Six New Jersey 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, Healthcare Quality Strategies, Inc., the QIO for New Jersey, worked with six 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.
Newark Beth Israel Medical Center in Newark, New Jersey, implemented "One Source of Truth" for documentation of medication history that empowers staff to make updates as new and more reliable information becomes available. The complete medication history entered in the emergency department is used by the inpatient unit and validated upon admission. This change in process from multiple medication lists compiled by various departments to a streamlined process of "One Source of Truth" led to a 10 percent improvement in completion of patients' medication history lists by physicians.
Riverview Medical Center in Red Bank, New Jersey, created "One Source of Truth" for patients with prescheduled joint replacement surgery. Patients are encouraged to bring their medication lists with them to the presurgery educational session. For patients without a list, the preadmission nurse calls the patient and completes a list by phone. Using that list, the nurse completes the medication reconciliation form at the presurgery education session. This list, which functions as the "One Source of Truth," is then validated upon admission and reviewed by the surgeon and anesthesiologist.
Memorial Hospital of Salem County in Salem, New Jersey, developed "One Source of Truth" for documentation of a medication history. The medication history initiated in the emergency room is no longer rewritten in the inpatient unit. Instead, it is printed from the electronic medical record and validated when the patient is admitted. Nursing staff is responsible for the collection of the medication history, and the pharmacy must follow up with physicians on incomplete lists. Marla Maybrook, M.H.A., Chief Quality Officer, says, "Our participation in the project has given us the opportunity to identify issues with our medication reconciliation process, network with other institutions, and implement strategies to improve communication with our patients, which will ultimately improve patient care."
Trinitas Regional Medical Center in Elizabeth, New Jersey, entered the collaborative with a process that generated two medication lists when a patient was admitted as an inpatient from the emergency department. Following process redesign, the medication list obtained in the emergency department now serves as the "One Source of Truth" and is validated by the inpatient unit. As a result, compliance with medication reconciliation at admission improved by 53 percent, and compliance with medications listed on the discharge medication reconciliation form matching medications on discharge instructions improved by 20 percent. Sharon Greasheimer, PharmD, RPh, M.P.A., Director of Pharmacy, notes, "The process redesign led to a more accurate 'One Source of Truth.' The MATCH tools contained great resources in project planning, tips for conducting a medication interview, and suggestions that will enable patients to be involved in the medication reconciliation goal."
Jersey Shore University Medical Center in Neptune, New Jersey, did not have "One Source of Truth" to document medication history prior to participating in the project. Focusing on the heart failure patient population, the interdisciplinary team developed and implemented a "One Source of Truth" process at admission that would follow the patient through discharge. As a result, medication reconciliation upon admission improved in the pilot unit from 80 to 100 percent and upon discharge from 70 to 90 percent. Andrea Palisi, RN, MSN., Outcomes Manager, says, "As a result of the hospital's participation in this collaborative, our long-term goal is the incorporation of the 'One Source of Truth' into the electronic medical record, so that all practitioners can use the form and the end result is easily understood by patients."
University Medical Center at Princeton focused its project on patients scheduled for elective orthopedic surgery. Patients were educated on completing a home medication list to share with health care providers. Consistent with the "One Source of Truth," it was stressed that the list be complete with dose, route, and frequency. As a result of interventions with orthopedic patients, improvement in the completeness of the patient's home medication list increased from 80 to 100 percent. Home medication lists matching the physicians' lists also improved from 60 to 70 percent. Given these successes, the facility expanded the interventions to all patients with elective surgeries. In addition, the home medication form is sent to patients at discharge to encourage and educate them on creating a home medication list. Geri Karpiscak, RN, MSN., Director of Professional Development, Education, and Customer Service, says, "We thought the medication collaborative was great. The process was very organized, efficient, and streamlined. We walked away from every learning session and phone conference with useful ideas and tools."
AHRQ QIO Learning Network session activities were held in partnership with Healthcare Quality Strategies, Inc. 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.