedRec video and references
January 13, 2014
10:00 am–11:15 am UBC: 52 groups of 8 students (4 MD/4Rx +/-1 RN)
UNBC: 5 groups of 7 students (5 MD/1Rx/1RN)
UVIC: 4 groups of 8 students (6 MD/1Rx/1RN)
Review case, identify discrepancies, draft
recommendations, submit group assignment online
11:30 am–12:00 pm Debriefing on IP concepts and reviewed recommendations

33. Student Evaluation 2014
 “It was a complex case and realistic in terms of what occurs in the
hospital. Interesting to see perspectives of the different groups of
students with regards to medications.” Medical Student
 “I think having a variety of forms which we haven’t been exposed to is
helpful, and to shift our thinking to a more hospital discharge based
setting is new and contributed to a lot of great ideas.” Pharmacy student
 “Excellent opportunity to meet pharmacy students and collaborate in
a collegial environment. The pharmacy students were knowledgeable,
helpful, and pleasant to work with. Nursing opinions were also
appreciated, as they spend by far the most time with patients, and are
involved in medication administration, monitoring for adverse effects,
receiving patient questions and complaints, etc.” Medical Student

34. MedRec Successes
 Executed event involving 480 senior Medical, Pharmacy,
and Nursing students
 Involved 3 sites (Vancouver, Victoria, and Prince
George)
 Valuable learning experience for students
 Worked with IPE leadership from other healthcare
academic units
 Blended learning model

35. MedRec Challenges
 Logistics in developing, implementing, and evaluating
this event
 Overall coordination between academic units
 Lack of resources
 Online MedRec course shell in Blackboard
 Timing of the event

36. Future Opportunities
 Expanding involvement of nursing and nurse
practitioner students
 Involve more pharmacists at the external sites
 Enhance initial introduction of MedRec by a
knowledgeable representative of each profession
 More time for students to collaborate on the cases
 Explore incorporation of facilitators with small
groups

37. Questions?
Contact Information
Arun Verma: arun.verma@ubc.ca
Judith Soon: judith.soon@ubc.ca

38. www.saferhealthcarenow.ca
Upcoming MedRec Webinars
38
Thank you for attending
Our next MedRec webinar will take
place in September/October 2014.
Details to follow.

39. www.saferhealthcarenow.cawww.ismp-canada.org
39
We encourage you to report
medication incidents
Practitioner Reporting
https://www.ismp-canada.org/err_report.htm
Consumer Reporting
www.safemedicationuse.ca/

40. www.saferhealthcarenow.cawww.ismp-canada.org
Medication Safety Self-Assessment®
• Hospitals (acute care)(2006) – free for Ontario*
• Long-term care (2012) – free for Ontario*
• Complex Continuing Care and Rehabilitation
(2008) – free for Ontario*
• Community and Ambulatory Pharmacy (2007) –
free for Ontario*
• Operating Room Medication Safety Checklist
(2009) – free for Ontario*
• Oncology (2012)
• Anticoagulant Safety (VTE) – free for Ontario*
• HYDROmorphone Safety Self-Assessment (2014)
- $50
* Supported by the Ontario MOHLTC
For more information visit www.ismp-canada.org/MSSA or email mssa@ismp-canada.org