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Acute Myocardial Infarction	Medication Reconciliation (ADE)
Boards on Board	Pressure Ulcers
Catheter-Associated UTI	Rapid Response Teams
Central Line Infections	Surgical Complications
Congestive Heart Failure	Surgical Safety Checklist
High-Alert Medications	Surgical Site Infections
MRSA	Ventilator-Associated Pneumonia

Use this table to quickly find a mentor for the prevention of Adverse Drug Events (Medication Reconciliation) with demographics similar to your own, or use 'ctrl+f' in your web browser to search for specific key words on this page.

Buena Vista Regional Medical Center – Storm Lake, IA
Availability Status: Available to answer requests
Licensed Beds: 35
Teaching / Non-Teaching Status: Non-teaching
Setting: Rural
Start Date of Intervention Work: November 2004
Mentor Contact Name: Michele Kelly, RNC, MSN, Dir. of Quality
Mentor Contact Email: kelly.michele@bvrmc.org
Mentor Contact Phone: 712-213-8604

Additional Information:

90-100% Compliance with Med rec process across all units

• Developed and implemented medication reconciliation process throughout all inpatient and oupaitent areas.
Documentation tools vary somewhat from inpatient to outpatient settings. All documentaion is currently done on "paper" pending implementation of electronic health record system.

• Process includes use of standardized medication reconciliation documentation forms that are initiated within 8 hours of inpatient hospital admission, updated throughout hospitalization, and again at the time of discharge.

• Process includes gathering patient medication history, verification of history, and reconciliation with medications ordered at time of admission, transfer and discharge.

• Medication Reconciliation Policy developed to describe guidelines for use of documentation tool.

• Outpatient med rec process begins at the time of the pre-admission/pre-procedure phone call, with a medication history obtained as part of the phone call.

Where are we now?
 
1. Monitoring Compliance via Medical Record Review

2. Special Challenges with ER, imaging & ambulatory services
 Policy developed using TJC guidelines for med rec in short stay situations.

Additional steps taken/Sustaining the gains:

1. Post-discharge follow up phone calls. 
Our Inpatient Care Coordinators phone discharged patients and verify understanding of discharge medication orders.  Frequently near misses are caught when lack of understanding of discharge meds is found.  
       
2. Taking Med Rec into the community setting
We communicate regularly with local physician offices, home health providers, pharmacies, and long term care providers to verify medication orders, both at admission and discharge.

3. Electronic medication lists saved for “frequent flyers”
Although we do not have an electronic medical record yet, we are maintaining an electronic version of current medication lists at the time of discharge for our patients who are frequently readmitted.

4. We have incorporated compliance with med rec standards into annual employee evaluations.  We have defined the behavior & evaluate compliance.

5. Engage staff in making changes to the process
We continue to tweak and evaluate our process based on user feedback.

Mentor designation - 4/17/06
Information updated - 11/17/09

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Centra Health – Lynchburg, VA
Availability Status: Available to answer requests
Licensed Beds: 403
Teaching / Non-Teaching Status: Non-teaching
Setting: Urban
Start Date of Intervention Work: June 2005
Mentor Contact Name: Karen Douglas, RN, BSN, BC (Patient Safety Coordinator)
Mentor Contact Email: karen.douglas@CentraHealth.com
Mentor Contact Phone: 434-947-7720

Additional Information:

• Joined the VHA Medication Reconciliation Collaborative in June of 2006 and participate in their coaching and content calls
• Began with two units, a draft form and two nurses and added additional units and team members approximately every two weeks until process rolled out to all inpatient and outpatient areas by February 2006.  Worked with Pharmacy to implement using form for ordering admission medications.
• Team members responsible for staff education and data collection.  Sent bi-weekly reminders to collect data and had drawings (to win $25.00 gift certificates) each month for those team members that turned in stats on time.
• To educate MDs, sent letters and put up education posters in MD bathrooms and lounges
• Enlisted Chief Medical Officer, a JD in health law, to answer questions that came up regarding legalities associated with the process. 
• Met with team of surgeons, specialists, and nurses from outpatient areas to address special concerns re: outpatient medication reconciliation and have developed separate form for outpatients/short stays
• Initiated public outreach with article in local paper March 7, 2006 regarding importance of maintaining current, complete list of home medications to be given to healthcare providers when seeking care.  Contacted Parrish Nursing groups to spread the word in local churches.

