Medication ReconciliationPatty Grunwald, PharmD, BCPSClinical Pharmacy CoordinatorFrederick Memorial Hospital, Frederick, Maryland

JCAHO 2006 National Patient Safety GoalGoal 8Accurately and completely reconcile medications across the continuum of care.

8AImplement 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.

8BA 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.

Steps in Reconciliation ProcessDevelop complete and accurate medication listCompare (reconcile) the listed medications with any new ordersUpdate the list as orders changeCommunicate the updated list to the next provider of care.

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 minimumAny time the organization requires orders be rewrittenAny time the Patient changes service, setting, provider or level of care and new medication orders are writtenFor transitions not involving new medications or rewriting of orders, the organization determines whether reconciliation must occur.

RoadblocksMedical staff acceptanceOvercoming concerns related to the accuracy of solicited medication listOwnership for medication oversightMy patient-type is very uniqueYou just dont understandConsistency among residents and physician extendersCommunication among consultants

Medication Reconciliation:Whos Responsibility is it?

Problems With Getting Accurate ListPatient brings in incorrect listPatient does not take what is marked on the bottlePatient does not know what is on and family, pharmacy not availableWrong name of med on ED sheetMed bottles dont jive with what the patient saysPatient is unable to tell you. No family available. MD on call does not know either.Cant call the pharmacy after hours

FMH ProcessA work in progressThree domains:AdmissionTransfer/re-order post-opDischarge

FMH Form

FMH Form (cont)

Medication Reconciliation Results

Number of Patients

Admissions Unit PilotBegins January 16, 2006Uses current workflowNurse will print form right before patient leaves unitMD to review/sign within 24 hrs of admissionExpand to SDSS in January 2006

Plan for TransfersWork in progressRevise current transfer/reorder list to have the same information as medication reconciliation formWill decrease physician time in reordering medications post-op

Plan for DischargesCreate a form based on the admission reconciliation formInclude lay language on how to take medicationInclude statement to notify physicians of interchanges

Evaluation Process100% review during pilotThereafter, 25 cases per area per monthData collected:Number possible reconciliationsPercent charts with formPercent with signed formsNumber home medications restartedNumber hospital medications DCd

Contact InformationPhone: 240-566-3797E-mail: pgrunwald@fmh.org