| In 2005 the NHA Board identified the following as the designed future for healthcare in Nebraska: In 2010, the Nebraska Hospital Association is the influential voice in the state for health care. Nebraska is home to healthy communities where hospitals are known as leaders of quality initiatives. Health care sets the standard for service excellence and Nebraska’s hospitals foster innovation. Working from this set of shared values, health care has come to be the industry of choice in the state. Nebraskans are assured access to health care; there is full coverage and a fair payment system in place.
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To help Nebraska’s hospitals achieve the goal of being leaders in quality initiatives, we will be sharing with you some of the quality initiatives that are taking place right now in Nebraska. Each month we will bring you an innovative, reproducible model of a healthcare quality initiative.
This month we feature Oakland Memorial Hospital and their
Implementation of a Medication Reconciliation Process .
Click here to view the Archives.
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Hospital of the month - Oakland Memorial Hospital, Oakland, NE
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Implementation of a Medication Reconciliation Process at Oakland Memorial Hospital
One of the goals of our quality improvement plan is to provide care that is safe, avoiding injuries to patients from the care that is intended to help them. We felt that a medication reconciliation project would help us reach this patient safety goal.
Medication reconciliation is defined by the Institute for Healthcare Improvement (IHI) as a formal process of obtaining a complete and accurate list of each patient’s current home medications, including name, dose, frequency and route, and comparing the physician’s admission, transfer and/or discharge orders to that list. Discrepancies are brought to the attention of the physician and, if appropriate, changes are made to the orders.
Our process began when three hospital nurses attended the workshop “Medication Reconciliation Across the Continuum of Care” in April of 2005. Upon returning to the hospital, a medication reconciliation audit was done on medical records. We looked at records representing patients across the continuum – (1) hospital admission, transfer to swing bed and discharge back to nursing home; (2) patient residing in his/her home, admitted and transferred to another acute care facility for advanced care; (3) patient residing in his/her home, admitted and discharged back to his/her own home; and (4) patients admitted from nursing home and discharged back to the nursing home. From these medical records, 42 medications were examined and 21 discrepancies and possible errors were identified.
The process improvement initiative took several months to implement and involved many different people. It truly is a Team Effort.
The team consisted of:
- The patient and their families – they play a vital role by keeping and carrying with them an up-to-date medication list.
- The Provider – to address all home medications and encourage their patient to keep an up-to-date list and communicating that information to other healthcare members.
- The Nurse – to obtain, verify, clarify and reconcile the medication list; to assure that the accurate medication list follows the patient at transition points; and to educate all patients about their responsibility for an accurate and up-to-date medication list.
- Administration – to support the clinicians as they implement, maintain, and continually improve the process.
Our medication reconciliation initiative involved several key processes:
- The Medication Reconciliation Sheet – the team engaged the medical staff and one physician came forward to champion the process. Several iterations of the form were developed which were trialed on patient medical records. Our final form addresses medications on admission, transfer and discharge. From the medication reconciliation sheet, providers can order the medications on admission, transfer and discharge, without having to re-write them on the physician’s order form. Ongoing monitoring for improvements is taking place.
- Provider Education – As the medication reconciliation sheet was being finalized, it was brought to the medical staff meeting for all providers to review and approve. An explanation of the provider’s role in using the sheet was given; discussion followed and questions were answered to the providers’ satisfaction.
- Hospital Nurse Education – The Medication Reconciliation Sheet was discussed at the nurses meeting. Again an explanation of the sheet and its purpose was given; discussion followed and questions were answered to the nurses’ satisfaction. The nurse’s role in completing the form was explained. The drug card that was provided to all patients was also reviewed and explained. The importance of patient education regarding their medications and the use of the drug card was stressed.
- Patient and Public Education – A news release was run in the local newspapers about the hospital’s role in keeping them safe. The release included the importance of patient knowledge of their medications and their role in maintaining an accurate list of their medications. New drug cards in fluorescent yellow were developed and distributed to patients following the article in the local newspapers. This was begun in July of 2005 and continues with every patient who comes to the clinics or hospital for medical care.
- Clinic Nurse Education – The new drug cards were distributed to both clinics in Oakland. The medication reconciliation process was explained to clinic staff and the importance of educating patients on their role with medication safety was completed in June 2005. The clinic staff continue to distribute the drug cards to patients when indicated.
So, have we made a difference?
Audits of our processes are done on a quarterly basis. During the last audit, 43 medications were reconciled and 4 discrepancies or possible errors were noted. This is a definite improvement over our baseline audit. As a result of our medication reconciliation process, some medical records have no discrepancies. One area that stills needs improvement is the patient who is transferred from our emergency department to another acute care facility.
Another result we identified is that patients are calling the clinics less often with questions about their medications. We attribute this to the education that was provided to patients and the fact that their medications are now all reconciled which results in less confusion to the patient. In fact, now when patients present to the hospital or clinic they have their drug cards ready for hospital/clinic personnel to update.
What were some of our lessons learned?
- Developing the forms and the system does take time; but in the long run, it will save time and more importantly, it reduces the opportunity for errors.
- Reconciling medications is a team process; all disciplines and the patient play a role.
- Change is difficult.
- Communication is important and ongoing.
- It is essential to success to have a physician champion.
- Patients are complex – their list may differ from the provider’s list, they may see multiple providers, and sometimes they resume the medications they have at home by themselves. We must keep educating the patient and all healthcare providers regarding the importance of medication reconciliation.
Oakland Medication Reconciliation Form
Oakland Medication Card
If you have any questions or would like your hospital's quality
initiatives to be featured on the NHA Web site, contact Monica Seeland, Vice
President, Quality Initiatives, (402) 742-8152 or mseeland@nhanet.org.
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