Transcript Medication Reconciliation

Medication
Reconciliation
Patty Grunwald, PharmD, BCPS
Clinical Pharmacy Coordinator
Frederick Memorial Hospital,
Frederick, Maryland
JCAHO 2006 National Patient Safety
Goal
Goal 8
Accurately and completely reconcile
medications across the continuum of care.
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8A Implement a process for obtaining and documenting a complete
list of the patient’s current medications upon the patient’s admission to
the organization and with the involvement of the patient. This process
includes a comparison of the medications the organization provides to
those on the list.
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8B A complete list of the patient’s medications is communicated to
the next provider of service when a patient is referred or transferred to
another setting, service, practitioner or level of care within or outside
the organization.
Steps in Reconciliation Process
Develop complete and accurate
medication list
 Compare (reconcile) the listed medications
with any new orders
 Update the list as orders change
 Communicate the updated list to the next
provider of care.
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When Should Reconciliation Occur?
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Whenever the organization…
“… refers or transfers a patient to another setting,
service, practitioner, or level of care within or outside
the organization.”
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At a minimum…
Any time the organization requires orders be rewritten
Any time the Patient changes service, setting, provider
or level of care and new medication orders are
written
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For transitions not involving new medications or
rewriting of orders, the organization determines
whether reconciliation must occur.
Roadblocks
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Medical staff acceptance
Overcoming concerns related to the accuracy of
solicited medication list
Ownership for medication oversight
“My patient-type is very unique”
“You just don’t understand”
Consistency among residents and physician
extenders
Communication among consultants
Medication
Reconciliation:
Who’s Responsibility is it?
Problems With Getting Accurate List
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Patient brings in incorrect list
Patient does not take what is marked on the
bottle
Patient does not know what is on and family,
pharmacy not available
Wrong name of med on ED sheet
Med bottles don’t jive with what the patient says
Patient is unable to tell you. No family available.
MD on call does not know either.
Can’t call the pharmacy “after hours”
FMH Process
A work in progress
 Three domains:
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– Admission
– Transfer/re-order post-op
– Discharge
FMH Form
FMH Form (con’t)
Medication Reconciliation
Results
450
400
350
Number of medications
300
250
# home meds
# changed home meds
# hosp meds
# hosp meds changed
200
150
100
50
0
June
October
November
2005-2006
December
January
Number of Patients
35
30
25
20
15
10
5
0
June
October
November
2005-2006
December
January
Admissions Unit Pilot
Begins January 16, 2006
 Uses current workflow
 Nurse will print form right before patient
leaves unit
 MD to review/sign within 24 hrs of
admission
 Expand to SDSS in January 2006
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Plan for Transfers
Work in progress
 Revise current transfer/reorder list to have
the same information as medication
reconciliation form
 Will decrease physician time in reordering
medications post-op
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Plan for Discharges
Create a form based on the admission
reconciliation form
 Include lay language on how to take
medication
 Include statement to notify physicians of
interchanges
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Evaluation Process
100% review during pilot
 Thereafter, 25 cases per area per month
 Data collected:
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– Number possible reconciliations
– Percent charts with form
– Percent with signed forms
– Number home medications restarted
– Number hospital medications DC’d
Contact Information
Phone: 240-566-3797
 E-mail: [email protected]
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