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Tips for medication reconciliation: How one hospital implemented a new system

Nurse Leader Weekly, July 29, 2005

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Improving how hospitals report a patient's medication requirements across departments and units greatly decreases incidents of adverse drug events, according to the Institute for Healthcare Improvement (IHI). Reconciliation is a key component to the IHI's 100,000 Lives campaign.

OSF Saint Francis' (IL) efforts to reduce medication errors was part of its implementation of manufacturing efficiency standards, says the hospital's Director of Patient Safety Cassy Horack, RN, BSN.

The first step was to define medication reconciliation. Horack says the hospital decided the process had three distinctive steps:
1. Collecting a complete medication list for the patient
2. The treating physician consciously deciding what medications to order for the patient
3. The pharmacy filling the order and updating the patient's medication list

The next step was in the intake holding unit. Between 30% and 60% of the hospital's admissions came from the unit, making it a prime location for the pilot program, Horack says.

The unit created new tools to improve reconciliation. For example, new forms were designed to help reduce the number of steps staff had to take when reconciling medications.

"We put [the patient's medication information] on our medication reconciliation form, which was [also] an order sheet," Horack says.

Another innovation was creating a carbon-copy form for admissions and discharges. Nurses admitting patients would reconcile the medications on the front sheet, which served as the admission form, and the bottom sheet was used for discharges. This ensured the same information made it through the system while saving the steps to duplicate the information.

Other changes involved prescreening patients' medications before those patients arrived for surgeries, says Horack.

Although the new forms worked well, the hospital has since moved to a computerized record system. Nurses and physicians involved in a patient's care now enter the data into a computer program and print the form, which a physician then uses as an order form for medications.

"The physician can see everything on one sheet," says Horack. "When you enter medications into the system, it becomes part of the EMR [electronic medical record]."

The ease of the new reconciliation system was a big selling point to the staff, says Horack.

The entire adoption process was done openly, giving staff a chance to make suggestions and raise concerns about the new system. With that level of input, there was greater acceptance of the new methods, she adds.

Source: Adapted from Briefings on JCAHO (June 2005), published by HCPro, Inc.

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