Four 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 four 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.
St. John's Hospital-Lebanon in Lebanon, Missouri, entered the project with a "One Source of Truth" medication reconciliation form in place, but faced challenges in obtaining medication strength and dose upon admission. A baseline audit showed that medication lists developed at admission were complete only 55 percent of the time. As a result of implementing the MATCH toolkit, clinics began instructing patients to bring a medication list to their appointment. Corrections to the list are entered into the electronic medical record, and patients are given an updated medication list before leaving. Compliance with completing the medication lists with medication strength and dose increased from 55 to 78 percent over a 5-month period.
SSM St. Mary's Health Center in St. Louis, Missouri, entered the collaborative shortly after going "live" with a fully integrated electronic medical record. Baseline findings demonstrated that the medications listed in physicians' discharge summaries and medications in the patients' discharge instructions matched only 76 percent of the time. Using the MATCH toolkit, the team at SSM St. Mary's charted their medication reconciliation process to ensure a successful match. The team focused on utilization of the "Discharge Navigator" function in the electronic medical record and employed a multidisciplinary team to drive compliance with this function.
Through these efforts, SSM St. Mary's match rate improved from 76 to 94 percent. According to John Ingrassia, RN, J.D., Executive Director of Quality, Risk Management, and Patient Safety, "Through the AHRQ QIO learning sessions and support calls, we gained a deeper understanding of the positive impact on patient safety generated through a successful medication reconciliation program."
Moberly Regional Medical Center in Moberly, Missouri, identified discrepancies in the electronic medication reconciliation system used in the emergency department. The facility responded by adding pharmacists' hours for medication reconciliation and educating nursing staff on the best method to collect and input complete information on medication history into the electronic medical record. Interventions implemented in the emergency department resulted in medication reconciliation accuracy improvement from 17 to 57 percent.
Moberly's pharmacy also educated inpatient unit nurses about medication reconciliation, which helped improve accuracy of the medication history on the inpatient unit from 22 to 48 percent. The facility continues to collect and report on medication reconciliation accuracy across all nursing units to further improve compliance.
Ann M. Hils, PharmD, says, "The pharmacy department at Moberly Regional Medical Center believes in the importance of accurate medication reconciliation. We believe we have made significant progress in improving our process for obtaining accurate medication reconciliation by working together in the best interest of our patients."
Liberty Hospital in Liberty, Missouri, implemented the MATCH toolkit in April 2010 and focused on gaps in its electronic medication reconciliation process. Staff members were educated about correct implementation of the electronic reconciliation system. Continuous and transparent audit and feedback were used to improve compliance. The facility implemented a pharmacy consult and asked patients to take responsibility for creating and maintaining their medication lists.
This multifaceted approach led to improvements in Liberty's medication reconciliation process. In a 6-month period, unreconciled medications improved by 4.6 percent; admissions with unreconciled medications improved by 13.6 percent; and unreconciled medications per 100 admissions improved by 36.5 percent.
Megan Fischer, MBA, Director of Performance Improvement, says, "Participation in this program helped us to focus not only on improving the medication reconciliation process, but understanding methods for creating better teamwork among nurses, pharmacists, physicians, and the community. This was a very helpful program. I would recommend it to my colleagues."
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.