Institute for Healthcare Improvement: Improvement Stories

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Medication Systems

IHI.org has two types of Improvement Stories:

IHI.org Stories that describe the changes and results in specific organizations.
Improvement Project Reports from IHI.org users that describe improvement projects in their organizations.

We all learn from others' experiences testing and implementing changes in real settings — who should be on the team; what measures were tracked; which changes worked best or didn't work at all; and what lessons were learned.

Improvement Project Reports, submitted by IHI.org users, accelerate our learning. In the spirit of "all teach, all learn," we encourage you to share your Improvement Report with the IHI.org community. Please click the Submit an Improvement Report button below.

For more Improvement Stories, see Safety: General Improvement Stories.

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Fairview Health Services: Where Medication Reconciliation Improves Safety and Avoids Additional Costs
Medication reconciliation is complex on a system level, particularly as patients move in and out of the hospital. Using a combination of electronic medical records, inpatient pharmacy systems, and pharmacy technicians, Fairview has achieved an average 90.6 percent success rate for outpatients in its 60-some clinics, and an average success rate of 74.1 percent for inpatients across its seven hospitals.

OSF St. James–John W. Albrecht Medical Center: Where Patients Receive Focused Outpatient Medication Management
At OSF St. James, the anticoagulation clinic helps patients manage their high-alert medication — a contrast to the more typical care model in which patients are managed by their primary care provider.

Profiles in Improvement: Lynn Eschenbacher of Duke University Hospital
Who’s improving health care? People are — at hospitals and in office practices all across the US and internationally. Listen to the story of Lynn Eschenbacher of Duke University Hospital.

Innovation at Its Best: Medication Reconciliation
The actual process of reconciling a medication list is relatively easy. The hard part is figuring out how to organize and implement the system that will ensure that this reconciliation happens reliably. Learn about innovative ideas to improve patient safety and leaders in medication reconciliation.

Proactive Approaches to Reduce Harm from High-Alert Medications
In this 2007 National Forum Workshop presentation, two medication safety experts report on efforts at their hospitals to prevent medication errors.

The Five Rights of Medication Administration
One of the recommendations to reduce medication errors and harm is to use the “five rights”: the right patient, the right drug, the right dose, the right route, and the right time.

High-Alert Medications Require Heightened Vigilance
The classification "high-alert medication" is helping those concerned with patient safety to draw attention to the risks associated with certain drugs, even when used as intended, and the steps that can be taken to prevent injury.

What Medications Does Your Patient Take? Enhancing Medication Safety in the Outpatient Setting
Mindful of the high number of mishaps that occur during transitions in care, hospitals are implementing medication reconciliation systems that compile, maintain, and confirm accurate information about patients’ medications at every transfer point during an inpatient stay. This process, when fully implemented, must also include the outpatient setting.

Medication Reconciliation at Contra Costa Regional Medical Center
Contra Costa Regional Medical Center (Martinez, California, USA) reduced the percent of unreconciled medications upon admission by 94 percent (from 21.4 percent to 1.2 percent) on the medicine, surgery, ICU and IMCU units; and reduced the rate of unreconciled medications upon transfer by 66 percent (from 12 percent to 4 percent).

University of Massachusetts Memorial Medical Center Has 95 Percent of Patients’ Hospital Medical Records Free of Medication Reconciliation Errors
Medication reconciliation at UMass Memorial Medical Center (Worcester, Massachusetts, USA) has changed the fabric of the organization, including processes, roles and responsibilities. The effort has paid off: up to 90 percent of patients have a reconciliation form in their chart, and 95 percent of patients’ hospital medical records are free of reconciliation errors.

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