Six New Jersey Hospitals Reduce Adverse Events With AHRQ Medication Reconciliation Toolkit

Between January and September 2010, AHRQ partnered with seven Quality Improvement Organizations (QIOs) to deliver a series of onsite learning sessions and provider support calls focusing on implementation of the AHRQ-funded toolkit, Medications at Transitions and Clinical Handoffs (MATCH). These events were part of a QIO Learning Network established through an AHRQ Knowledge Transfer project. As a result of this project, Healthcare Quality Strategies, Inc., the QIO for New Jersey, worked with six hospitals in the State to develop a single medication history list based on the AHRQ toolkit.

The goal of the MATCH toolkit is to decrease the number of patients who receive potentially conflicting medications when they leave the hospital or are transferred between different health care settings. The toolkit helps accomplish this goal by providing clear instructions on creating flowcharts to avoid gaps in reconciling medications, identifying roles and responsibilities for medication reconciliation, collecting data to measure progress toward improved patient safety, and assisting in the design and implementation of a single, shared medication history called the "One Source of Truth." MATCH is designed to assist clinicians in all types of organizations—including hospitals and outpatient settings—and is compatible with both electronic medical records and paper-based systems.

Clara Maass Medical Center in Belleville, New Jersey, redesigned its process for medication reconciliation during transfers in levels of care. The "One Source of Truth" was redesigned to support effective communication among nursing staff, pharmacy staff, and physicians at every level of care. Pharmacy notification of patient transfers and pharmacists' review of medication lists for these patients have improved communication regarding medications. Emergency department nurses now follow up with community physicians and pharmacy staff on missing information in a patient's medication history to create "One Source of Truth." Shelly Schneider, RNC, MS, APN, Director of Quality Standards, says, "The project has enhanced collaboration among nursing, physicians, and pharmacy with medication reconciliation on transfer. It also supports the further success of our medication reconciliation process."

Our Lady of Lourdes Medical Center in Camden, New Jersey, used the MATCH toolkit to create a grand rounds module about medication reconciliation that was presented to physicians and nurses. The medication reconciliation team reported that the project advocated evidence-based practices and accurate, concise communication with a focus on safe medication outcomes, accurate handoffs, and the reduction of errors.

Monmouth Medical Center in Long Branch, New Jersey, identified pharmacy delays due to non-formulary medication ordering by physicians. The facility educated both the nurses collecting medication information and the ordering physicians about the online formulary list. As a result, the time required to fill patient orders improved by 25 percent. According to Jeannette Wilson, RN, Performance Improvement Coordinator, Quality/Risk Management Department, "The project has been successful in raising pharmacists' awareness of reducing the time for on-hold medications."

Ocean Medical Center in Brick, New Jersey, focused its project on ensuring that the medication history gathered at admission was 100 percent accurate and included medication name, route, dose, and frequency. Two registered nurses developed a six-step algorithm to use as a resource and guide for obtaining a complete and accurate medication history at admission. Through education on the use of this six-step tool, the medication reconciliation process and compliance with obtaining an accurate medication list improved dramatically. Compliance with the creation of an accurate medication history surpassed the goal of 85 percent and rose to 94 percent—a significant improvement over the baseline of 64 percent. Virginia Carbone, RN, Coordinator of Quality Performance Improvement, says, "Front line staff emerged as team leaders in using the MATCH tools to look at process redesign for the medication reconciliation process, which led to the overall success of the project."

South Jersey Healthcare Regional Medical Center in Vineland, New Jersey, and Elmer Hospital, in Elmer, New Jersey focused their project on the medication history compiled in the emergency department to include time of last dose taken. Following implementation, compliance with documentation of last dose taken improved from 94 to 99 percent. Sharon Grusemeyer, RN, BSN, CPHQ, Director of Performance Improvement and Patient Safety, notes, "Through participation in the AHRQ QIO Learning Network, we were able to hear from our peers, reinforce how this intervention will make a difference, report to leadership, and receive approval for expansion beyond the pilot."

Hackensack University Medical Center in Hackensack, New Jersey, entered the collaborative after recently implementing an electronic medical record system, which revealed unanticipated challenges to the medication reconciliation process. The team spent considerable time and effort reviewing the electronic medication reconciliation process and worked with the vendor to ensure information printed at discharge serves as the "One Source of Truth." According to Robert Fakelmann, RPh, MBA, Administrator of Clinical Services, "The committee recognizes the impact transitioning to an electronic medical record system has had on process and patient safety. The AHRQ collaborative served as the catalyst for revitalizing our focus on medication reconciliation."

AHRQ QIO Learning Network session activities were held in partnership with Healthcare Quality Strategies, Inc. Kristine Gleason, RPh, of Northwestern Memorial Hospital, developed the MATCH toolkit, and presented information during onsite learning sessions and provided expert support during calls with hospital staff.