“Presented to”

GHAREF Hospital Engagement NetworkIn Partnership with the Georgia Foundation for Medical Care

Kristine Gleason, MPH, RPh - Clinical Quality Leader, Northwestern Memorial Hospital

Vicky Agramonte, RN, MSN - Project Manager, Healthcare Quality Improvement Program , IPRO

Medication Reconciliation “Office Hours”Medication Reconciliation “Office Hours”Using the MATCH ToolkitUsing the MATCH Toolkit

Today’s Objectives1. Provide an overview of the MATCH Toolkit to implement a

robust medication reconciliation process, highlighting a one “source of truth.”

2. Link medication reconciliation with other safety / quality initiatives to achieve synergies.

3. Review “Frequently Asked Questions” from the Regional Meetings and available MATCH customizable tools for a successful improvement project.

4. Share and discuss best practices and solutions to common medication reconciliation issues among HEN participants.

YOUR Mission (to implement a successful med rec process) if YOU Choose to ACCEPT It

Webinar 1July 11

Office Hours Call # 1

September 24

Webinar 2July 31

Regional Meetings August 20 OR August 27

Establish a Measurement

Strategy

Design/ Redesign the

Process

Identify Team Members

Process Map

Develop a Charter

Data Collection Plan

Collect Data

Identify Key Drivers

Flow Chart

Gap Analysis

Process Design

Implementation Plan

Pilot Test

Education / Training

Monitor Performance

Address low compliance

Sustainability

Office Hours Call # 2 October

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“Levels” of Medication ReconciliationAre We at the Beginning or Nearing the End?

1. Obtaining and reconciling list of patient’s current medications to orders to identify/correct unintended discrepancies and repeating process at discharge to prevent patient harm.

2. Reconciling medication regimen to patient’s condition(s) (e.g., purpose).

3. Reconciling medication regimen to recommended evidence-based therapies.

4. Adjusting medications based on patient characteristics (e.g., renal or liver function, age) and/or interactions (e.g., drug-drug, drug-food).

5. Optimizing medication therapy based on patient response / outcomes.

Dynamic process

that involves ongoing

assessment, monitoring and patient education.

“Bundling” Medication Reconciliation with Current Initiatives

Harm Estimate/Evidence from Literature Harm Estimate/Evidence from Organization

Phases of Medication Management

Measurement / Analysis

Prioritize / Implement Evidence-Based Interventions

Care Transitions

Measure Improvements / Monitor for Sustainability

A Step-by-Step Guide to Improving the A Step-by-Step Guide to Improving the Medication Reconciliation ProcessMedication Reconciliation Process

MATCH Toolkit, with customizable, actionable information, is available

at: http://www.ahrq.gov/qual

/match/match.pdf

Build the Project Foundation

Assemble Your Team and Construct a High Level Process Map

1. Get Team together - include all stakeholders

2. Define and agree to a process

3. List all participants of the process – depts., mgrs, and job

performers

4. Define beginning and end points

5. Brainstorm key process steps

6. Determine order of process steps

7. Validate by physically walking through process

Steps

Example: High Level Process Map

A High Level Process Map is a simple picture of a complex process

represented by 4-8 key steps. It is essential to better understand the

process being improved and to gain agreement on project scope.

Develop a Charter

“One Source of Truth”

• Medication reconciliation process design should center on a single list - “One Source of Truth” - to document patient’s current medications.

• All clinicians should be working from the same centrally located, easily visible medication list, regardless of format.

• List becomes reference point for ordering decisions, screening and reconciliation.

• Each discipline should have the ability to update the home medications as new or more reliable information becomes available.

Establish a Measurement

Strategy

Caution: Jumping into data collection without a clear plan wastes time, energy, resources, etc.

What to Measure

Operational Definition

Collection Method

Sampling Plan

What Where When How ManyQuestion the

data will answer

Specific Definition

System, existing forms,

new handwritten forms, etc.

Elements to be collected

Physical location

Timing and frequency

of collection

Number of data points

to be collected

Was an updated

medication list provided to the

patient and reviewed at discharge?

“Medication instructions

were reviewed with the patient”

checked on At-Home Meds List

form

Manual collection from existing forms

Copy of At-Home Meds

List form, reasons for

non-compliance.

Use Med Rec audit form

GI Lab 2-weeks all shifts.

August 15 - 31

All visits

Data Collection Plan

Collect Data1. Work with the team and

staff to identify potential drivers and build a data collection form.

2. Seek assistance from the team and staff in collecting the data to increase buy-in.

3. Observe the data collection process periodically to identify issues, errors.

4. Graph the data you intend to collect to (1) confirm how you plan to use the data and (2) identify any missing data elements.

Identify Key Drivers

Involvement of Frontline Staff is KEY

The backside of the baseline data collection form:

Identifying (& addressing) the problematic

issues that drive outcomes

will lead to lasting

improvement

Design/Redesign the Process

Flow Charting and Gap Analysis

A flowchart outlines current workflow and helps

identify:1.Successful medication reconciliation practices.2.Current roles and responsibilities for each discipline.3.Potential failures 4.Unnecessary redundancies and gaps in the process

Implement the Process

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Improvement Planning

To implement solutions successfully, five areas must be carefully considered and planned for:

1. Interventions

2. IT

3. Communication

4. Training

5. Measurement

Implementation Plan

50% of the work begins now50% of the work begins now

Be sure to always include…• Detailed actions

• Team member assignments• Completion dates

Educational Tools

Assessment and Process Evaluation

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Monitoring Performance

Vicky Agramonte, RN, MSNProject Manager

Healthcare Quality Improvement Program Island Peer Review Organization, Inc. (IPRO)

 Albany, NY 12211-2370(518) 426-3300 X115vagramonte@ipro.org

Kristine Gleason, MPH, RPhClinical Quality Leader

Northwestern Memorial Hospital Chicago IL 60611

312.926.9172kmgleaso@nmh.org

Questions and Discussion

THANK YOU!THANK YOU!

If you want to learn more about IPRO, please visit our website at: http://www.ipro.org If you want to learn more about Northwestern Memorial Hospital, please visit our website at http://www.nmh.org