1. Medication Reconciliation in the Medical Floor A Patient Safety Quality Improvement Initiative Medication reconciliation is defined as a formal process of obtaining a compete and accurate list of each patient’s current home medications (including name, dosage, frequency and route and comparing the physicians admission, transfer and/or discharge orders to that list. The process involves: Verification (collection of medication history) Clarification (ensuring the medications & doses are appropriate) Reconciliation (documentation of changes in the orders)Background Key Steps continued Goals & Objectives Key Steps Goal: To develop and implement a Medication Reconciliation process that incorporates the best possible medication history (BPMH) and facilitates timely and accurate admission/transfer/discharge orders. Improvement Objectives: To decrease the number of undocumented intentional and unintentional discrepancies for patients admitted to the Medical Floor from ER by 75% by June 2007. To increase the number of BPMH completed by nurses, pharmacists, and physicians admitted to the Medical Floor by 75% by June 2007. Hospital admission, transfer and discharge are key medication-related vulnerable moments (history taking & ordering) where patients are at increased risk of medication discrepancies that potentially can lead to adverse drug events. Figure 1. Summary of Process Map Admission to Medical Floor ICU Surgical Vulnerable Moment #1 Vulnerable Moment #3 Vulnerable Moment #4 ER OR Return to Medical Floor Home 3. Baseline Data Collected – Audit Results Step 1 Development of Process Step 1 Development of Process Step 2 Implementation of Med Rec Step 3 Evaluation Evaluation/Discussion Chart audits of 20 patients, revealed a mean Success Index of 75%. This is within the National Mean. This is prior to implementation of the Med. Rec. Process. Our goal is to improve our success index in 1 year by 75% of our baseline (95%). We will continue to monitor our success (on a monthly basis) using the same performance measurement. We will continue to implement Medication Reconciliation, Test Results, Spread and Evaluate. We will know this change is an improvement using our 3 performance measures (compare future changes with current performance) and by measuring nursing satisfaction, physician satisfaction, pharmacy satisfaction & patient satisfaction. Identified Potential Barriers to Success Include: No clear owner of process, roles & responsibilities Lack of understanding of potential impact Use of various forms in various areas/no standardized process Figure 6. Mean # of Undocumented Intentional Discrepancies (Type 2) Figure 7. Mean # of Unintentional Discrepancies (Type 3) ICU = Intensive Care Unit ER = Emergency Room Vulnerable Moment #2 Step 2 Implementation of Med Rec (Pilot in Medical Floor) Step 1 Development of Process - Develop Team/FMEA - Design of tools - Baseline data collection Step 1 Development of Process - Develop Team/FMEA - Design of tools - Baseline data collection Step 3 Evaluation -Audits -Success Index -Hospital-wide roll out Table 1. Summary of Failure Mode Effects Analysis Figure 2. Project Plan Table 2. Failure Mode Summary Figure 3. Best Possible Medication History-Baseline Audit Tool Figure 4. Automated Discharge Prescription (Meditech) 2. Tools Developed Hospital Information Complete List of Medications Physician Name & Signature Patient Reminder Patient Information Figure 5. Automated Discharge Summary (Meditech) No Need to Dictate Medications – Information Flows Through to Discharge Summary 1. Failure Mode Effects Analysis Disseminated information through various mediums Presentations to TDH Quality Council, Hospital Board, pharmacists, program core team, staff meetings Inservices to Medical Floor Resource Nurses outlining process for completing a BPMH & medication reconciliation Media campaign (newspaper & television) Signage & email Figure 8. Medication Reconciliation Success Index (Pre-Implementation) Patient Safety Committee, 2006