1. Department of Family Medicine
Implementation of a Ambulatory Medication Reconciliation Process Utilizing Non-physican Staff
William Jih, M.D.
Medical Director
Department of Family Medicine
Loma Linda University

2. Background Academic Faculty Practice
18 faculty physicians
3 Mid-level faculty practitioners
Approximately 60K patient visits per year
Implemented Electronic Medical Record in 2006

3. Background EMR was supposed to be “easier” and “safer”
Reality was that the EMR created more steps and more work that wasn’t previously done.
Created more confusion and frustration
Electronic Medication lists were confusing.
More options for medication “Actions”

4. Goals Reduction in Medication List errors to improve Patient Safety
Errors resulting in Harm: >1.5 million/year
Deaths: 7,000/year
Cost: $3.5 billion/year
Balance the workload
Working at the top of their license
Toyota Lean “Kaizan”

5. Process implementation using Medical Assistants in Medication Reconciliation
Phase 1
“Creating a culture”
Trained M.A. on how to conduct a Medication History
Used a printout of the Electronic Medication List
Still relied on Clinicians to reconcile the list electronically
Phase 2
Trained M.A. staff to delete and complete medications electronically and cue refills
Trained M.A. staff to add in by history medications not on the list
Eliminated paper printouts / implemented communication sheet as a replacement

6. Methods Audited Patient Charts after office visit
Classified 6 types of errors
Duplicates
Class redundancy
Outdated Medications
Discrepancy with Documentation
Antibiotics not discontinued
Acute Medications (prn)
Audited at Baseline and after each phase

7. Exclusion Criteria Excluded patients <25
Less likely to have Chronic Medications
Excluded any medication from review prescribed after the office visit
Phone refill, eRx etc…
Excluded any medication list changes made by other practices/specialties after the office visit

8. Results # Charts reviewed # Charts with errors % Charts with errors
# Charts correct
% Charts Correct
Baseline 91 72
79.12 19
20.08
Phase 1
185
132
71.35 53
28.64
Phase 2
247
36.84
156
63.15

16. Discussion Culture Challenges Balancing the work load Staff Buy-in
Clinician Buy-in
Balancing the work load
Shifting work across the different areas

17. Discussion Knowledge deficit Physician putting up barriers
Confusion about how to interpret errors
Physician putting up barriers

18. Future Steps Sustaining Change Queuing up refills
Spread to other institutional clinics

19. Acknowledgements Resident Researchers Research Director
Albert Mu, D.O.
Heidi Choi, M.D.
Research Director
Kelly Morton, Ph.D.
Staff Leadership
Garcia Troy, R.N.
Christina Meza, L.V.N.
Corrine Castro, L.V.N.
Jamie Martin, L.V.N.