• Baseline data demonstrated a rate 54.8% unreconciled medications on admission to Centra Hospitals.  Goal is to reduce rate by 75% or 13% unreconciled medications on admission.
• As of February 1, 2006,  have reduced number of unreconciled medications on admission to 18%.

[3/30/06]

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Columbus Regional Hospital – Columbus, IN
Availability Status: Available to answer requests
Licensed Beds: 325
Teaching / Non-Teaching Status: Non-teaching
Setting: Rural
Start Date of Intervention Work: July 2002
Mentor Contact Name: Mary Sitterding
Mentor Contact Email: msitterdin@crh.org
Mentor Contact Phone: 812-376-5474

Additional Information:

Columbus Regional Hospital has adopted medication reconciliation as a key strategy in alignment with our organizational priority to keep patient's safe.  The Medication Reconciliation Team thrived within a culture that embraces the combination of rapid cycle testing, LEAN, and a complex adaptive systems approach to problem identification, solution generation and testing.  Principles of complex adaptive systems as they relate to medication reconciliation are illustrated through structure, process, and pattern cycle changes.  Innovative collaboration between IT and the Interdisciplinary Improvement Team resulted in an automated solution that dramatically reduced the number of steps required for medication reconciliation as well as the need for transcription.  The team learned that standardizing forms, personal check lists, working harder next time, feedback of information, and awareness and training (Reser, 2003) will only allow a team to move so far.  Steps implemented by the team that got us a little close to Level 2 (Reser, 2003) included: building decision aids and reminders into the system, redundancy, taking advantage of habits and patterns, and standardization of the process.

Admission Reconciliation Accuracy
1.  Pilot nursing unit:  59 unreconciled medications/1140 medications reviewed (5% unreconciled/ 95% accuracy)
2.  Hospital wide nursing units: 562 unreconciled medications/4078 medications reviewed (13% unreconciled/87% accuracy.

Discharge Reconciliation Accuracy
1.  Pilot Nursing Unit - 100% accuracy
2.  Hospital Wide nursing units - 88% accuracy
[1/31/06]

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Community Hospital North – Indianapolis, IN
Availability Status: Available to answer requests
Licensed Beds: 629
Teaching / Non-Teaching Status: Non-teaching
Setting: Urban
Start Date of Intervention Work: September 2005
Mentor Contact Name: Cleo Ann Burgard
Mentor Contact Email: cburgard@ecommunity.com
Mentor Contact Phone: (317) 621 5329

Additional Information:

This intervention is spread throughout our five (5) Network hospitals:  Community Hospital Anderson, Community Hospital East, Community Hospital North, Community Hospital South, and the Indiana Heart Hospital

• The Community Health Network utilized LEAN Methodology to focus on improvement opportunities involving medication reconciliation
• Nursing satisfaction surveys conducted by pharmacy have noted a low level of dissatisfaction with their role in the medication reconciliation process
• Utilization of pharmacists to augment the medication history process is widely accepted by nursing, physicians and hospital administration to be essential to obtaining the most complete and accurate medication list at time of admission
• Partnership with the IT department has resulted in the development of an electronic document linking the admission home medication list to the current MAR facilitating discharge plans for patients
• Involving pharmacists in the medication reconciliation process has dramatically increased their clinical visibility and expanded clinical services
• Serial nursing/pharmacy and physician surveys will be used to track satisfaction with the process changes involving medication reconciliation

• Pharmacy has completed more than 1000 medication histories and provided improved accuracy and completeness in more than 85% of the histories as compared to the original record obtained
• Pharmacy has quantified that the average duration of time to complete a medication history is approximately 25 minutes
• Process redesign has resulted in more than 50% of the clinical pharmacist's day is spent with direct patient care interactions
[2/14/06]

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Contra Costa Regional Medical Center – Martinez, CA
Availability Status: Available to answer requests
Licensed Beds: 166
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: August 2005
Mentor Contact Name: Steven Tremain, MD
Mentor Contact Email: stremain@hsd.cccounty.us
Mentor Contact Phone: (925) 370-5122

Additional Information:

We have conducted pre- and post-implementation measurements to assess the impact medication reconciliation on admission has had in our first three services to go live.  Our goal was to reduce the percent of unreconciled medications by 50% within three months of roll-out and we have exceeded that goal. 

