Missouri Hospitals Improve Medication Reconciliation Process Using AHRQ Toolkit

After participating in AHRQ-sponsored learning sessions and provider support calls, Primaris, the Missouri Quality Improvement Organization (QIO), worked with hospitals 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.

Fitzgibbon Hospital in Marshall, Missouri, used the MATCH toolkit to flowchart its existing medication reconciliation process on a specific unit, and as a result modified the process to include the use of a "One Source of Truth" to document home medications. Staff members used the MATCH tools to educate nursing and medical staff on the new process and created laminated pocket cards that include interview questions to use to obtain an accurate medication history. Over 6 months, compliance with the collection of a complete home medication list increased from 43 to 80 percent, and medications reconciled at admission increased from 37 to 57 percent. "Participating in this project heightened our awareness of the importance and complexity of medication reconciliation and united pharmacy, nursing, and medical staff with a common goal of improving medication reconciliation for our patients," says Lori Berger, RPh, Pharmacist.

St. Anthony's Medical Center in St. Louis, Missouri, made changes to its medication reconciliation process by creating a new form for the emergency department waiting room that asked patients to complete their home medication list. It also trained the nursing staff to maximize the use of electronic medical records for medication reconciliation. Over 4 months, compliance with collection of a complete home medication list increased from 63 to 73 percent, with reconciliation of home medications and admission orders also improving from 63 to 73 percent.

Sac-Osage Hospital in Osceola, Missouri, used the MATCH toolkit to develop a "One Source of Truth" for collecting medication histories and to define policies for reconciling medications. The facility also created a process for updating the "One Source of Truth" as new information becomes available. It purchased software to facilitate the new processes and conducted staff education on the new procedures. Over 8 months, compliance with collection of a complete home medication list improved from 90 to 100 percent, and medications reconciled upon admission improved from 80 to 95 percent.

Now that Nevada Regional Medical Center in Nevada, Missouri, has implemented computerized physician order entry in three areas of the hospital, medication history lists now convert to an order sheet that creates a "One Source of Truth" for documenting and ordering medications. "We were successful in our electronic medication reconciliation project because we continued to test, and test, and test after listening to other hospitals' success stories from the AHRQ project and what they had done with the same software we were using," says Holly Bush, RN, Performance Improvement Administrative Officer.

Additional Missouri hospitals that improved medication reconciliation by updating their policies and establishing a "One Source of Truth" after participating in onsite learning sessions and technical assistance calls include:

• Cedar County Memorial Hospital in El Dorado Springs.
• Ozarks Community Hospital in Springfield.
• Phelps County Regional Medical Center in Rolla.