Two Indiana Facilities Use AHRQ Toolkit to Revise Medication Reconciliation

After participating in AHRQ-sponsored learning sessions and provider support calls, Health Care Excel, the Indiana Quality Improvement Organization (QIO), worked with two providers in the State to improve their medication reconciliation process.

Between January and November 2011, AHRQ partnered with six State QIOs to focus on implementation of the AHRQ-funded toolkit, Medications at Transitions and Clinical Handoffs (MATCH). 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. These events were part of a QIO Learning Network established through an AHRQ Knowledge Transfer project.

The MATCH toolkit's goal is to decrease the number of patients receiving potentially conflicting medications when they leave the hospital or transfer to different care settings. The toolkit provides clear instructions on creating flowcharts to avoid gaps in reconciling medication; identifying roles and responsibilities for medication reconciliation; collecting data to measure progress; 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 health care organizations—including hospitals and outpatient settings—and is compatible with both paper-based and electronic medical records.

Providence Health Care, an assisted living and retirement community of the Sisters of Providence in St. Mary of the Woods, Indiana, identified gaps in its medication reconciliation process, particularly following a resident's hospital stay. The facility now requests medication information from the hospital before a resident returns to the nursing facility to resolve any discrepancies. Providence also educated its residents on the importance of maintaining an accurate medication list in the event that they transition from the retirement community to the nursing facility. Over 5 months, compliance with the collection of a complete home medication list improved from 57 to 100 percent, and patient records containing an unreconciled medication decreased from 100 to 0 percent. "Taking part in this project brought to our attention the gaps in our medication reconciliation process and gave us the opportunity and tools to establish and improve our internal process," says Jessica Bland, LPN, Supervisor.

Union Hospital in Terre Haute, Indiana, focused on medication reconciliation for patient transfers into and out of the intensive care unit (ICU). The hospital assigned responsibility for completing medication reconciliation to the ICU charge nurse to eliminate the confusion that occurred previously when the responsibility was split between the ICU and floor nurses. The project also helped gain leadership support for installing 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 also resolved the problem of physicians' difficulty in finding an updated medications list in a consistent place on the medical chart.