AHRQ met with Quality Improvement Organizations (QIO) in six states in 2011 to see if the medication reconciliation process could be improved when patients leave the hospital or transfer to different care settings. The goal was to find out if the AHRQ-funded toolkit “Medications at Transitions and Clinical Handoffs” (MATCH) works with hospitals and patients effectively.
For example, Hughston Hospital in Columbus Georgia used the MATCH toolkit to analyze their medication reconciliation process in their acute and rehabilitation inpatient units. Their baseline data showed that staff members consistently omitted medications on 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 increased from 0 to 100 percent from February through April 2011.
The Upson Regional Medical Center in Thomaston Georgia along with a team of multidisciplinary staff and hospital leaders came up with the idea to use the MATCH toolkit to create a flowchart for the medication reconciliation process. They also developed a patient census board using colored magnets to track medications This helped the team to identify a multitude of system and process issues and was so effective that the reconciliation of the medication lists increased from 60 to 90 percent over six months.
Located in Athens Georgia, St. Mary’s Health Care Systems used the MATCH toolkit to create a new admissions process in the surgical unit. Under the new process, preoperative nurses receive the medication list from patients during their preoperative appointment. The facility has identified five medications such as anticoagulants, insulin, and heart, seizure, and psychiatric medications as the five critical medications that must be reconciled correctly and immediately upon admission.
In addition, the hospital provided medication bags in the Emergency Department and registration areas to encourage patients to bring their medications to physician visits and the hospital. As a result, compliance with the collection of a complete admission medication list increased from 73 to 85 percent over six months.
In Baltimore Maryland, Union Memorial Hospital created their “Discharge Counseling Service”. This approach has the pharmacist working with the medical teams to develop a discharge medication list where the team is able to educate patients about taking new medications, whether to continue or stop home medications, and the importance of adhering to their medication regimen. In the three months since the hospital has implemented the service on their medical floors, medications reconciled at discharge have increased from 50 to 85 percent.
In Terre Haute Indiana at Union Hospital, the focus is on medication reconciliation for patient transfers into and out of the ICU. The hospital assigned responsibility for completing medication reconciliation to the ICU charge nurse to eliminate the confusion that can occur when the responsibility is split between the ICU and floor nurses.
The project also installed new medication reconciliation report software on all nursing unit computers. The post-anesthesia care unit can now print an updated medication list after surgery and the surgeon is able to reconcile medications before the patient returns to the nursing unit. The new process has resolved the problem of physicians’ having difficulty in finding an updated medications list in a consistent place on the medical chart.
For more information, go to www.ahrq.gov/about/casestudies/ptsafety.