Five Nebraska Hospitals Use AHRQ Toolkit to Improve Medication Reconciliation Across Care Settings
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, CIMRO, the QIO for Nebraska, worked with five 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.
The Nebraska facilities that worked together to implement changes to their medication reconciliation process were:
- Nebraska Medical Center, an acute care hospital in Omaha serving as the primary referral source of patients to the participating nursing homes and home health agencies in the project.
- Hillcrest Health and Rehabilitation, a skilled nursing facility in Bellevue.
- Hillcrest Home Care, a home health agency in Bellevue.
- Lutheran Home, a skilled nursing facility in Omaha.
- Visiting Nurse Association, a home health agency in Omaha.
These providers concentrated on examining the transition in care when a patient is discharged from the hospital and then admitted to one of the nursing homes or home health care agencies. By creating a flowchart of the medication reconciliation process that occurred from hospital discharge to admission to their facilities, the nursing homes and home health agencies identified that they received multiple medication lists for patients discharged from the hospital. This made it difficult to identify the list serving as the "One Source of Truth."
Using the "One Source of Truth" concept from the MATCH toolkit, the Nebraska Medical Center—together with the nursing homes and home health agencies—identified which medication list sent at discharge was the most accurate and should function as the "One Source of Truth." This helped to clarify the medication reconciliation process for all facilities.
The nursing home and home health participants collected data about the medication discrepancies on patients who had been referred from the hospital. They communicated these discrepancies to the Nebraska Medical Center, the hospital that is the primary source of patient referrals. Together the hospital, home health agencies, and nursing homes worked to minimize medication discrepancies. During the 6 months of the project, chart audits demonstrated that this community partnership resulted in a 5 percent reduction in discrepancies. Lavonne Reed, RN, Director of Nursing at the Lutheran Home says, "The lack of a single accurate medication list was identified by the group as the main barrier. It was very helpful to implement the tools from the MATCH Web site, and then work as a group to identify the cause of the problem and not place blame for medication discrepancies on any one group."
AHRQ QIO Learning Network session activities were held in partnership with CIMRO. 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.