Pharmacy-Led Medication Reconciliation
Medication errors represent the most common patient safety issue in hospitals today, with the average hospitalized patient subjected to roughly one medication error per day. More than 40 percent of these errors are believed to be the result of inadequate reconciliation in handoffs between admission, transfer and discharge, with 20 percent of those errors resulting in harm.
Prior to implementing the new initiative, medication reconciliation at Beaufort Memorial Hospital was primarily the nurses’ responsibility. Due to the high demands placed on nursing staff, details were often overlooked or missed entirely while compiling a patient medication history. The list then was entered into the EHR by the physician and reviewed by a pharmacist.
Reduce medication errors by placing a trained pharmacist or pharmacy technician in charge of the medication list at each stage of the process (admission, transfers, discharge) to prevent mistakes in the medical record and during medication reconciliation.
Method & Implementation:
Set up a medication reconciliation team (three pharmacists and one technician at Beaufort Memorial) who will see all patients within 24 hours of being admitted to the hospital. The team is housed in the emergency department, allowing patients to be seen as soon as they are deemed eligible for admission by the emergency department physician. The team gathers data through interviews, retail/mail order history, primary care office records, patient prescriptions, insurance billing history and a controlled substance monitoring system.
In phase two, patients who are prescribed high-risk medications are seen by a pharmacist or pharmacy technician at discharge as well. A complete medication list is provided to the patient and prior authorizations are completed before the patient leaves the hospital. Patients are provided education on the new medication by the pharmacist.
Challenges & Barriers:
Getting buy-in from hospital administration to hire the necessary pharmacy staff
Educating nurses and doctors about new procedures to avoid duplicate efforts
Having pharmacy staff fully available for all admissions and discharges
Identifying qualified pharmacy technicians
A clear process and department delineated roles, reduced work for all providers, and increased physician and nurse satisfaction
Hired pharmacists from the community because they have worked with a larger formulary and with multiple providers
Errors in active medication lists dropped from 34% to 2%
Return on Investment:
The pharmacy believed an estimated 85% of medication errors would be avoided, with a predicted cost avoidance of $153.30 per pharmacy intervention, which translated to $3,833 per day and more than $500,000 annually.
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References to Support Work:
Gleason KM, Brake H, Agramonte V, Perfetti C. Medications and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation. AHRQ publication No. 11(12)-0059. Rockville, MD: Agency for Healthcare Research and Quality. Revised August 2012. Available at www.ahrq.gov/professionals/quality-patientsafety/patient-safety-resources
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