In 2005 Joint Commission included medication reconciliation as one of its national patient safety goals (NPSG’s). However, because of the considerable difficulties organizations encountered in implementing medication reconciliation and lack of clearcut best practices, Joint Commission temporarily removed grading of compliance with the standard from formal accreditation surveys.
In 2009 the Society of Hospital Medicine convened a conference of key stakeholders, including IHI and ISMP among others, to develop a consensus statement and key priniciples and necessary first steps in making medication reconciliation patient centered, clinically relevant, and implementable (Greenwald 2010). While they reaffirmed that medication reconciliation must take place across all transitions of care, they recognized that a phased approach, tailored to local organizational structures and workflows, was probably necessary for overall success. They also identified the need for development of clinically meaningful measures of medication reconciliation and alignment of reimbursement systems with medication safety goals. They strongly encouraged clinical research into best practices for medication reconciliation and dissemination of lessons learned and best practices from multiple organizations.
AHRQ has just published its new toolkit “Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation” (Gleason 2011). The toolkit starts at square one and discusses getting leadership buy in to medication reconciliation as a key patient safety program and developing the business case for medication reconciliation. It has good recommendations about building teams, mapping workflows, developing tools, educating and rollout strategies, metrics and monitoring, piloting projects, and involving the patient and families.
A few of their key lessons learned:
· There is no electronic substitution for a thorough medication interview with patients and/or their caregivers to obtain and verify current medication regimens.
· Medication reconciliation should be an integral part of handoffs and communication during transitions in care.
· The patient plays a key role in medication reconciliation and should be educated on the importance of managing medication information at the time of discharge or at the end of an outpatient encounter.
· They stress the importance of the patient giving a list to their primary care provider, updating their own list when medications are discontinued, doses are changed, or new medications (including OTC’s) are added, and carrying their medication information at all times in case of an emergency.
· They also stress the importance of enlisting the support of primary care physicians and community pharmacists to encourage patients to carry and update their medication list at every encounter.
They also stress integrating medication reconciliation into processes other than just transitions of care. They recommend integrating medication review and reconciliation in daily rounds so medications can be reviewed at the point when clinical decisions are made and modified accordingly.
They provide good tips for medication interviews with patients and families, and good tips for your discussions with physicians.
They have lots of good examples of tools, forms, scripts, etc. that will be helpful to you regardless of whether your organization is still struggling with medication reconciliation or whether you have well-developed processes.
Greenwald JL, Halasyamani L, Greene J, et al. Making inpatient medication reconciliation patient centered, clinically relevant and implementable: A consensus statement on key principles and necessary first steps. Journal of Hospital Medicine 2010; 5(8): 477–485
Gleason KM, Brake H, Agramonte V, Perfetti C. Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation. (Prepared by the Island Peer Review Organization, Inc., under Contract No. HHSA2902009000 13C.) AHRQ Publication No. 11(12)-0059. Rockville, MD: Agency for Healthcare Research and Quality. December 2011.