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MEDICATION RECONCILIATION Medication Reconciliation Patty Grunwald PharmD BCPS

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									    Medication
   Reconciliation
Patty Grunwald, PharmD, BCPS
 Clinical Pharmacy Coordinator
  Frederick Memorial Hospital,
       Frederick, Maryland
          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 patient’s current medications upon the patient’s 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 patient’s 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 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.
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.
                  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 don’t understand”
   Consistency among residents and physician
    extenders
   Communication among consultants
 Medication
Reconciliation:
Who’s Responsibility is it?
    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 don’t jive with what the patient says
   Patient is unable to tell you. No family available.
    MD on call does not know either.
   Can’t call the pharmacy “after hours”
                FMH Process
 A work in progress
 Three domains:
    – Admission
    – Transfer/re-order post-op
    – Discharge
FMH Form
FMH Form (con’t)
                         Medication Reconciliation
                                  Results
                        450



                        400



                        350



                        300
Number of medications




                        250                                                     # home meds
                                                                                # changed home meds
                                                                                # hosp meds
                        200                                                     # hosp meds changed



                        150



                        100



                        50



                         0
                              June   October   November    December   January
                                               2005-2006
            Number of Patients
35




30




25




20




15




10




5




0
     June    October   November    December   January
                       2005-2006
        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
          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
         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
           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 DC’d
       Contact Information
 Phone: 240-566-3797
 E-mail: pgrunwald@fmh.org

								
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