Four New York Providers Use AHRQ Medication Reconciliation Toolkit to Improve Care
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, Island Peer Review Organization (IPRO), the QIO for New York, worked with four providers 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.
Eddy Heritage House Nursing and Rehabilitation Center in Troy, New York, implemented a "One Source of Truth" process for documentation of medication reconciliation. Nurses now use this form to provide patient education on medications. Phone calls to the discharging hospital have also been initiated to review medications taken prior to admission to the nursing and rehabilitation center.
As a result of the intervention, Eddy Heritage staff have identified and resolved potential adverse drug events. Examples of medication discrepancies identified include: insulin excluded from the hospital discharge medication reconciliation list, a patient discharged on Percocet with a known allergy for the drug, and dosing orders for atenolol and fentanyl.
Linda Obercon, MSH, Eddy Heritage Administrator, reports, "The improvements in our medication reconciliation process and cross-setting communications have resulted in a process that is easier for the nurses, is more accurate, and has positively impacted the continuity of care for our short-term rehabilitation patients and families."
Eddy Visiting Nurses Association (VNA) in Troy validated which of the many lists sent by the discharging hospital was the most accurate and would serve as the "One Source of Truth" at discharge. Any discrepancies between the "One Source of Truth" from the discharging facility and the one created by the agency upon admission to Eddy VNA home health care services are reviewed. As a result, compliance with the home medication list matching the discharge list improved by 40 percent. Nursing documentation of a complete and accurate "One Source of Truth" upon admission increased by 50 percent. Sunny Baldwin, RN, Supervising Community Health Nurse, noted, "The tools and resources provided on the MATCH Web site were helpful in supporting improvement of the medication reconciliation process."
Glens Falls Hospital in Glens Falls, New York, entered the collaborative with a "One Source of Truth." Using the tools in the MATCH toolkit, the nursing staff was instructed on patient interviewing techniques and skills for obtaining a medication history. Staff found the training informative and helpful in raising awareness of the techniques to obtain a complete and accurate home medication list. These interventions resulted in the medication lists being complete and accurate 88.2 percent of the time. Nancy Huntington, PharmD, Director of Pharmacy, reported, "It is Glens Falls' intent to actively use and apply the multitude of refined tools provided in the MATCH toolkit to facilitate broad systematic change."
Staten Island University Hospital in Staten Island, New York, had a medication reconciliation process that was adhered to just 60 percent of the time. One problem was that medication histories collected in the emergency department upon admission were missing information. In addition, the staff was not able to update the medication history when new and more reliable information became available. These factors prevented the medication history from functioning as a "One Source of Truth."
The hospital redesigned its medication history form to be more user friendly and serve as a "One Source of Truth" upon admission. The form is a "living" document that is updated during the daily interdisciplinary rounds. The hospital also created a new unit chief position—a hospitalist with the responsibility for overseeing and coordinating care for the patient, including oversight and accountability for medication reconciliation.
As a result of these efforts, compliance with medication reconciliation has exceeded 78 percent since June 2010 at Staten Island University Hospital. According to Cynthia D'Auria, RN, Patient Safety Officer, "Although we are still in the early pilot stage, the creation of a medication reconciliation process that serves as a 'living document' can be considered a success for this project. As we are in the process of developing a computerized medical record, this document will assist in setting the framework for an electronic version."
AHRQ QIO Learning Network session activities were held in partnership with IPRO. 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.