Indiana Hospital Improves Medication Reconciliation for Diabetes Patients With AHRQ 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, Health Care Excel, the QIO for Indiana, worked with one hospital 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.
HealthSouth Deaconess Rehabilitation Hospital in Evanston, Indiana, focused its medication reconciliation project on patients with diabetes. The hospital used the tools and resources in the MATCH toolkit to compare "reconciled" orders received from the acute care hospital at discharge with orders made by HealthSouth at the time of admission to identify discrepancies resulting from transfers. A 10 percent discrepancy was identified with the "reconciled" medication lists received from the acute care hospital at discharge. Examples included a missing dose for a warfarin order, two different doses listed for metoprolol and ciprofloxacin, and a different number of days listed for a continued antibiotic order. HealthSouth staff implemented a detailed cross-check system to clarify discrepant orders received from the acute care hospital.
As a result of participating in the AHRQ project, HealthSouth is sharing its discharge medication reconciliation findings with hospital partners. According to Linda Doerflein, R.N., B.S.N., C.P.H.R.M., "This project has helped us to work together to understand how medication reconciliation impacts care across provider settings."
AHRQ QIO Learning Network session activities were held in partnership with Health Care Excel. Kristine Gleason, R.Ph., of Northwestern Memorial Hospital, developed the MATCH toolkit, and presented information during onsite learning sessions and provided expert support during calls with hospital staff.