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“Presented to”
GHAREF Hospital Engagement NetworkIn Partnership with the Georgia Foundation for Medical Care
Kristine Gleason, MPH, RPh - Clinical Quality Leader, Northwestern Memorial Hospital
Vicky Agramonte, RN, MSN - Project Manager, Healthcare Quality Improvement Program , IPRO
Medication Reconciliation “Office Hours”Medication Reconciliation “Office Hours”Using the MATCH ToolkitUsing the MATCH Toolkit
Today’s Objectives1. Provide an overview of the MATCH Toolkit to implement a
robust medication reconciliation process, highlighting a one “source of truth.”
2. Link medication reconciliation with other safety / quality initiatives to achieve synergies.
3. Review “Frequently Asked Questions” from the Regional Meetings and available MATCH customizable tools for a successful improvement project.
4. Share and discuss best practices and solutions to common medication reconciliation issues among HEN participants.
YOUR Mission (to implement a successful med rec process) if YOU Choose to ACCEPT It
Webinar 1July 11
Office Hours Call # 1
September 24
Webinar 2July 31
Regional Meetings August 20 OR August 27
Establish a Measurement
Strategy
Design/ Redesign the
Process
Identify Team Members
Process Map
Develop a Charter
Data Collection Plan
Collect Data
Identify Key Drivers
Flow Chart
Gap Analysis
Process Design
Implementation Plan
Pilot Test
Education / Training
Monitor Performance
Address low compliance
Sustainability
Office Hours Call # 2 October
24
“Levels” of Medication ReconciliationAre We at the Beginning or Nearing the End?
1. Obtaining and reconciling list of patient’s current medications to orders to identify/correct unintended discrepancies and repeating process at discharge to prevent patient harm.
2. Reconciling medication regimen to patient’s condition(s) (e.g., purpose).
3. Reconciling medication regimen to recommended evidence-based therapies.
4. Adjusting medications based on patient characteristics (e.g., renal or liver function, age) and/or interactions (e.g., drug-drug, drug-food).
5. Optimizing medication therapy based on patient response / outcomes.
Dynamic process
that involves ongoing
assessment, monitoring and patient education.
“Bundling” Medication Reconciliation with Current Initiatives
Harm Estimate/Evidence from Literature Harm Estimate/Evidence from Organization
Phases of Medication Management
Measurement / Analysis
Prioritize / Implement Evidence-Based Interventions
Care Transitions
Measure Improvements / Monitor for Sustainability
A Step-by-Step Guide to Improving the A Step-by-Step Guide to Improving the Medication Reconciliation ProcessMedication Reconciliation Process
MATCH Toolkit, with customizable, actionable information, is available
at: http://www.ahrq.gov/qual
/match/match.pdf
Assemble Your Team and Construct a High Level Process Map
1. Get Team together - include all stakeholders
2. Define and agree to a process
3. List all participants of the process – depts., mgrs, and job
performers
4. Define beginning and end points
5. Brainstorm key process steps
6. Determine order of process steps
7. Validate by physically walking through process
Steps
Example: High Level Process Map
A High Level Process Map is a simple picture of a complex process
represented by 4-8 key steps. It is essential to better understand the
process being improved and to gain agreement on project scope.
“One Source of Truth”
• Medication reconciliation process design should center on a single list - “One Source of Truth” - to document patient’s current medications.
• All clinicians should be working from the same centrally located, easily visible medication list, regardless of format.
• List becomes reference point for ordering decisions, screening and reconciliation.
• Each discipline should have the ability to update the home medications as new or more reliable information becomes available.
Caution: Jumping into data collection without a clear plan wastes time, energy, resources, etc.
What to Measure
Operational Definition
Collection Method
Sampling Plan
What Where When How ManyQuestion the
data will answer
Specific Definition
System, existing forms,
new handwritten forms, etc.
Elements to be collected
Physical location
Timing and frequency
of collection
Number of data points
to be collected
Was an updated
medication list provided to the
patient and reviewed at discharge?
“Medication instructions
were reviewed with the patient”
checked on At-Home Meds List
form
Manual collection from existing forms
Copy of At-Home Meds
List form, reasons for
non-compliance.
Use Med Rec audit form
GI Lab 2-weeks all shifts.
August 15 - 31
All visits
Data Collection Plan
Collect Data1. Work with the team and
staff to identify potential drivers and build a data collection form.
2. Seek assistance from the team and staff in collecting the data to increase buy-in.
3. Observe the data collection process periodically to identify issues, errors.
4. Graph the data you intend to collect to (1) confirm how you plan to use the data and (2) identify any missing data elements.
Identify Key Drivers
Involvement of Frontline Staff is KEY
The backside of the baseline data collection form:
Identifying (& addressing) the problematic
issues that drive outcomes
will lead to lasting
improvement
Flow Charting and Gap Analysis
A flowchart outlines current workflow and helps
identify:1.Successful medication reconciliation practices.2.Current roles and responsibilities for each discipline.3.Potential failures 4.Unnecessary redundancies and gaps in the process
Improvement Planning
To implement solutions successfully, five areas must be carefully considered and planned for:
1. Interventions
2. IT
3. Communication
4. Training
5. Measurement
Implementation Plan
50% of the work begins now50% of the work begins now
Be sure to always include…• Detailed actions
• Team member assignments• Completion dates
Vicky Agramonte, RN, MSNProject Manager
Healthcare Quality Improvement Program Island Peer Review Organization, Inc. (IPRO)
Albany, NY 12211-2370(518) 426-3300 [email protected]
Kristine Gleason, MPH, RPhClinical Quality Leader
Northwestern Memorial Hospital Chicago IL 60611
Questions and Discussion
THANK YOU!THANK YOU!
If you want to learn more about IPRO, please visit our website at: http://www.ipro.org If you want to learn more about Northwestern Memorial Hospital, please visit our website at http://www.nmh.org