Centre hospitalier de l'Université de Montréal (QC)

  • Christiane Arbour, Directrice Adjointe, affaires médicales et académiques, et Directrice adjointe de la Direction des services professionnels, Centre hospitalier de l'Université de Montréal, Montréal, Québec (Assistant Director, Academic and Medical Affairs, and Assistant Director, Professional Services Department)
  • Joanne Guay, Directrice adjointe intérimaire, Direction des Regroupements clientèles, Centre hospitalier de l'Université de Montréal, Montréal, Québec (Acting Assistant Director, Client Groupings Department)
  • Jean-François Guévin, Chef-adjoint, innovation et pratique professionnelle/département de pharmacie, Centre hospitalier de l'Université de Montréal, Montréal, Québec (Assistant Head, Innovation and Professional Practice /Department of Pharmacy)

L’usage d’une intervention pour supporter l’implantation du BCM

An Intervention to Support the Implementation of Medication Reconciliation

At CHUM, the deployment of a medication reconciliation (MedRec) process including the professional involvement of pharmacy technicians (PT) facilitates the collection of data and the entry of information related to patients’ medication. Once the information is entered in the patient’s electronic health record, the physician is able to reconcile the patient’s drug regimen. This step is acknowledged as an important contributor to the safety of patients in healthcare settings.

Our EXTRA project has supported the roll-out of a MedRec process by measuring various indicators on two different care units within CHUM. The assessment of 250 patient records has helped identify different outcome measures. These outcomes have allowed us to assess buy-in for the suggested model by the various stakeholders involved in the change, determine the efficiency of the model based on enhancing the PT’s role and identify any impact on workflows within the pharmacy and healthcare teams and on organizational operating costs. Our EXTRA project draws heavily on various implementation models for quality improvement projects within healthcare facilities. Thanks to a dedicated project team, it was possible to tweak the interventions on the ground and thus achieve better results and a better understanding of the objectives sought by the stakeholders and clinicians involved in the project. The main steps of the models (plan, do, study and act) have enabled us to implement an improvement cycle and help us achieve our desired goals through timely adjustments. 

Organizational projects such as the MedRec process roll-out require the involvement of all teams. Thanks to the careful consideration of Shortell’s management model and its four levels, the EXTRA team was able to share lessons learned throughout the course of the project. 

The four levels of Shortell’s model are:

  • Strategic,
  • Structural,
  • Cultural, and
  • Technical.

Once our findings were identified and organized based on each of Shortell’s levels, we drafted recommendations to address the issues for which one or multiple actions needed to be carried out to ensure the continued implementation of medical reconciliation and its sustainability.

The MedRec roll-out project at CHUM has generated a lot of interest from other healthcare organizations. The proposed model, as well as the results of its evaluation and the suggested adjustments following the EXTRA improvement project will ensure its spread. Naturally, CHUM will benefit from the recommendations and apply them to other ongoing projects within its confines. Indeed, several of the recommendations are applicable to other situations, which involve the same stakeholders as those who were impacted by the MedRec process.

Based on the EXTRA project’s outcomes, various updates to governance, timelines and procedures will be presented to the steering committee in order to adjust the ongoing implementation of MedRec at CHUM. Lessons learned will be shared with other leaders within the organization in order to ensure that future organizational projects benefit from documented evidence.