Six Texas Hospitals Improve Care With AHRQ Medication Reconciliation Toolkit
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, TMF Health Quality Institute, the QIO for Texas, worked with six 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.
Valley Grande Manor, a nursing home in Weslaco, Texas, used chart audits to learn that one of its referring acute care hospitals was not providing a complete reconciled medication list when it discharged patients. The list was often incomplete, with drugs listed that did not indicate whether the medication should be continued. Duplicate medications were also on the lists. As a result of the MATCH project, the nursing home began working with the hospital to improve medication reconciliation.
Valley Grande Manor also now provides patients, families, community physicians, and home health agencies with a reconciled medication list upon discharge from the nursing home. This list functions as a "One Source of Truth" and provides clear and complete information, including medication name, dose, route, and indication for use.
Weslaco Nursing and Rehabilitation Center now has its director of nursing visit patients' homes to develop and reconcile medication histories prior to admission to the facility. When a patient is admitted from a home health agency, the nursing home obtains a medication list from the agency to ensure that the medication history collected upon admission serves as a "One Source of Truth" for medication reconciliation.
PACE Health Care in Weslaco identified that few medication profiles were obtained from physicians for newly referred patients. Physicians were also not consistently resolving medication discrepancies within 24 hours, and there was no established process for the nurses to follow up. Additionally, once admitted to the home care agency, there were discrepancies concerning post-hospital stays because nurses did not have medication profiles available when they resumed the patient's care at home.
To address these problems, PACE implemented a new monitoring tool to follow up on orders needing physician clarification. Current medication profiles are now printed and brought with the nurse on the post-hospital visit. These changes have improved the accuracy of the medication profile.
House Calls Homebased Health Care in McAllen, Texas, identified discrepancies between the medications that patients were actually taking and the medication list in the agency's electronic medical record. Prior to participation in the MATCH project, patients did not receive a copy of their medication lists from the home health agency at admission.
After participating in the MATCH project, the agency implemented a system to deliver the patient medication profile—as well as the electronic medication record—to ensure that there is a valid and accurate "One Source of Truth." The facility also now gives a copy of this list to patients whenever it is updated, and patients are encouraged to bring the profile to medical appointments or if admitted to a hospital. Audits demonstrate that patients now receive a copy of their profiles 100 percent of the time.
Rio Home Care in Alamo, Texas, identified discrepancies between hospital reconciled lists at discharge and the medication reconciliation list created upon admission to its home care agency. In order to decrease discrepancies, medication reconciliation is discussed weekly during agency case conferences and more emphasis is placed on medication reconciliation during employee orientation.
IMS Home Health Care in Donna, Texas, focused its project on updating both the medication profile left at a patient's house when a medication change occurs and in the office chart. The agency educated patients and caregivers to keep the medication lists in patients' homes and updated so that it functions as a "One Source of Truth." In addition, a new electronic medical record system was implemented, allowing the physician to review the "One Source of Truth" at any time. The electronic record system also now updates patient medication charts whenever a change in medications is entered.
AHRQ QIO Learning Network session activities were held in partnership with TMF Health Quality Institute. 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.