Transcript Medication Reconciliation: Implementation of a

Medication Reconciliation:
Implementation of a Standardized
Process in the Electronic Medical
Record
Kathryn Montanya, PharmD
Camille Robinson, RN
Sue Flores, RN
Jeri Katsaros, RN
Pamela Malone, RN
Lu Ann Vis, RN
Connie Giere, RN
Cindy Fellencer, RN
Bridget Gaughan, RN
Martina Novotny, PharmD
Project Aims

Design and implement a process to
document an accurate list of the patient’s
current medications upon entry into our
organization.
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
This includes a process to compare, or reconcile
the medications to be provided with those on the
list.
Provide the list of medications to the patient
and their next care provider.
Standardized Process

Outpatient medication list is documented in EPIC
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
By admitting MD for inpatients
By RN or other caregiver for ambulatory
List is reviewed (reconciled) prior to new
medications being ordered
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By ordering MD for inpatients

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Documentation required – EPIC alert
By MD during H&P approval in procedure areas
By MD in ambulatory
Standardized Process

Updated list is provided to patient
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MD creates list and RN reviews with patient at inpatient
discharge
Procedure area staff provides list if meds are prescribed
Clinic staff provides list to all patients
Updated list is provided to the next caregiver
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All LUHS providers have access through EPIC
For inpatients, Admitting identifies outside provider, Medical
Records will mail the list
For ambulatory and procedure patients, the list is provided to
outside providers via referral letters
Current Goals

Increase the number of inpatients with an outpatient
medication list documented in EPIC

Decrease the number of errors in outpatient
medication lists

Increase the number of outpatient medication lists
that have been “Reviewed” during current admission
Percent of Inpatient Charts with Documented Outpatient Medication List
110
100
90
Mean = 82.22
80
70
60
Month
This information is confidential and to be used for quality improvement purposes only
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LCL = 56.09
M
Percent of charts reviewed with Outpatient Medications documented in EPIC
UCL = 108.36
Percent of Outpatient Medication Lists Containing Errors
80
UCL = 79.02
70
60
50
Mean = 40.05
40
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20
10
LCL = 1.09
Month
This information is confidential and to be used for quality improvement purposes only
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Percent of Outpatient Medication Lists REVIEWED during admission
140
UCL = 135.81
MD Doc go-live (review alert)
100
Mean = 95.45
80
60
LCL = 55.09
UCL = 54.26
40
Mean = 28.60
20
LCL = 2.94
Month
This information is confidential and to be used for quality improvement purposes only
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Percent of charts "Reviewed" since admission date
120
Future Goals
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Increase number of patients discharged with
accurate medication list.
Decrease number of RN and PharmD
interventions required to correct medication
lists.
Evaluate and improve the inpatient transfer
process.
Develop ambulatory and procedure area
process measures.