North Country Hospital Patient Safety Quality Improvement Project
Medication Reconciliation
Initiated in 2005

Problem Statement
Managing and tracking the medications that are administered to hospital patients is an industry-wide problem in healthcare. This problem has been identified by the Joint Commission on Accreditation of Healthcare Organizations, Centers for Medicare & Medicaid Services, and the Institute for Healthcare Improvement.

The Institute for Healthcare Improvement describes Medication Reconciliation as follows. Reconciliation is a process of identifying the most accurate list of all medications a patient is taking — including name, dosage, frequency, and route — and using this list to provide medications correctly for patients anywhere within the health care system. Reconciliation involves comparing the patient’s current list of medications against the physician’s admission, transfer, and/or discharge orders. Experience from hundreds of organizations has shown that poor communication of medical information at transition points is responsible for as many as 50% of all medication errors and up to 20% of adverse drug events in the hospital. Each time a patient moves from one setting to another, clinicians should review previous medication orders alongside new orders and plans of care, and reconcile any differences. If this process does not occur in a standardized manner designed to ensure complete reconciliation, medication errors may lead to adverse events and harm.

Project Goal
Hospitals, clinics, and physician practices are recognizing the need to manage and reconcile patient medications. The goal of this Medication Reconciliation project is to ensure that 100% of the patients discharged from North Country Hospital have an updated list of medications that can be presented on their next admission or to their primary care providers or to the emergency room.

Intervention
North Country Hospital, along with its provider practices, has created a new process to facilitate reconciliation and to make sure patients are discharged with a list of their updated medications. Patients are instructed to keep this medication list for reference and to have it available when engaging the services of healthcare providers in the future. Once all healthcare providers in the hospital service area adopt this system of medication reconciliation, patients will consistently have an accurate and updated list of their medications.

North Country has developed a form that is part of a patient's permanent medical record. Prior to this form, there was complete reliance on patients to recall their medication prescriptions.
The Director of Nursing of the Medical/ Surgical unit developed a form that utilizes check-boxes to indicate medications a patient takes at home, is ordered or discontinued during a hospital stay, or will be added to their medication list on discharge. Following development of the form, nurses were educated about the form individually and during formal nursing education sessions. The form and associated reconciliation process was then presented to the Medical Staff to educate the physicians. Patients are also educated about the form and its purpose.

Evaluation Process
The evaluation process is ongoing. Consequently, more quantitative information will be gathered as the project continues. Preliminary results are showing that close to 100% of patient medical records contain the medication reconciliation form. Furthermore, physician utilization and acceptance of the form has increased dramatically. Approximately 80% of physicians are consistently using the form. There have already been instances of patients presenting their form when seeking services in the emergency department.

Medication Reconcilaition Form *

For more information, contact:

Ann Guy, RN
Director of Medical/ Surgical Services
North Country Hospital
189 Prouty Drive
Newport, VT 05855

Tel: 802.334.3205
Email: cguy@nchsi.org

* Free Adobe Acrobat Reader required