Statistics that follow illustrate the % of unreconciled medications on admission (among patients who are admitted with a history of at-home meds):

Medicine Service = 22% (pre) and 1% (post)     April 09 stats 0.6%
Surgery Service = 36% (pre) and 5% (post)      April 09 stats 4.0%
ICU/IMCU Service = 10% (pre) and 2% (post)   April 09 stats 0.0%

Techniques that led to success included:

• weekly 45-minute meetings that stayed on task;
• a physician champion;
• pilots followed by spread;
• adopting and adapting the Med Rec form from Missouri Valley Baptist Hospital;
• reducing work for the caregivers (one less form, not one more form!);  and
• electronic generation of med rec/order form for all in-hospital transfers.

As of October 08, the above are still in place, but meetings have decreased in frequency from weekly to monthly.

Mentor designation - 3/14/06
Information updated - 11/17/09

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Cooley Dickinson Hospital – Northampton, MA
Availability Status: Available to answer requests
Licensed Beds: 125
Teaching / Non-Teaching Status: Non-teaching
Setting: Urban
Start Date of Intervention Work: August 2005
Mentor Contact Name: Tammy Cole-Poklewski, RN, MS
Mentor Contact Email:  Tammy_Cole-Poklewski@cooley-dickinson.org
Mentor Contact Phone:  413-582-4736

Additional Information:

Cooley Dickinson Hospital does not have an electronic MAR or CPOE.  Therefore, our process is completely paper and pencil driven.  An interdisciplinary team initiated the medication reconciliation process in August 2005 with the development of a process for reconciliation of medications at the time of transfer utilizing pharmacists.

We quickly identified the need for better lists of "home medications" when patients arrive for care.  CDH created a wallet card for medication lists and medical history and offered it to the public through numerous public relations efforts.  We collaborated with physician practices in the region to also make cards available in office waiting areas and to have them updated during provider visits.

Medication reconciliation is currently operational in all inpatient and outpatient service areas.  We have found outpatient areas (particularly the emergency department) to be more challenging and continue to fine-tune that process.

Chart audits have demonstrated 85% reconciliation of all medications including inpatient and outpatient episodes of care.  Issues with reconciliation are now more performance issues with specific individuals and some areas have achieved 100% reconciliation of medications.
 [7/25/06]

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Fairview Health Services – Minneapolis, MN
Availability Status: Available to answer requests
Licensed Beds: Depending on the site, from 41 beds to 1,700
Teaching / Non-Teaching Status: one teaching, the rest non-teaching
Setting: Some rural and some urban
Start Date of Intervention Work: January 2001
Mentor Contact Name: Steven Meisel
Mentor Contact Email: smeisel1@fairview.org
Mentor Contact Phone: 612-672-7061

Additional Information:

Like most Campaign hospitals, Fairview is far from perfect in our reconciliation efforts. We have, however, creatively used technology and technicians to achieve our successes. We

• Use our ambulatory EMR, our inpatient EMR, and our inpatient pharmacy system in different ways in different sites.
• Use pharmacy technicians in several different ways.
• Work with our competitor hospitals on integrating our technology so that when a patient shows up at an ER of one site, and is a patient of a competing health system, a suitable abstract is available to the clinicians.
• Have successfully defined a business case for reconciliation which has allowed several of our sites to add staff for our reconciliation efforts.

