Project Name: Medication Reconciliation

Project Timeframe: October, 2007 – September 2008

Project Description and Purpose:
The project purpose is to create a medication reconciliation process for all patients across the continuum from admission, or clinic visit to visit end, or discharge. The medication reconciliation process begins with the identification of the patient’s home medications and ends with the reconciled list of discharge medications for the patient. A pilot will occur involving the Surgical Care Unit, Emergency Department and Ambulatory Care Unit.

Project Team:
The Core Team, lead by an RN in the Performance Improvement department consists of members of the Medical Staff, an Orthopedic Surgeon, Case Managers, Pharmacist, Accreditation/Patient Safety Coordinator, Information Systems Specialist, RNs from multiple departments including Emergency Department, Psychiatric Services, Surgical Services, Medicine and Outpatient Surgical Services. Nursing contacts from all other in and outpatient area within the facility are also involved. The Core Team is under the guidance of a Steering Committee comprised of three senior leaders in the organization.

Project Goals & Objectives:

• Develop and deploy a documented, systematic process for medication reconciliation that will lead to improved patient safety, satisfaction, quality care and communication between care providers.
• Implement a monitoring & feedback step within the process
• Define requirements for a future integrated information system whichsupports medication reconciliation
• Meet all regulatory and accreditation requirements; Joint Commission National Patient Safety Goal #8.
• Documentation that the medication reconciliation process is being used consistently across all areas within the facility that provide conscious sedation, and administers medications.
• Meet Joint Commission standards at the next on-site survey
• Implement the process by early 2008.

Evaluation Process:

• Having defined and assessed the current system and situation areas for improvement were identified.
• Baseline data was obtained and analyzed and assisted us in identifying system elements and specific areas in which to focus our efforts to achieve the improvements in the process needed.
• Measures around the use of our Data Capturing System and process will be ongoing during the pilot and quarterly through the review process established by the Nursing Quality Improvement Council.
• Feedback to the staff in each nursing area is planned on a scheduled basis.

Project Progress/Results:
The team is currently analyzing the three points where medication reconciliation needs to occur; at Admission, Transfer and Discharge and is focusing on the processes of verification, clarification and reconciliation.

The Improvement Theory is in the process of being developed based upon our understanding of the data and the tools utilizing the Rutland Regional Medical Center’s model for improvement (MEDIC).

We anticipate that the Improvement Theory will be developed around our policies, patient safety requirements, training and education as well as further development of supporting forms and processes currently in use. We have identified our current strengths and plan to build upon those. Patient’s sharing with us the most accurate list of medications both prescribed and over the counter that they take at home is extremely important in helping us meet their care needs.

Our focus of change keeps patient safety as the primary goal while streamlining the medication reconciliation process to improve communication and efficiency for caregivers and providers as well.