Medication Reconciliation Dept of Family Medicine and Community Health Bethesda, Broadway, Phalen, Smileys Clinics Nov 8, 2018

Disclosures No funding disclosures

Quality Gap Patient safety Medication reconciliation seldom done <5% of visits with documented medication reconciliation MIPS measure

Aim / Measures Aim By Sept 30 2018, implement a systematic medication reconciliation process and document provider or pharmacist medication reconciliation* on 70% of patient visits. * Med reconciliation defined as the process of identifying the most accurate list of medications that a patient is taking. This includes name, dosage, frequency, and route. The list should include all known prescriptions, OTC, herbals, and vitamin/mineral/dietary(nutritional) supplements. Measures % visits with med rec documented by provider or pharmacist (outcome) % visits with attempted med rec documented by PCS staff (process) % staff/providers able to articulate med rec process (process) % staff/providers satisfied with med rec process (balance)

Interventions Design a team-based med reconciliation process (June-Oct 2017) -- Multiple PDSAs -- Process flow diagram -- Pilots (Aug-Oct 2017) 2. Training and implementation (Nov/Dec 2017) 3. Re-education / training (July 2018) 4. Satisfaction surveys (June 2017, May 2018, Sept 2018)

Intervention - Process Flow Diagram (1)

Intervention - Process Flow Diagram (2)

Interventions – Examples of PDSAs Medication review methodology by PCS – PDSAs Paper method EMR – Meds section EMR – Orders section EMR – Home meds section

Outcomes Re-education Training Pilots

Sustain / Spread Sustain Spread Standard work written Supervisor audits for PCS Monthly data Review data quarterly at FaMQIC Intervene if needed Spread Presenting at STFM Practice Improvement Conference (Dec 2018)