Depending on the specific site:
• % home meds addressed by MD increased from 60% to 85%
• % defects/patient reduced from 1.7 to 0.2 in scheduled surgery patients
• reconciliation on transfer out of ICU increased from 40% to 96%
• admission reconciliation performed increased from 77% to 100%
• % of unreconciled meds on admission reduced from 48% to 7%
• admission reconciliation performed increased from 34% to 56%
• % meds reconciled on discharge increased from 50% to 80%
[1/31/06]

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Frederick Memorial Hospital – Frederick, MD
Availability Status: Available to answer requests
Licensed Beds: 224
Teaching / Non-Teaching Status: Non-Teaching
Setting: Rural
Start Date of Intervention Work: June 2005
Mentor Contact Name: Cindy Russell
Mentor Contact Email: crussell@fmh.org
Mentor Contact Phone: 240-566-3326

Additional Information:

• As part of the ICU Collaborative, Frederick Memorial Hospital successfully implemented Medication Reconciliation in the ICU on all patients that changed levels of care within the ICU or were transferred out to another level of care.
• The model was so successful that it was rolled out to our admission center so that all admitted patients would have Medication Reconciliation performed on admission. This represented 80% of all hospital admissions.
• The model is now being adopted in our same day surgical area.
• The model incorporates the prescribing/re-ordering activity by physician, which is valued highly by our physicians.
• Our process was received very favorably during our most recent JCAHO review in July 2005.
• Our process has been received well by nursing due to our method of incorporating the procedure into existing nursing workflow.

• 0.2% Unreconciled Medication upon admission to the hospital through the admission center or Same Day Surgical suite.
• 0% Unreconciled Medication upon transfer from ICU Level of care, since the inception of Medication reconciliation in June 2005.
[2/14/06]

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Holy Spirit Hospital – Camp Hill, PA
Availability Status: Available to answer requests
Licensed Beds: 317
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: January 2006
Mentor Contact Name: Franchesca J. Charney, RN, BS, MSHA, CPHRM, CPSO
Mentor Contact Email: FCharney@hsh.org
Mentor Contact Phone: 717-763-2982

Additional Information:

Key reasons for our mediation reconciliation success:

• Our program provides support to our staff on this process.
• Multidisciplinary collaboration.
• We use a form that can be utilized as physician order sheet
• Our efforts have helped increase recognition of medication reconciliation as a patient safety concern.

Holy Spirit Hospital is a community hospital that currently works with a paper system.  Our medication reconciliation committee consists of members from nursing, pharmacy, physicians, education, and IT specialists.  (We are in the process of working on a computerized documentation system.) This initiative is fortunate to have a physician and nurse champion who collaborate closely with our pharmacy and risk management departments. 

Our program is unique in that we utilize a team of LPNs who are responsible for obtaining a medication list from patients on admission.  This team works directly under the Medication Reconciliation Coordinator (an RN) and is located in the Pharmacy department.  This arrangement has contributed to strong collaboration and more effective communication between departments. 

Although getting buy-in from all the necessary stakeholders has at times been challenging, with a strong educational effort and support from administration, we were able to implement this program on January 1st hospital-wide with good success.  Buy-in from some physicians is still sometimes a challenge, but our family practice and internal medicine physicians have found the form we created to be a great reference and use it when they see patients. 

Our medication reconciliation form is currently being utilized as an order sheet, but we are currently revisiting this process with the different medicine and surgery departments. On discharge, we fax a reconciled list of medications to patients’ discharging physician or family physician.

Reduction in the percent of unreconciled medications on admission from 39% to 12-16% since January 2006.
Goal is to decrease the number of unreconciled medications on admission by 75% within 12 months.
[8/4/06]

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Mercy Medical Center – Baltimore, MD

Availability Status: Available to answer requests
Staffed Beds: 283
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: January 2006
Mentor Contact Name: For process related questions:  Chip Hatchell.  For IT-related questions:  Kathleen Thomas
Mentor Contact Email: chatchell@mdmercy.com; kthomas@mdmercy.com
Mentor Contact Phone: 410-576-5286

Additional Information:

• A multidisciplinary team, which included Nursing, Medical Staff, Pharmacy, Case Management, Administration, Quality, IT, and Risk Management developed an automated medication reconciliation process in Meditech, the hospital's electronic medical record (EMR). 
• Medication Reconciliation is completed for inpatients, outpatients, and hospital-based physician practices on admission/point of entry, transfers to another unit, postoperatively, and on discharge.
• Nursing begins the process by collecting the home medication list and entering it into EMR.  The home medication list automatically populates the physician's order sets for admissions, transfers, and discharges.  The physician will choose to either continue, modify or discontinue each of the medications.  Pharmacy is able to view both the home medication list and ordered medications to alert physicians of any discrepancies.  On discharge, the medication list is printed on the automated discharge instructions, of which a copy is given to the patient and the next care provider. 

