Medication Reconciliation

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Medication Reconciliation

• Patty Grunwald, PharmD, BCPS
• Clinical Pharmacy Coordinator
• Frederick Memorial Hospital, Frederick, Maryland

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JCAHO 2006 National Patient Safety Goal

• Goal 8 Accurately and completely reconcile
  medications across the continuum of care.
• 8A Implement a process for obtaining and
  documenting a complete list of the patients
  current medications upon the patients admission
  to the organization and with the involvement of
  the patient. This process includes a comparison
  of the medications the organization provides to
  those on the list.
• 8B A complete list of the patients medications
  is communicated to the next provider of service
  when a patient is referred or transferred to
  another setting, service, practitioner or level
  of care within or outside the organization.

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Steps in Reconciliation Process

• Develop complete and accurate medication list
• Compare (reconcile) the listed medications with
  any new orders
• Update the list as orders change
• Communicate the updated list to the next provider
  of care.

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When Should Reconciliation Occur?

• Whenever the organization
• refers or transfers a patient to another
  setting, service, practitioner, or level of care
  within or outside the organization.
• At a minimum
• Any time the organization requires orders be
  rewritten
• Any time the Patient changes service, setting,
  provider or level of care and new medication
  orders are written
• For transitions not involving new medications or
  rewriting of orders, the organization determines
  whether reconciliation must occur.

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Roadblocks

• Medical staff acceptance
• Overcoming concerns related to the accuracy of
  solicited medication list
• Ownership for medication oversight
• My patient-type is very unique
• You just dont understand
• Consistency among residents and physician
  extenders
• Communication among consultants

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Medication Reconciliation

• Whos Responsibility is it?

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Problems With Getting Accurate List

• Patient brings in incorrect list
• Patient does not take what is marked on the
  bottle
• Patient does not know what is on and family,
  pharmacy not available
• Wrong name of med on ED sheet
• Med bottles dont jive with what the patient says
• Patient is unable to tell you. No family
  available. MD on call does not know either.
• Cant call the pharmacy after hours

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FMH Process

• A work in progress
• Three domains
• Admission
• Transfer/re-order post-op
• Discharge

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FMH Form
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FMH Form (cont)
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(No Transcript)
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(No Transcript)
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Medication Reconciliation Results
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Number of Patients
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Admissions Unit Pilot

• Begins January 16, 2006
• Uses current workflow
• Nurse will print form right before patient leaves
  unit
• MD to review/sign within 24 hrs of admission
• Expand to SDSS in January 2006

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Plan for Transfers

• Work in progress
• Revise current transfer/reorder list to have the
  same information as medication reconciliation
  form
• Will decrease physician time in reordering
  medications post-op

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Plan for Discharges

• Create a form based on the admission
  reconciliation form
• Include lay language on how to take medication
• Include statement to notify physicians of
  interchanges

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Evaluation Process

• 100 review during pilot
• Thereafter, 25 cases per area per month
• Data collected
• Number possible reconciliations
• Percent charts with form
• Percent with signed forms
• Number home medications restarted
• Number hospital medications DCd

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Contact Information

• Phone [phone]
• E-mail pgrunwald_at_fmh.org