Medication Medication ReconciliationReconciliation

Patty Grunwald, PharmD, Patty Grunwald, PharmD, BCPSBCPS

Clinical Pharmacy CoordinatorClinical Pharmacy Coordinator

Frederick Memorial Hospital, Frederick Memorial Hospital, Frederick, MarylandFrederick, Maryland

JCAHO 2006 National Patient JCAHO 2006 National Patient Safety GoalSafety Goal

Goal 8Goal 8 Accurately and completely Accurately and completely reconcile medications across the reconcile medications across the continuum of care.continuum of care.

8A8A Implement a process for obtaining and documenting a Implement a process for obtaining and documenting a complete list of the patient’s current medications upon the complete list of the patient’s current medications upon the patient’s admission to the organization and with the patient’s admission to the organization and with the involvement of the patient. This process includes a involvement of the patient. This process includes a comparison of the medications the organization provides to comparison of the medications the organization provides to those on the list.those on the list.

8B8B A complete list of the patient’s medications is A complete list of the patient’s medications is communicated to the next provider of service when a patient communicated to the next provider of service when a patient is referred or transferred to another setting, service, is referred or transferred to another setting, service, practitioner or level of care within or outside the organization. practitioner or level of care within or outside the organization.

Steps in Reconciliation Steps in Reconciliation ProcessProcess

Develop complete and accurate Develop complete and accurate medication listmedication list

Compare (reconcile) the listed Compare (reconcile) the listed medications with any new ordersmedications with any new orders

Update the list as orders changeUpdate the list as orders change Communicate the updated list to the Communicate the updated list to the

next provider of care.next provider of care.

When Should Reconciliation When Should Reconciliation Occur?Occur?

Whenever the organization…Whenever the organization… “… “… refers or transfers a patient to another setting, refers or transfers a patient to another setting,

service, practitioner, or level of care within or service, practitioner, or level of care within or outside the organization.”outside the organization.”

At a minimum…At a minimum…Any time the organization requires orders be Any time the organization requires orders be

rewrittenrewrittenAny time the Patient changes service, setting, Any time the Patient changes service, setting,

provider or level of care and new medication provider or level of care and new medication orders are writtenorders are written

For transitions not involving new medications For transitions not involving new medications or rewriting of orders, the organization or rewriting of orders, the organization determines whether reconciliation must determines whether reconciliation must occur.occur.

RoadblocksRoadblocks

Medical staff acceptanceMedical staff acceptance Overcoming concerns related to the Overcoming concerns related to the

accuracy of solicited medication listaccuracy of solicited medication list Ownership for medication oversightOwnership for medication oversight ““My patient-type is very unique”My patient-type is very unique” ““You just don’t understand”You just don’t understand” Consistency among residents and Consistency among residents and

physician extendersphysician extenders Communication among consultantsCommunication among consultants

Medication Medication Reconciliation:Reconciliation:

Who’s Responsibility is it?Who’s Responsibility is it?

Problems With Getting Problems With Getting Accurate ListAccurate List

Patient brings in incorrect listPatient brings in incorrect list Patient does not take what is marked on the Patient does not take what is marked on the

bottlebottle Patient does not know what is on and family, Patient does not know what is on and family,

pharmacy not availablepharmacy not available Wrong name of med on ED sheetWrong name of med on ED sheet Med bottles don’t jive with what the patient Med bottles don’t jive with what the patient

sayssays Patient is unable to tell you. No family Patient is unable to tell you. No family

available. MD on call does not know either.available. MD on call does not know either. Can’t call the pharmacy “after hours”Can’t call the pharmacy “after hours”

FMH ProcessFMH Process

A work in progressA work in progress Three domains:Three domains:

– AdmissionAdmission– Transfer/re-order post-opTransfer/re-order post-op– DischargeDischarge

FMH FormFMH Form

FMH Form (con’t)FMH Form (con’t)

Medication Reconciliation Medication Reconciliation ResultsResults

0

50

100

150

200

250

300

350

400

450

June October November December January

2005-2006

Nu

mbe

r o

f m

edi

catio

ns

# home meds

# changed home meds

# hosp meds

# hosp meds changed

Number of PatientsNumber of Patients

0

5

10

15

20

25

30

35

June October November December January

2005-2006

Admissions Unit PilotAdmissions Unit Pilot

Begins January 16, 2006Begins January 16, 2006 Uses current workflowUses current workflow Nurse will print form right before Nurse will print form right before

patient leaves unitpatient leaves unit MD to review/sign within 24 hrs of MD to review/sign within 24 hrs of

admissionadmission Expand to SDSS in January 2006Expand to SDSS in January 2006

Plan for TransfersPlan for Transfers

Work in progressWork in progress Revise current transfer/reorder list to Revise current transfer/reorder list to

have the same information as have the same information as medication reconciliation formmedication reconciliation form

Will decrease physician time in Will decrease physician time in reordering medications post-op reordering medications post-op

Plan for DischargesPlan for Discharges

Create a form based on the Create a form based on the admission reconciliation formadmission reconciliation form

Include lay language on how to take Include lay language on how to take medicationmedication

Include statement to notify Include statement to notify physicians of interchangesphysicians of interchanges

Evaluation ProcessEvaluation Process

100% review during pilot100% review during pilot Thereafter, 25 cases per area per Thereafter, 25 cases per area per

monthmonth Data collected:Data collected:

– Number possible reconciliationsNumber possible reconciliations– Percent charts with formPercent charts with form– Percent with signed formsPercent with signed forms– Number home medications restartedNumber home medications restarted– Number hospital medications DC’dNumber hospital medications DC’d

Contact InformationContact Information

Phone: 240-566-3797Phone: 240-566-3797 E-mail: pgrunwald@fmh.orgE-mail: pgrunwald@fmh.org