• A computerized process for medication reconciliation was developed in 2005 for implementation in January 2006. Baseline data from 2005 - - 0% compliance as no process existed.
• In January 2007, the number of cases audited that had the home medication list collected and reconciled against the history and physical within 24 hours of admission was 53.3% (330/619).  By May 2007, compliance with this process measures was above 90% and continues to remain above the target goal of 90%.
• In January 2007, the number of cases audited that had discharge instructions with the home medication list and a copy sent to the next care provider was 68% (393/578).  By June 2007, compliance with this process measure was 95.5% and then 100% by August 2007.
• Compliance with these process measures increased significantly in May/June 2007 due to mass education and fine-tuning of the automated process within the EMR. 
• Additional process measures include:
     • In May 2007, in 99% of cases audited, physicians reconciled medications on admission through the automated
      medication reconciliation process on the admission order sets.
     • In May 2007, in 97% of cases audited, physicians reconciled medications postoperatively through the automated  
      medication reconciliation process on postoperative/admission order sets.
     • In May 2007, in 94% of cases audited, physicians reconciled medications upon transfers in and out of the ICU.   

[12/05/08]

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The Nebraska Medical Center – Omaha, NE
Availability Status: Available to answer requests
Licensed Beds: 548
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: November 2005
Mentor Contact Name: Christopher Shaffer, PharmD, Director of Pharmaceutical and Nutrition Care
Mentor Contact Email: cshaffer@nebraskamed.com
Mentor Contact Phone: 402-559-4225

Additional Information:

Under the direction of the Department of Pharmacy, The Nebraska Medical Center successfully implemented a medication reconciliation process that spans both inpatient and outpatient.  Inpatient medication reconciliation is a collaboration between pharmacy, nursing, and the medical staff to ensure that the patient's medication history is accurately obtained, documented, compared to admission medication orders, and reconciled to assure that all discrepancies are addressed. Upon discharge the medication discharge list is reconciled against the active inpatient orders and the admission medication history.  Any discrepencies are addressed and the patient is provided with a medication list that not only addresses the medications they are to leave the hospital on, but what action is required related to their previous medications from their home list. The paper copy includes the name of the medication (generic and brand), the dosing schedule, and when it is appropriate to take the next dose. 

The Ambulatory Medication Reconciliation program was started in January 2007.  Prior to a patient arriving at The Nebraska Medical Center for a diagnostic test or procedure, the patient is contacted at home by nurses in pre-surgical/pre-diagnostic screening services.  Along with obtaining the patient's history and insurance information, the nurse interviews the patient regarding their medications.  The medication list is entered into a computer system that is designed to flag medications and patient characteristics that have been predetermined to put the patient at risk for medication errors:  drugs that will interact with procedure or diagnostic medications; patients >65 years of age; medications determined by Budnitz and collegues to lead to an emergency room visit; and transplant recipients.  Each high-risk patient file electronically displays on a patient list for a pharmacist that is stationed in pre-surgical/pre-diagnostic screening services.  The pharmacist reviews the medication list and speaks with the patient, calls the patient's pharmacy, or contacts the patient's primary health care provider to address any concerns identified during the medication review.  The main goal of the Ambulatory Medication Reconciliation program is to ensure no significant drug interactions or contraindications exist between the patient's home medications and any medications that will be used during the procedure or diagnostic test.  The medication lists of the identified high-risk patients are reviewed to assess any drug-drug or drug-disease problems. Following the procedure the patient is provided with a copy of their medication list that has been reviewed by a health-care professional.  In addition, the pharmacist contacts the patient's primary care provider regarding any identified concerns or issues.

Out of an average 1880 monthly inpatient admissions, over 97% of all patients have a medication history obtained by a pharmacist upon admission.

Over 95% of all interventions are documented as having a note placed in the chart notifying the health care provider the patient has been interviewed and addressing any concerns or discrepancies identified by the pharmacist during the interview.

During a 10 month period, pharmacists reported intercepting 706 potentially significant errors during the admission reconciliation process. This represents 3% of all inpatients completing the admission reconciliation process. Additionally, 1328 (8% of patients) intercepted errors were reported during the inpatient discharge reconciliation process.

