Georgia Hospitals Improve Medication Reconciliation Process With AHRQ Toolkit
After participating in AHRQ-sponsored learning sessions and provider support calls, Allina/GMCF, the Quality Improvement Organization (QIO) for Georgia, in conjunction with the Georgia Hospital Association, worked with 26 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.
Using the MATCH toolkit, Hughston Hospital in Columbus, Georgia, extensively analyzed its medication reconciliation process for acute and rehabilitation inpatient units. Baseline data showed that staff members consistently omitted medication route in home medication lists because the electronic form lacked enough space to enter the information. Once programmers made a minor change to the electronic form, compliance with collection of a complete medication list upon admission, to include medication route, increased from 0 to 100 percent from February through April 2011 and remained at 100 percent through September 2011. "Hughston Hospital's experiences during the medication reconciliation project showed that the frontline staff's involvement empowers staff to take ownership of medication administration safety," says Freya Gilbert, RN, Director, Quality and Clinical Practice, and Medication Reconciliation Project Sponsor.
Upson Regional Medical Center in Thomaston, Georgia, created a team of multidisciplinary staff and hospital leaders that used MATCH tools to create a flowchart of the medication reconciliation process. The team described its flowcharting experience as the "most eye opening 3 hours ever" because it identified a multitude of system and process issues. After conducting staff education, the team revised the medication reconciliation process, establishing an 18-hour timeframe to complete it. Primary care nurses took responsibility for starting the process, and the electronic Patient Care Report for nurses included a prompt to document medication reconciliation. The team used colored magnets on the unit patient census to track the status of medication reconciliation: red indicates the process is not started; yellow indicates in process; and green indicates completed. "Who would have ever thought simple colored magnets on a patient census board could potentially save a patient's life and prevent patient harm?" says Dawn Hurst, RNC, MS, Director Perinatal Service, and Project Lead. As a result of these efforts, compliance with the collection of a complete medication list increased from 70 to 100 percent, with reconciliation of the medication list increasing from 60 to 90 percent over 6 months.
Clinch Memorial Hospital, a critical access hospital in Homerville, Georgia, requires its emergency department (ED) staff to reconcile patients' medications regardless of whether or not they are admitted, so the chart can serve as a starting point if a patient needs treatment later. Using MATCH tools and concepts, the hospital developed a "One Source of Truth" within its electronic medical record system to document patients' home medication lists, which the physician can use to order medications. The hospital also reached out to community pharmacies to clarify medication histories, partnered with emergency medical services to collect medication information, and educated the community on the importance of creating and maintaining a medication list. Over 7 months, compliance with the collection of a complete medication list increased from 12 to 77 percent, and reconciliation of medication lists increased from 25 to 95 percent. "The project brought to light many opportunities for our organization to better serve the community," says Wayne Lee, RN, Director of Nursing. "This project benefited our organization, as all home medications are now individually verified and ordered by the physician, which provides less opportunity for transcription errors or communication failures."
St. Mary's Health Care System in Athens, Georgia, used MATCH tools and resources to create a new admissions process to the surgical unit. Under the new process, preoperative nurses receive a medication list from patients during their preoperative appointment. The facility also identified the "High Five"—anticoagulants, insulin, and heart, seizure, and psychiatric medications—as the five critical medications that must be reconciled correctly and immediately upon admission. The hospital also provided medication bags in the ED and registration areas to encourage patients to bring their medications to physician visits and the hospital. As a result of these efforts, compliance with the collection of a complete admission medication list increased from 73 to 85 percent over 6 months.
Additional Georgia hospitals that improved medication reconciliation from February through November 2011 after participating in onsite learning sessions and technical assistance calls include:
- Appling Hospital in Baxley.
- Colquitt Regional Medical Center in Moultrie.
- Crisp Regional Hospital in Cordele.
- Bleckley Memorial Hospital in Cochran.
- Dorminy Medical Center in Fitzgerald.
- Elbert Memorial Hospital in Elberton.
- Flint River Hospital in Montezuma.
- Floyd Medical Center in Rome.
- Gordon Hospital, part of Adventist Health System, in Calhoun.
- Henry Medical Center in Stockbridge.
- Houston Medical Center in Warner Robins and Perry Hospital in Perry, both part of Houston Healthcare.
- The Medical Center of Central Georgia in Macon.
- Pioneer Community Hospital of Early in Blakely.
- Southeast Georgia Health System Campuses in Brunswick and Camden.
- Southern Regional Medical Center in Riverdale.
- Southwest Georgia Regional Medical Center in Cuthbert.
- Ty Cobb Healthcare System-Cobb Memorial Hospital in Royston and Hart County Hospital in Hartwell.
- Washington County Regional Medical Center in Sandersville.
- WellStar Cobb Hospital in Austell.
- WellStar Paulding Hospital in Dallas.