An accurate list of a patient’s prescriptions is critical to maintaining continuity of care.
It also helps to decrease medication errors, and one of the Joint Commission’s national patient safety goals requires medication reconciliation at hospitals and clinics.
So, in order to protect patient safety, it's crucial caregivers compare the medications a patient is taking (and should be taking) with newly ordered medications.
The Infectious Disease/Oncology team at Cumberland Medical Office Building in Atlanta had a high percentage of patient records in KP HealthConnect that listed duplicate medications.
To improve medication reconciliation, the team did a manual cleanup of patient charts over a period of several weeks. Then it instituted a new process for checking medication. They had the licensed practical nurses (LPNs) and medical assistants (MAs) call patients and ask them to bring their bottles of medication to their office visit.
During the initial workup, the MAs and LPNs reviewed patient medications, and checked off in the members’ charts which medications the patients were and were not taking.
The providers then confirmed medications once again with the member and removed all possible duplicate oncology meds from the patient’s record.
In collaboration with the clinical pharmacist, the MAs printed out a snapshot of the patient’s medications and gave it to the nurse practitioner for review and removal of any expired medication.
As they found success, the team included more medications in the process.
For instance, the team members reviewed patient records for infusion medications and one-time-only meds a patient might need to take before a procedure. Infectious disease pharmacists also began removing duplicate medications for their overlapping oncology patients.
Team members reviewed statistics for duplicate medications from KP’s National Reporting Portal, analyzed the data at huddles and posted it in the department.
They also monitored whether providers increased the number of times they had to reorder medications (which would indicate they were too aggressive in deleting prescriptions). As it turned out, the reorder rate was unaffected by the project.
The percentage of duplicate medications fell to 15 percent, far exceeding the team’s goal. And by avoiding hospital admissions due to inadequate medication reconciliation, the team saved $90,000 in three months.
It also created better communication with patients.
“Knowledge is power,” says Gwendolyn Brown, the team’s management co-lead. “It helped patients and their families ask more questions.”
And a full team effort helped the project succeed, as they moved from Level 2 to 4 in Path to Performance.
“It is tiring and frustrating when you are the only person doing the work,” says Brown. “Here, everyone is involved.”