In the outpatient arena, nearly 80% of the 2500 patients seen monthly at The Nebraska Medical Center for a procedure or diagnostic test complete the reconciliation process and receive a computer generated medication list.

During a 5 month period, pharmacists in Pre-surgical/Pre-diagnostic screening services recorded nearly 2,000 interventions for patients that were identified as being at high risk for medication adverse events.

Combining inpatient and outpatient areas, during a 10 month period over 30,000 medication lists have been generated and provided to our patients.

[12/6/07]

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New Milford Hospital – New Milford, CT
Availability Status: Available to answer requests
Licensed Beds: 85
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: Febuary 2007
Mentor Contact Name: Sharon Narducci, Chief Quality Officer
Mentor Contact Email: narduccis@nmhct.org
Mentor Contact Phone: 860-210-5065

Additional Information:
Here is a snapshot of the changes made at New Milford Hospital to improve our medication reconciliation  process:

• Recruited a multidisciplinary task force including physician champions.
• Researched regulatory standards and best practices and compared them to our existing processes.
• Defined guiding principles to streamline decision-making: Focus on what is best for the patient; be true to the intent of the standard; continuously seek input from affected departments/disciplines during development and refining the process following implementation; maintain practices within each discipline's scope of practice; create efficient processes and prevent/eliminate redundant work; do not shift work to others; work within current systems and capabilities; and use fiscal resources responsibly.
• Purchased computer software to support a hybrid documentation system (partial computer, partial paper system).
• Created specialty dividers in the medical record and modified the standard discharge instruction form to drive practitioners to use the medication reconciliation forms on discharge.
• Trained all disciplines using multiple education methods such as formal presentations, poster board presentations, quick-look guides, internal newsletter, electronic mail, staff and department meetings, etc.
• Developed a wallet-sized medication card for patients on discharge.
• Implemented a community campaign including an article in the local newspaper, and distribution of the wallet sized medication cards at local events and community physician offices.
• Monitored compliance with the process components and communicated the results and action plans on a regular basis using multiple communication strategies.
• “Stopped the line” based on bedside nursing staff feedback and reworked the process to better meet the needs of the patient and staff.
• Persistence, patience, trials of change, and consideration of feedback from staff helped to keep the task force and the staff focused on the goal. 

100% compliance with a complete home medication list present on the chart.
98% compliance with a complete/reconciled home medication list given to patients on discharge.
Anecdotally, we have seen an increase in the number of patients that arrive at the hospital with a current medication list.
[2/8/08]

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Our Lady of Lourdes Memorial Hospital – Binghamton, NY
Availability Status: Available to answer requests
Licensed Beds: 267
Teaching / Non-Teaching Status: Non-teaching
Setting: Rural
Start Date of Intervention Work: February 2005
Mentor Contact Name: Caryl Ann Mannino, RN, Director Professional Practice
Mentor Contact Email: cmannino@lourdes.com
Mentor Contact Phone: 607-798-5183

Additional Information:

Lourdes developed a process and policy for medication reconciliation on admission. After multiple tests of change, we spread throughout the pilot unit.  One week later, we spread to all inpatient units and the ED. Next, we successfully spread to our Primary Care Network and Home Care service line. We are currently including patients who receive services in the Ambulatory Surgery Unit. A structured educational plan was implemented that involved Nursing, Pharmacy, and Medical Staff.  The educational plan has been incorporated into nursing orientation.

Monthly chart reviews (a sample drawn from all inpatient units) demonstrated that we have had only 1 ADE since September 2005. Unreconciled medications on admission have been reduced to 5% or lower since February 2005.  In November and December, the rate was 0% and 0.6%, respectively.
[1/31/06]

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Prince William Hospital – Manassas, VA
Availability Status: Available to answer requests
Licensed Beds: 170
Teaching / Non-Teaching Status: Non-teaching
Setting: Urban
Start Date of Intervention Work: June 2005
Mentor Contact Name: June Lyda, Performance Improvement Manager
Mentor Contact Email: jlyda@pwhs.org
Mentor Contact Phone: (703) 369-8824

Additional Information:

Prince William Hospital implemented a pilot electronic medication reconciliation program in our Critical Care Unit. In July 2005, the pilot was completed and analysis was such that this program was rolled out hospital-wide.

