Three Missouri Hospitals Use AHRQ Toolkit to Improve Medication Reconciliation

Between January and September 2010, AHRQ partnered with seven Quality Improvement Organizations (QIOs) to deliver a series of onsite learning sessions and provider support calls focusing on implementation of the AHRQ-funded toolkit, Medications at Transitions and Clinical Handoffs (MATCH). These events were part of a QIO Learning Network established through an AHRQ Knowledge Transfer project. As a result of this project, Primaris, the QIO for Missouri, worked with three hospitals in the State to develop a single medication history list based on the AHRQ toolkit.

The goal of the MATCH toolkit is to decrease the number of patients who receive potentially conflicting medications when they leave the hospital or are transferred between different health care settings. The toolkit helps accomplish this goal by providing clear instructions on creating flowcharts to avoid gaps in reconciling medications, identifying roles and responsibilities for medication reconciliation, collecting data to measure progress toward improved patient safety, and assisting in the design and implementation of a single, shared medication history called the "One Source of Truth." MATCH is designed to assist clinicians in all types of organizations—including hospitals and outpatient settings—and is compatible with both electronic medical records and paper-based systems.

Citizens Memorial Healthcare in Bolivar, Missouri, created a "One Source of Truth" list for use by its hospital, long-term care, outpatient clinics, and home care services. The health system defined and standardized a process for medication reconciliation and worked with its electronic medical record vendor to accommodate this approach. The long-term care facility implemented a new "One Source of Truth" list for the permanent documentation of a home medication list in the medical record. Kim Maples, RN, BSN, Information Services Specialist, says, "Participating in this project not only raised awareness of medication reconciliation, but also identified issues that were happening across the heath system that weren't being addressed at an organizational level."

Cooper County Memorial Hospital in Boonville, Missouri, had a medication reconciliation process that was buried in a 12-page admission assessment. The hospital developed a "One Source of Truth" medication list that was pilot tested and implemented throughout the facility. Compliance with collection of a home medication list improved from 85 to 90 percent, with list completeness improving from 30 to 70 percent. Sheryl Hopkins, RN, Clinical Staff Educator, says, "Involvement in the medication reconciliation project has given me the satisfaction of being able to directly impact patient safety."

Texas County Memorial Hospital in Houston, Missouri, had an electronic medical record system that did not support the "One Source of Truth" medication history list. According to Amanda Turpin, RN, BSN, Quality Management Director, "Participation in the medication reconciliation project demonstrated how important having a 'One Source of Truth' list is in developing an effective medication reconciliation process. It helped us obtain support for the purchase of an upgraded software program that included a 'One Source of Truth' approach for medication reconciliation."

AHRQ QIO Learning Network session activities were held in partnership with Primaris. Kristine Gleason, RPh, of Northwestern Memorial Hospital, developed the MATCH toolkit, and presented information during onsite learning sessions and provided expert support during calls with hospital staff.