Auditing medication reconciliation

BIDMC has a major focus on process improvement and lean approaches to workflow.

When we declare a goal we develop metrics to track our processes and remeasure our performance to ensure our changes have a lasting effect.

I was recently asked about our adherence to medication reconciliation, a Joint Commission requirement and a pay for performance goal for us.

We have 3 major medication reconciliation workflows - Emergency Department, Inpatient and Outpatient - which ensure we document a complete medication list at every transition and communicate that list to the next provider, ensuring continuity of care.

Our last audit was completed on November 19, 2008.

* A total of 1326 records across the various areas were reviewed

* We found 95% compliance with Communication of Updated List of Medications to Next Provider of Care.

Each time we do an inpatient review, we select a date and then review discharges from the prior two days. In the last round, the date selected was 11/19, and we reviewed 161 discharges from 11/17 and 11/18. There were 263 discharges on those days, so the % reviewed was 61%.

Our full results are below:

Service Line Visits Reviewed Medications Added Sent to Next Provider %
ED 76 39 38 97%
Inpatient 161 144 133 92%
Same Day Surg 55 38 35 92%
Procedure 168 10 10 100%
Ambulatory 866 341 328 96%
Total 1326 572 544 95%

We will continue this quarterly monitoring into 2009 and the dates to save include:

Wednesday, February 11, 2009

Wednesday, May 20, 2009

Wednesday, August 19, 2009

Wednesday, November 18, 2009