Interdisciplinary team formed with Physician as Leader, recent past president of the Medical Staff.  Team Members included Chief Pharmacist, Clinical Pharmacist, Information Systems Specialist, Clinical Manager of  Information Systems, Nurse Manager of Medical Floor, Intensive Care Unit Staff Nurse, Training & Development Nurse (education), and Performance Improvement (PI) Manager. After the pilot project we added staff nurses from other settings (outpatient, Birthing Center, Pre-operative surgery.)

PI Manager attended National IHI conference and focused on Medication Reconciliation. Informational articles and the National Patient Safety Goal were sent to team members and a Power Point Education were presented to the team at the first meeting.

Paper tools developed by other organizations (University of Massachusetts Memorial, Milford-Whitinsville Regional Hospital) were researched. Information Systems personnel determined that an electronic order tool could be developed through the existing software.
We piloted a small, restricted area and population of patients, the Intensive Care Unit (ICU) and those patients transferred out or discharged from the ICU. Multiple medications are frequently ordered as a patient is transferred from ICU.

In place of writing each medication, the physician can circle C=continue, M=Modify, or DC=stop the medication as it is printed on a form which was eventually authorized as a physician order sheet. The physician signs as an order sheet after circling the appropriate choice on each line item medication.
The medication list is derived from the on-line Pharmacy profile for that individual patient and is up-to-date as per the physician ordering. We did not have a paper tool to begin this process. Accurate information was obtained through this pharmacy module profile. Time was saved on the part of the physician, Nurse and pharmacist with this tool as a physician order.

During the pilot, use of the electronic medication reconciliation was voluntary, with a 50% usage. Of the cases utilizing the program, there were 0% medication errors.
[5/12/06]

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St. Luke’s Hospital – Cedar Rapids, IA
Availability Status: Available to answer requests
Licensed Beds: 560
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: March 2003
Mentor Contact Name: Sherrie Justice
Mentor Contact Email: justicsl@crstlukes.com
Mentor Contact Phone: 319-369-8367 or 1-800-369-7217 ext. 8367

Additional Information:

• Developed a community-wide personal health record card.  “Medication Matters” card is a small wallet-sized card providing patients a way to document their medication.  Program is supported by both community hospitals, all physician offices, the Cedar Rapids Health Care Alliance and local pharmacies.
• Developed and implemented medication reconciliation processes and electronic tools throughout all inpatient areas.  Includes use of standardized documentation forms that are utilized with every patient’s transition in care from admission to discharge.
• 150,000 “Medication Matters” cards distributed in the first year.  Between both hospitals, continue to distribute approximately 55,000 cards annually.
• As part of discharge process, nursing completes a “Medication Matters” card for their patient.  One nursing unit reports 95% compliance with this activity.
• Percentage of medications correctly reconciled at admission (May 2006) is 96% in the surgical population; 90% in the medical population.
[8/31/06]

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St. Peter Community Hospital – St. Peter, MN
Availability Status: Available to answer requests
Licensed Beds: 22
Teaching / Non-Teaching Status: Non-teaching
Setting: Rural
Start Date of Intervention Work: March 2005
Mentor Contact Name: Benjamin W. Chaska, M.D., MBA, CPE, Medical Director and Patient Safety Officer
Mentor Contact Email: bchaska@stpeterhealth.org
Mentor Contact Phone: 507-934-8416

Additional Information:

Actions Taken
•Developed and implemented SPCH medication reconciliation form.
•Redesigned operational flow to incorporate medication reconciliation process into the medication intake, order sets, transfer and discharge planning tools.

Results
•Medication reconciliation improved from 76% to 94.5%.
[1/31/06]

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UMass Memorial Medical Center – Worcester, MA
Availability Status: Available to answer requests
Licensed Beds: 751
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: April 2003
Mentor Contact Name: Eric Alper, M.D.
Mentor Contact Email: AlperE@ummhc.org
Mentor Contact Phone: (508) 856-6431

Additional Information:
 
Our hospital has successfully deployed a medication reconciliation form and process.  It is completed on admission and reviewed on transfer and discharge.  It is usually used as a physician order form for medication orders that should be ordered on admission.  This was deployed in a phased fashion through our hospital.  Physicians and nursing have received extensive education about this important process.

