John Halamka, CareGroup Health System, Life as a Healthcare CIO
John D. Halamka, MD, MS, is CIO of the CareGroup Health System, CIO and Dean for Technology at Harvard Medical School, Chairman of NEHEN, CEO of the MA-SHARE RHIO, Chair of HITSP, and a practicing emergency physician. He blogs at Life as a Healthcare CIO.
Auditing medication reconciliation
January 12, 2009
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
