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Auditing medication reconciliation

By John Halamka
10:48 AM
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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

When an audit is conducted, the number of charts reviewed per clinic varies based on the clinic's volume on the selected day:

Clinics w/ <30 visits review 100% of cases.
Clinics w/ 31-100 visits review 30 cases.
Clinics w/ >100 visits review 50 cases.

We've found that this level of monitoring rigor is necessary to demonstrate and sustain real process change.

As many have said "What gets measured gets done"