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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: firstname.lastname@example.org
"MEDICATION RECONCILIATION Medication Reconciliation Patty Grunwald PharmD BCPS"