MEDICATION RECONCILIATION Medication Reconciliation Patty Grunwald PharmD BCPS

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MEDICATION RECONCILIATION Medication Reconciliation Patty Grunwald PharmD BCPS Powered By Docstoc
					    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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