Quality Care
The Centre for Addiction and Mental Health (CAMH) was named a 2018 HIMSS Davies Enterprise Award recipient for leveraging the value of health information and technology to improve outcomes. The three award-winning use cases show how CAMH streamlined opioid agonist therapy through order sets in that reduced referral times, improved medication safety for patients with schizophrenia, and improved discharge medication reconciliation rates.
Case Studies
1. Buprenorphine Order Set & Rapid Access Referral
CAMH developed a pathway to treat opioid withdrawal patients with best-practice opioid agonist therapy by developing an order set that adheres to Health Quality Ontario standards and contains a referral to the rapid access COMPASS clinic. Patients receive evidence-based treatment for opioid-withdrawal in ED instead of waiting to be transferred to an inpatient unit. ED staff and new residents receive education and capacity-building training surrounding providing care according to best practice for patients in opioid-withdrawal. Availability of complex order sets have saved clinician time and facilitated standardized practice. Order sets have also reduced referral wait times within the organization by leveraging rapid access referral options.
2. Monitoring Protocol for Clozapine-induced Myocarditis
CAMH is the first organization in North America to include mandatory laboratory testing for myocarditis indicators within clozapine order sets to ensure all patients are proactively screened. Myocarditis and Ischemic Colitis monitoring and prevention protocols were deployed and enforced for all patients initiated on clozapine. Monitoring protocols included baseline and regular CRP and Troponin screening on a weekly basis for the first four weeks after beginning treatment, which assessed whether a patient should continue clozapine use. Physicians have saved time through development of a clozapine pre-treatment, and two clozapine initiation order sets. These order sets allow for establishment of baseline CRP and Troponin levels as well as serial monitoring through the first four weeks of treatment.
3. Discharge Medication Reconciliation
CAMH has substantially improved discharge medication reconciliation rates by implementing estimated discharge dates, patient-oriented discharge summaries, and an I-CARE alert notifying physicians if a discharge order is started when medication reconciliation has not been completed. Pharmacists are able to more regularly contribute to medication reconciliation upon discharge and are satisfied knowing that the patient is given accurate medication information upon discharge. Patient preferences were incorporated into the discharge process. Completion of medication reconciliation at discharge has better ensured that patients have complete and accurate information at discharge, which enables them to better pursue recovery.
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