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Medication Reconciliation: MSNU


Medication Reconciliation: MSNU Origins of Medication Reconciliation as a Patient Safety strategy The Institute for Healthcare Improvement (IHI) introduced the 100K ... – PowerPoint PPT presentation

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Title: Medication Reconciliation: MSNU

Medication Reconciliation MSNU
Origins of Medication Reconciliation as a Patient
Safety strategy
  • The Institute for Healthcare Improvement (IHI)
    introduced the 100K Lives Campaign in December
    2004 to challenge health care providers to join a
    national effort to make health care safer and
    more effective ensure hospitals achieve the
    best possible outcomes for all patients.
  • On April 12, 2005, the Canadian campaign, Safer
    Healthcare Now! was created. The IWK Health
    Centre is a registered member.

Medication Reconciliation
  • A formal process for
  • Obtaining a complete and accurate list of each
    patients current home medications (name, dosage,
    frequency, route)
  • i.e. the Best Possible Medication History
  • Comparing the physicians admission, transfer,
    and/or discharge orders to that list
  • (The IWK are currently piloting this process
    at admission)
  • Bringing discrepancies to the attention of the
    prescriber and ensuring changes are made to the
    orders, when appropriate

  • Concern over patient safety is growing, both
    among the Canadian public and among health care
  • 53.6 of enrolled patients had 1 unintended
    discrepancy (61.4 assessed as having no
    potential to cause serious harm but 38.6 had
    potential to cause severe discomfort or
    clinical deterioration)
  • ..the most common error was omission of a
    regularly used medication (46.4)
  • Cornish PL. Unintended medication
    discrepancies at the time of hospital admission.
    Arch Intern Med 2005165424-429.
  • Greater than 50 of all hospital medication
    errors occur at the interfaces of care
    (Admission,Transfer and Discharge)
  • .Rozich JD. Medication safety One
    organizations approach to the challenge. JCOM.

Why now?
  • Reduces medication error potential for patient
  • Is a key component of seamless care strategies
  • Saves time for physicians, nurses, and
    pharmacists in the long-term
  • Medication Reconciliation is a new Canadian
    Council on Health Services Accreditation Patient
    Safety Standard for 2008 / ROP(required
    organizational practice)
  • Executive Leadership has endorsed Medication
    Reconciliation as a project of high priority

Accreditation Patient Safety Communication
  • ROP
  • Reconcile medications with the patient/client
    at referral or transfer, and communicate the
    patients/clients medications to the next
    provider of service at referral or transfer to
    another setting, service, service provider or
    level of care within or outside the organization.

  • Tests for compliance
  • -Is there a demonstrated , formal process to
    reconcile patient medications
  • -Does the process involve generating a single
    documented ,comprehensive list.
  • -Does the process include documentation of the
    differences between the history and orders list
  • -Do processes take place as a shared
    responsibility, involving the patient/client,
    nursing staff, medical staff, and pharmacists, as
  • -Does the organization have a plan for spread

How do we define discrepancies? What tools will
be using ?
Types of Discrepancies
  • Type O No discrepancy.
  • The medication name/dose/frequency taken at
    home by patient is the same as what was ordered
    for the patient in the admission orders.
  • Type 1 Intentional discrepancy
  • The physician has made an intentional choice
    to add, change or discontinue a medication and
    their choice is clearly documented.
  • Types 1s are considered to be best
    practice in medication reconciliation

  • Type 2 Undocumented Intentional discrepancy
  • The physician has made an intentional choice
    to add, change or discontinue a medication but
    their choice is not clearly documented.
  • Do not usually represent a serious threat to
    patient safety but causes confusion, rework and
    may lead to medication error.
  • Can be reduced by standardizing the method
    for documenting admission medication orders
  • Type 2s account for 25-75 of all
  • Type 3 Unintentional discrepancy
  • The physician has unintentionally changed,
    added or omitted a medication that the patient
    was taking prior to admission.
  • Can be reduced by multidisciplinary training at
    obtaining in-depth
  • medication history and involving clinical
    pharmacists to identify and reconcile
  • Type 3s can lead to a med.error with the
    potential for an ADE.

Aim Scope
  • Aim
  • To reduce the number of undocumented
    intentional and unintentional discrepancies
    (Types 2 3) for the inpatient population by 75
  • SHN to raise bar for participating teams to
    90 in fall 2007 and move toward transfer and
    discharge interfaces of care
  • Scope
  • Medication reconciliation to be completed
    within 24 hours of admission for all patients
    admitted to MSNU who are currently taking

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Steps for shared responsibility
  • Step 1 Collecting the BPMH- Pharmacy, Nursing and
  • Interview the patient/family on admission to
    get the best possible medication history (BPMH)
  • Complete the Medication History and Order Sheet
  • listing all home medications.
  • Sign the record as the interviewer
  • Nursing On the Admission/ Visit Assessment
    Record (7070)
  • Document, See Medication History and Order
  • Ensure that form 6360 is on the chart and
  • __________________________________________________
  • Step 2 BMPH becomes admission orders
  • Physician reviews the BPMH ,reconciles the list
    and signs the medication history and order sheet.
  • The BMPH list becomes the Admission Medication
    orders, upon signing.

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Potential Impact
  • Implementation of medication reconciliation along
    with other interventions decreased the rate of
    medication errors by 70 and adverse drug events
    by 15, over a seven month period.
  • Whittington J, Cohen H. OSF healthcares
    journey in patient safety. Q Manage Health Care
  • Implementation in a surgical population reduced
    potential adverse drug events by 80 within four
    months of implementation.
  • Michels RD, Meisel S. Program using pharmacy
    technicians to obtain medication histories. Am J
    Health System Pharmacy 2003601982-1986

Supporters of this Project
  • Questions?