New Process Improves Medication Reconciliation

Time Frame: Began October, 2006 and finished September, 2008

Project Description: Prior to the start of the project, 75% of our in-patients experienced at least one instance where there were inconsistencies between the medications these patients were taking prior to hospitalization and medications being ordered for them once they were hospitalized. We also found that 10% of the patient’s pre-hospital medications documented in the medical record contained at least one error – either in omission, dose, route, frequency or name.

The process of gathering a complete and accurate list of a patients medications, and making sure those medications are continued during hospitalization unless the physician chooses otherwise is known as “reconciliation”. Reconciliation is done to avoid medication errors such as inadvertent omissions, duplications, dosing errors or drug interactions. Reconciliation errors are directly linked to adverse drug events resulting in patient harm or the potential for harm, increased length of stay and inefficiencies for staff and physicians associated with rework and other non-value added activities.

This project was designed to develop a standardized process for accurately and reliably gathering patients’ pre-hospital medications and making sure those medications were either continued, changed or discontinued based on the physician’s preference.

Project Goals: To reduce the percentage of patients who experience a reconciliation error from 75% to 10% or less; and to reduce the percentage of medication documentation errors from 10% to 5% or less.

Interventions: The team developed a process by which a nurse or physician can enter pre-hospital medications into the patient’s electronic medical record upon admission. The pre-hospital medications are printed as a list on a form that the admitting physician uses to verify the patient’s medications and to indicate whether or not each medication should be ordered, changed or discontinued upon the patient’s admission. The form also serves as a visual check after the patient has been admitted to ensure all medications have been appropriately documented and reconciled.

Project Results: Once the solutions were implemented, the project’s process owner monitored weekly chart review to ensure the changes yielded the desired results, and that those results were sustained.

• Reduced percentage of documented medications with reconciliation errors from 10% to 2.5%.
• Reduced the percentage of patients who experience a reconciliation error from 75% to 11%.
• Reduced the average time it takes to gather and document a patient’s pre-hospital medication list from 29 minutes to 15 minutes.
• Eliminated the need for physicians to rewrite patient medications upon admission.