1. “Presented to” GHAREF Hospital Engagement Network In Partnership with the Georgia Foundation for Medical Care Kristine Gleason, MPH, RPh - Clinical Quality Leader, Northwestern Memorial Hospital Vicky Agramonte, RN, MSN - Project Manager, Healthcare Quality Improvement Program, IPRO Medication Reconciliation “Office Hours” Using the MATCH Toolkit

2. Today’s Objectives 1.Provide an overview of the MATCH Toolkit to implement a robust medication reconciliation process, highlighting a one “source of truth.” 2.Link medication reconciliation with other safety / quality initiatives to achieve synergies. 3.Review “Frequently Asked Questions” from the Regional Meetings and available MATCH customizable tools for a successful improvement project. 4.Share and discuss best practices and solutions to common medication reconciliation issues among HEN participants.

3. YOUR Mission (to implement a successful med rec process) if YOU Choose to ACCEPT It DEFINEMEASUREANALYZEIMPROVECONTROL Webinar 1 July 11 Office Hours Call # 1 September 24 Webinar 2 July 31 Regional Meetings August 20 OR August 27 Establish a Measurement Strategy Design/ Redesign the Process Implement the Process Assess and Evaluate Build the Project Foundation Identify Team Members Process Map Develop a Charter Data Collection Plan Collect Data Identify Key Drivers Flow Chart Gap Analysis Process Design Implementation Plan Pilot Test Education / Training Monitor Performance Address low compliance Sustainability Office Hours Call # 2 October 24

4. “Levels” of Medication Reconciliation Are We at the Beginning or Nearing the End? 1.Obtaining and reconciling list of patient’s current medications to orders to identify/correct unintended discrepancies and repeating process at discharge to prevent patient harm. 2.Reconciling medication regimen to patient’s condition(s) (e.g., purpose). 3.Reconciling medication regimen to recommended evidence- based therapies. 4.Adjusting medications based on patient characteristics (e.g., renal or liver function, age) and/or interactions (e.g., drug- drug, drug-food). 5.Optimizing medication therapy based on patient response / outcomes. Dynamic process that involves ongoing assessment, monitoring and patient education.

5. “Bundling” Medication Reconciliation with Current Initiatives Harm Estimate/Evidence from LiteratureHarm Estimate/Evidence from Organization Med History, Reconcile Order, Transcribe, Clarify Procure, Dispense Deliver Monitor Educate, Discharge Administer Monitor Educate, Discharge Phases of Medication Management Measurement / Analysis Prioritize / Implement Evidence-Based Interventions EDAdmission Intra- hospital Transfer Discharge Post- Discharge Care Transitions Measure Improvements / Monitor for Sustainability

6. A Step-by-Step Guide to Improving the Medication Reconciliation Process MATCH Toolkit, with customizable, actionable information, is available at: http://www.ahrq.gov/qual /match/match.pdf http://www.ahrq.gov/qual /match/match.pdf

7. Build the Project Foundation

8. Assemble Your Team and Construct a High Level Process Map 1.Get Team together - include all stakeholders 2.Define and agree to a process 3.List all participants of the process – depts., mgrs, and job performers 4.Define beginning and end points 5.Brainstorm key process steps 6.Determine order of process steps 7.Validate by physically walking through process Steps

9. Example: High Level Process Map A High Level Process Map is a simple picture of a complex process represented by 4-8 key steps. It is essential to better understand the process being improved and to gain agreement on project scope. Physician places discharge orderPhysician writes new prescriptionPhysician prepares d/c instructions Nurse collects the d/c instructions and prescription and counsels the patient Patient discharged

10. Clearly ties the project to organizational goals Strategic Linkage Concise description of the issues Problem Statement Describes planned accomplishments Goal Area to be covered – avoid scope creep Scope Tangible end-products, must align with goal Deliverables Necessary requirements for project success Resources Objective measurement of progress Metrics Used to monitor progress and maintain focus Milestones Develop a Charter

11. “One Source of Truth” Medication reconciliation process design should center on a single list - “One Source of Truth” - to document patient’s current medications. All clinicians should be working from the same centrally located, easily visible medication list, regardless of format. List becomes reference point for ordering decisions, screening and reconciliation. Each discipline should have the ability to update the home medications as new or more reliable information becomes available.

12. Establish a Measurement Strategy

13. Caution: Jumping into data collection without a clear plan wastes time, energy, resources, etc. What to Measure Operational Definition Collection Method Sampling Plan WhatWhereWhenHow Many Question the data will answer Specific Definition System, existing forms, new handwritten forms, etc. Elements to be collected Physical location Timing and frequency of collection Number of data points to be collected Was an updated medication list provided to the patient and reviewed at discharge? “Medication instructions were reviewed with the patient” checked on At-Home Meds List form Manual collection from existing forms Copy of At- Home Meds List form, reasons for non- compliance. Use Med Rec audit form GI Lab2-weeks all shifts. August 15 - 31 All visits Data Collection Plan

14. Collect Data 1.Work with the team and staff to identify potential drivers and build a data collection form. 2.Seek assistance from the team and staff in collecting the data to increase buy-in. 3.Observe the data collection process periodically to identify issues, errors. 4.Graph the data you intend to collect to (1) confirm how you plan to use the data and (2) identify any missing data elements.

15. Identify Key Drivers Involvement of Frontline Staff is KEY The backside of the baseline data collection form: Identifying (& addressing) the problematic issues that drive outcomes will lead to lasting improvement

16. Design/Redesign the Process

17. Flow Charting and Gap Analysis A flowchart outlines current workflow and helps identify: 1. Successful medication reconciliation practices. 2. Current roles and responsibilities for each discipline. 3. Potential failures 4. Unnecessary redundancies and gaps in the process

18. Implement the Process 18

19. Improvement Planning To implement solutions successfully, five areas must be carefully considered and planned for: 1.Interventions 2.IT 3.Communication 4.Training 5.Measurement Implementation Plan 50% of the work begins now Be sure to always include… Detailed actions Team member assignments Completion dates

20. Educational Tools

21. Assessment and Process Evaluation 21

22. Monitoring Performance

23. Vicky Agramonte, RN, MSN Project Manager Healthcare Quality Improvement Program Island Peer Review Organization, Inc. (IPRO) Albany, NY 12211-2370 (518) 426-3300 X115 vagramonte@ipro.org Kristine Gleason, MPH, RPh Clinical Quality Leader Northwestern Memorial Hospital Chicago IL 60611 312.926.9172 kmgleaso@nmh.org Questions and Discussion THANK YOU! If you want to learn more about IPRO, please visit our website at: http://www.ipro.orghttp://www.ipro.org If you want to learn more about Northwestern Memorial Hospital, please visit our website at http://www.nmh.orghttp://www.nmh.org