Four Kentucky Hospitals Use AHRQ Toolkit to Improve Medication Reconciliation
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 Kentucky, worked with four hospitals 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.
Hazard ARH Regional Medical Center in Hazard, Kentucky, was using a "One Source of Truth" medication reconciliation form that did not incorporate all disciplines. The hospital pharmacy is now responsible for medication order clarification, and interventions have led to a decrease in discrepancies between the medication list in the admission history and the medications listed on the medication reconciliation form. Vivian Campbell, RN, Director of Performance Improvement, says, "Our participation in the AHRQ QIO Learning Network project has been a positive experience and afforded our hospital the opportunity to focus on improving quality patient care."
Morgan County ARH Hospital in West Liberty, Kentucky, focused its project on patients who are discharged while taking warfarin. Baseline data showed that 24 percent of these patients had a discrepancy in their dosage at discharge. Orders for alternate doses were often not stated correctly on the discharge instructions, and patients were not being educated about this high-risk medication. The facility redesigned its discharge process for patients taking warfarin, incorporating distribution of AHRQ consumer publications, including the DVD "Staying Healthy and Active With Blood Thinners." According to Dolores Luke, RN, BSN, NHA, CPHQ, Chief Nursing Officer, Performance Improvement, "The process redesign has been effective, and the facility has achieved 100 percent compliance in accurate discharge instructions regarding warfarin dosage."
Trover Health System in Madisonville, Kentucky, adopted an electronic medical record system in April 2010 that includes a "One Source of Truth" medication reconciliation form. With a new medication reconciliation process that involves the hospital pharmacy, audits show pharmacy staff are proactively reconciling medications and contacting physicians to resolve discrepancies. Amy Smith, RN, Quality Outcomes Facilitator, says, "Trover Health System found its participation in the AHRQ QIO Learning Network to be beneficial in forming data collection tools, identifying barriers, implementing changes, and gaining adherence to its electronic medication reconciliation process."
Meadowview Regional Medical Center in Maysville, Kentucky, identified that the medication history list initiated in the emergency room was not revalidated when a patient was admitted to the inpatient unit. To reinforce the "One Source of Truth" concept, pharmacy staff were given access to the medication reconciliation list in the electronic medical record system. They could then update information when clarification was obtained. According to June Fultz, RN, Education Director, "Participation in this project allowed us to spend time reviewing and revising our process. We feel we have a solid foundation to make this an excellent process for patient safety in our hospital."
AHRQ QIO Learning Network session activities were held in partnership with Health Care Excel. 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.