Michigan Providers Improve Medication Reconciliation Process With AHRQ Toolkit
After participating in AHRQ-sponsored learning sessions and provider support calls, MPRO, the Michigan Quality Improvement Organization (QIO), worked with providers in the State to improve their medication reconciliation process.
Between January and November 2011, AHRQ partnered with six State QIOs to focus on implementation of the AHRQ-funded toolkit, Medications at Transitions and Clinical Handoffs (MATCH). 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. These events were part of a QIO Learning Network established through an AHRQ Knowledge Transfer project.
The MATCH toolkit's goal is to decrease the number of patients receiving potentially conflicting medications when they leave the hospital or transfer to different care settings. The toolkit provides clear instructions on creating flowcharts to avoid gaps in reconciling medication; identifying roles and responsibilities for medication reconciliation; collecting data to measure progress; 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 health care organizations—including hospitals and outpatient settings—and is compatible with both paper-based and electronic medical records.
NexCare Health Systems—Holt Senior Care & Rehabilitation Center in Holt, Michigan, created a medication reconciliation policy to clearly define responsibilities for medication reconciliation and developed a "One Source of Truth" for documenting home medications. "When residents are discharged from our facility, they leave with their most accurate and current medication list," says Brenda Palmer, RN, Director of Nursing. The skilled nursing facility also conducts ongoing audits and monthly measurements of the process and discusses results with the quality assurance department for recommendations and followup. Over 5 months, compliance with collection of a complete home medication list increased from 0 to 100 percent, with all medications reconciled within 72 hours of admission to the facility increasing from 0 to 78 percent.
Botsford Hospital in Farmington Hills, Michigan, revised its "One Source of Truth" to include a column for the physician to check "continue" or "stop" for each home medication. In addition, the nurse documents each medication that should be continued at discharge and the last dose, date, and time the patient received the medication before discharge. Over 6 months, compliance with a complete medication list upon admission increased from 80 to 90 percent. "Participation in this project helped our facility improve our medication reconciliation process and patient safety in obtaining the most accurate home medication list on admission," says Pat Nelson, RN, Clinical Outcomes Coordinator.