Four New Jersey 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, Healthcare Quality Strategies, Inc., the QIO for New Jersey, 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.
Bayshore Community Hospital in Holmdel, New Jersey, identified that its "One Source of Truth" process for documenting medications at admission was sometimes missing medication strength and dose information. Since this form is also used as an order form, it was difficult to fill prescriptions. Based on information learned in the AHRQ project, nursing staff was designated to follow up with the patient, family, and physician on any incomplete prescriptions on the "One Source of Truth." As a result, compliance with medication reconciliation improved from 90 to 100 percent. According to Anne Brown, RPh, Acting Director of Pharmacy, "Participation in this learning network showed us that we have a good start with the medication reconciliation process, but we can still make the process easier and improve patient care."
Capital Health Regional Medical Center and the Mercer Campus in Trenton, New Jersey, entered the collaborative using an electronic medication reconciliation process that included "One Source of Truth." Physicians' concern with the accuracy of the medication list led to low compliance with its use. Physician compliance with medication reconciliation at discharge improved from 34 percent to 81 percent after they were included in the discharge medication reconciliation process. As a result, accuracy of the medication list provided to patients at discharge improved from 75 percent to 86 percent. MATCH interventions pilot tested on the behavioral health unit were then implemented throughout the facility. Debra Sansone, RN, M.P.A., Director of Quality and Risk Management, says, "The project helped us realize that active physician participation with medication reconciliation was paramount to institute a safe, valid, and effective medication reconciliation process."
Cooper University Hospital in Camden, New Jersey, redesigned its medication reconciliation process using the MATCH toolkit. The facility focused on inpatient admissions through the emergency department. According to Joanne Porter, RN, BSN, Director of Regulatory Affairs, "The business case model in the MATCH toolkit was used to obtain executive approval for hiring additional medication reconciliation technicians to ensure that accurate medication lists were obtained on admission. Once a list is entered into the system, it serves as the 'One Source of Truth' and is connected to the 'After-Visit Summary' generated through the electronic medical record."
Deborah Heart and Lung Center in Brown Mills, New Jersey, used the MATCH toolkit to create a flowchart of its medication reconciliation process. This helped the facility identify gaps in its process. The previous medication reconciliation form was not functioning as a single medication history list, pharmacy staff was not involved in medication reconciliation, and the home medication list was not always available to the admissions nurse. The hospital redesigned its medication reconciliation form to function as the "One Source of Truth."
AHRQ QIO Learning Network session activities were held in partnership with Healthcare Quality Strategies, Inc. 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.