Transcript Making A Title Slide

Applying DMAIC Methodology to
Medication Reconciliation
Prepared For
[Date]
By
Process Improvement Methodology (DMAIC)
DMAIC Provides An Easily Managed Systematic Process To Deliver Measurable
Results and Accelerate Change
Define
Measure
Who are the customers and
what is the problem from their
perspective?
Analyze
What are the most
important drivers of poor
performance?
How is the process
performing today and how
is it measured?
Improve
Control
How do we ensure that
we sustain the improved
performance?
How do we remove the
drivers of poor
performance?
Improvement Teams
Proper Team Establishment Increases Probability For Success
Project Executive Sponsor
Clinical / Academic Sponsor
(As Required)
Improvement Leader
Project Sponsor
Process Owner
Improvement Team
Defining Problem: Analysis of Root Causes
Medication
History,
Reconcile
Order,
Transcribe,
Clarify
Dispense,
Deliver
Administer
Monitor
Educate,
Discharge
Identified failure modes (FMEA)
Identified root causes
• Incomplete and/or incorrect
medication orders on admission
• Incomplete/inaccurate medication history
(omission, different dose, route or frequency,
look alike-sound alike)
• Inadequate or missing information
on the patient's admission profile
• No formalized approach/process to
obtaining and documenting a
medication history
 Patient’s ability to recall, especially upon
admission
 Time constraints
 Interview skills of clinician
• Multiple locations to document (free text)
• Pharmacist not formally integrated in process
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Defining Problem: Challenges to Obtaining Medication Histories
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Patient’s and/or surrogate’s ability to recall medications, doses and/or
frequency of use
Stress of transitioning through the healthcare system
Health literacy
Language barriers; cultural beliefs
Relationship with healthcare clinician obtaining history
Interview skills of clinician
Time constraints
Accuracy and completeness of medication histories obtained from other
resources; accessibility
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Medication History / Reconciliation: Pilot Results
Direct Admits to Med/Surg Units*
(N=204)
• 54% of patients had at least one medication discrepancy
• 42% of the discrepancies requiring intervention was complete
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omission of a medication
35% of the discrepancies requiring intervention was a different
dosage, route or frequency with what the patient reported taking
before admission
Of the discrepancies requiring clarification, in the absence of a
pharmacist intervention, 22% may have resulted in patient harm
during hospitalization and 59% may have resulted in patient harm
if continued beyond discharge
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* Gleason KM, Groszek JM, Sullivan C, Rooney D, Barnard C and Noskin GA.
Reconciliation of Discrepancies in Medication Histories and Admission Orders of Newly
Hospitalized Patients. Am J Health-Syst Pharm. 2004; 61:1689-95
Medication History / Reconciliation:
Most Effective Interventions
Medication
History,
Reconcile
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Order,
Transcribe,
Clarify
Dispense,
Deliver
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Monitor
Educate,
Discharge
Single source of truth: Medication list with technology support
Reconciliation process with technology support
I/T design and continuous monitoring
– Compliance, sustainability of new process
– Identify rate, etiology and potential harm of medication discrepancies for
process improvements
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Administer
Active patient involvement
Active pharmacist involvement
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MATCH Improvement Initiatives
Implement a system that achieves the below:
• Increase accuracy and completeness of medication history
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Create “one source of truth”
Complete medication description (drug name, dose, route or frequency – no free
text)
• Reconcile home medications with patient and/or family
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Reconcile all medications (home and current medication orders) at
admission, transfer and discharge
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Multi-disciplinary approach with physicians, nurses and pharmacists
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Approaches to Evaluate
Medication Reconciliation Process
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Determining compliance rates
Type and etiology of medication discrepancies requiring
interventions
Medications / medication classes involved in discrepancies
requiring interventions
Potential harm averted through intervention
Retrospective v/s prospective review
Questions and Discussion