1 Safer Healthcare Now – Medication Reconciliation – May 10, 2006

Safer Healthcare Now!

Adverse Drug Events (Medication Reconciliation) Project Plan

Guiding Principle

An up-to-date and accurate medication list is essential to ensure safe prescribing in any setting.

Background

Medication reconciliation is defined as a formal process of obtaining a name, dosage, frequency and route – and comparing the physician’s admission, transfer and/or discharge orders to that list. The process involves:

  • Verification (collection of medication history)
  • Clarification (ensuring that the medications and doses are appropriate)
  • Reconciliation (documentation of changes in the orders)

A more detailed summary of the definitions associated with Medication Reconciliation can be found in the Safer Healthcare Now! Campaign How-to Guide: Adverse Drug Events (Medication Reconciliation)

Key steps

  1. Secure Leadership Commitment

TEGH has committed to this component of the Safer Healthcare Now! strategy.

  1. Form a Team

A multidisciplinary team consisting of representatives from the following areas will be involved in the Medication Reconciliation Team:

Pharmacy (Carmine Stumpo, Katie Thede, Kelly Walker)

Nursing (Sarah Coppinger - Medicine, Pam Jones – PAC)

Physicians (Dr. Ian Fraser)

Gateway (Karen Hunter)

Quality and Risk (Julie Pike)

Emergency Department (Lynda Hookham)

  1. Collect Baseline Data

There will be data collection in two key areas:

  • Process Mapping: A process map will be developed, outlining how medication histories (including allergies) is collected and documented in the organization. The process map will describe the current state of medication and allergy histories.
  • Baseline Medication History Accuracy. Medication histories will be conducted in both Medicine and Surgery to determine a baseline discrepancy rate
  1. Set Aims (Goals and Objectives)
  2. Allergies: The Allergy function in Cerner will be implemented to provide an electronic means of documentation of allergies. Allergies in powerchart will be interfaced with the current pharmacy information system (MSMEDs) to provide allergy checking upon order entry.
  • Medication Histories: The group briefly discussed the various tools available in other hospitals for the purposes of ordering pre-admission medications. The group envisions the implementation of TEGH specific form based on the feedback from the baseline data collection and consultation with key stakeholders.
  1. Start with a Pilot Project
  1. Continue to Implement Medication Reconciliation
  1. Evaluate

Action Plan

Item / Date / Status / Action / Person(s) Responsible
Process Mapping / Dec. 15, 2006 / Develop process maps for the collection and documentation of medication and allergy history in Emergency / Medicine as well as the PAC / Julie with Karen, Sarah and Pam
Feb. 8, 2006 / Process map for PAC medication and allergy histories developed. Med. Histories conducted 6 times per patient per visit. / Julie to make adjustments to map and verify with G6 nurses
Carmine to review with PAC physician.
Maryann to convert file to Visio / Carmine, Julie
Mar 15, 2006 / Process map for PAC nearly complete. Input obtained by PAC physician and G6 staff. Error-prone areas include the multiple med histories collected at PAC and the point of ordering medications post op. / Julie to prepare a presentation of FMEA for the group next meeting
Subroutines for the medication histories and the post-op ordering will be developed.
Emerg process map scheduled for April / Julie to present on FMEA
Julie to coordinate fine tuning of process maps
May 10, 2006 / Julie presented on the process of FMEA. This process was then applied to our current work in the PAC. / A summary of the FMEA findings will be summarized and circulated (see attached) / Carmine to summarize
Medication History baseline data / Dec. 15, 2006 / Determine the baseline discrepancy rate for medication histories in medicine and surgery / Carmine with Kelly and Katie
Feb. 8, 2006 / 13 medication histories conducted (updated). Average unintentional discrepancies per patient = 3.4 / Complete 20 histories for baseline assessment.
Begin to investigate documentation tools for med histories / Carmine with Kelly and Katie
Mar 15, 2006 / 17 medication histories completed. Average unintentional discrepancy per patient = 3.1 / Will repeat once a BPMH tool is implemented. / Carmine and Sarah (student) to develop tool.