Slide Presentation from the AHRQ 2007 Annual Conference

Medication Reconciliation—Improvement Initiative

Multi-disciplinary team approach—physicians, nurses and pharmacists

• Increase accuracy and completeness of medication history
  • Create "one source of truth" (Med Profile)
  • Complete medication description (name; dose; route; frequency)
  • Validate home medications with patient, family and/or other sources
• Prompt clinicians to complete medication reconciliation
• Reconcile all medications (home and current medication orders) during transitions in care
• Achieve >90% compliance at admission and discharge to meet
• The Joint Commission requirement

Notes:

Medication histories were obtained from patients by multiple clinicians and documented throughout the medical record. No prompts existed to cross-reference and validate documentation, which oftentimes was conflicting. A single, shared medication list, the Med Profile, was created within Powerchart for all disciplines to document and review patients' outpatient medication regimens.
NMH endorsed the model of a multidisciplinary team approach for medication reconciliation:
Physician involvement is critical as patients' current medication regimens provide the basis for physicians' clinical decisions regarding prophylaxis and treatment.
Nursing involvement is critical as nurses spend more time with the patient and their families than other healthcare providers do and nurses monitor patients' responses to administered medications
Pharmacists involvement is critical to review for drug interactions, contraindications and appropriate dosing. In addition, based on their medication knowledge, pharmacists can help clarify medication histories and orders, especially for patients with complex regimens.
Information Technology Core Team is critical to help ensure Powerchart supports clinicians in medication reconciliation and integration into their respective workflows