Maryland Hospitals Revise Medication Reconciliation Process With AHRQ Toolkit

After participating in AHRQ-sponsored learning sessions and provider support calls, Delmarva Foundation for Medical Care, the Maryland Quality Improvement Organization (QIO), worked with hospitals 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.

Union Memorial Hospital in Baltimore, Maryland, created an innovative approach for medication reconciliation for patients at high risk for hospital readmission. Called the "Discharge Counseling Service," the approach has the pharmacist work with the medical team to develop a discharge medication list and then educate patients about new medications, continuing or stopping home medications, and the need to adhere to the medication regimen. In the 3 months after the hospital implemented the service on their medical floors, medications reconciled at discharge increased from 50 to 85 percent. During this same timeframe, the team noted a 20 percent decrease in the number of patients who were given an incomplete medication list at discharge.

Mercy Medical Center in Baltimore had a "One Source of Truth" for collecting medication histories in the emergency department (ED), but when patients were admitted to a unit, medication information was sometimes missing. In response, the hospital designated the inpatient unit as responsible for completing the information on the medication list when patients are admitted from the ED. Over 7 months, compliance with collection of a complete medication history increased from 65 to 90 percent, and reconciliation of all medications upon admission increased from 80 to 90 percent. "Participating in the Learning Network encouraged more networking among hospitals," says Chip Hatchell, RN, BSN, Director, Patient Safety. "To promote patient safety, we will continue to collect data on medication reconciliation and implement process changes as needed."

Bon Secours Baltimore Health System and Doctors Community Hospital in Lanham, Maryland, recognized that their processes also lacked clearly defined responsibilities for medication reconciliation. The hospitals found that no one was specifically required to ensure that a medication list was completed. The hospitals also did not have a process for what actions to take when new medication information became available during a hospital stay. By developing procedures that delineated each discipline's role, the hospitals saw measureable improvement in the collection of accurate medication lists, as well as a decrease in the number of potential discrepancies.

Additional Maryland hospitals that improved medication reconciliation by updating their policies and establishing a "One Source of Truth" after participating in onsite learning sessions and technical assistance calls include:

• St. Agnes Hospital in Baltimore.
• Calvert Memorial Hospital in Prince Frederick.
• Carroll Hospital Center in Westminster.
• Fort Washington Medical Center in Fort Washington.
• Harbor Hospital in Baltimore.
• Meritus Medical Center in Hagerstown.
• Sinai Hospital in Baltimore.
• St. Mary's Hospital in Leonardtown.
• Western Maryland Regional Medical Center in Cumberland.