Through deploying this form and process, we have been able to implement this process in approximately 85% of our hospital admissions.  By performing retrospective chart reviews of medication reconciliation and adverse drug events, (using the IHI trigger tool), we were able to demonstrate a substantial improvement in medication reconciliation (from ~50% baseline to 95-100%) over this period.  We also observed a reduction in the frequency of adverse drug events, from baseline of ~15% per 20 admissions to <5%.
[1/31/06]

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Waccamaw Community Hospital – Murrells Inlet, SC
Availability Status: Available to answer requests
Licensed Beds: 111
Teaching / Non-Teaching Status: Non-Teaching
Setting: Rural
Start Date of Intervention Work: January 2008
Mentor Contact Name: Gregory Nobles, R.Ph.
Mentor Contact Email: gnobles@georgetownhospitalsystem.org
Mentor Contact Phone: (843) 651-3433

Additional Information:
 
Waccamaw Community Hospital (WCH) approached medication reconciliation not solely as a hospital improvement  project but also as a community-wide medication safety improvement initiative.  Working from a grant funded jointly by the Georgetown Hospital System, (to which WCH belongs) and the Duke Endownment, WCH rolled out a Medication Toolkit developed jointly by the South Carolina Hospital Association’s Patient Safety Team.  It includes a Universal Medication Form, patient medication safety brochure, “What You Need to Know About Your Medicine” , a plastic pocket protector for carrying the UMF and insurance cards and an 8 minute video on the importance of maintaing an updated medication list.  Items are available on site and on both the hospital’s website and patient education channel.

• More than 45,000 Universal Medication Forms have been distributed locally
• More than 65 community medication safety lectures in surrounding areas
• Four state-wide presentations throughout South Carolina
• Served as the South Carolina state project during the National Patient Safety Corps.
• Presented as a model-project at the 2007 National Patient Safety Foundation: Annual Patient Safety Congress in Washington, DC.

Internal efforts to improve medication reconciliation:

• Developed one multi-disciplinary team to develop, implement and monitor the community-wide model of medication reconciliation
• Develop sub-task forces to ensure compliance in all internal aspects of medication reconciliation
            * Inpatient Admission Medication Reconciliation Task Force: develop a pharmacy-driven project with a Six Sigma approached based on successful pilot strategies. 
            * Next Provider of Care Task Force: developed process for sharing a medication list to all next providers of care regardless of setting.  This includes internal transfers and discharges
             * Core Team: to review policy, Information Systems improvements, Task Force coordination
             * Outpatient Task Force: developed processes for compliance involving all outpatient areas i.e. Emergency Department; Outpatient Surgical Services; Cardiopulmonary; Imaging; Wound Healing; Rehabilitation, etc.
             * Acute Rehabilitation Task Force: to ensure compliance in 29-bed acute rehabilitation facility
             * Education Task Force: developed a plan to provide education to all medication users and patients
                   * Hospital Staff
                   * Medical Staff – Internal
                   * Community Healthcare Providers
                   * Patients

Outcomes:

• Six Sigma admission medication reconciliation project developed a process with 96% of all admissions reconciled within 24 hours.  This is electronically documented on the patient’s Medication Administration Record and easily monitored via IT report.  This included an updated comprehensive HFMEA on the process.

• Next Provider of Care:
            * An estimated 98% of all patients leave with an updated Universal Medication Form that is scanned post-discharge into the electronic medical record therefore, remotely available to practitioners with appropriate IS access.
            * An updated Universal Medication Form is faxed to any non-GHS primary care providers and any other provider the patient has accepted an appointment at the time of discharge.

Future Plans:

      * Develop a Community Mediation RHIO to establish an electronic feed to connect data from all prescriptions filled in all local independent pharmacies in Georgetown County

      * Partnered with vendors to develop an electronic feed to connect data from all prescriptions filled in Chain Drugs Stores and/or those filled with an insurance card (Pharmacy Benefits Manager)

[8/15/08]