Patient Safety, 2012

Massachusetts Hospital Improves Medication Reconciliation With AHRQ Toolkit

March 2012

After participating in AHRQ-sponsored learning sessions and provider support calls, Masspro, the Massachusetts Quality Improvement Organization (QIO), worked with New England Rehabilitation Hospital in Woburn, Massachusetts, to improve its medication reconciliation process.

Between January and November 2011, AHRQ partnered with six State QIOs to focus on implementation of the AHRQ-funded toolkit, Medications at Transitions and Clinical Handoffs (MATCH). Kristine Gleason, RPh, of Northwestern Memorial Hospital, developed the MATCH toolkit and presented information during onsite learning sessions and provided expert support during calls with hospital staff. These events were part of a QIO Learning Network established through an AHRQ Knowledge Transfer project.

The MATCH toolkit's goal is to decrease the number of patients receiving potentially conflicting medications when they leave the hospital or transfer to different care settings. The toolkit provides clear instructions on creating flowcharts to avoid gaps in reconciling medication; identifying roles and responsibilities for medication reconciliation; collecting data to measure progress; and assisting in the design and implementation of a single, shared medication history called the "One Source of Truth." MATCH is designed to assist clinicians in all types of health care organizations—including hospitals and outpatient settings—and is compatible with both paper-based and electronic medical records.

New England Rehabilitation Hospital improved its "One Source of Truth" document to make sure it included home medications that patients were expected to continue after they were admitted to the hospital. Using MATCH tools, the hospital redefined the responsibilities of all disciplines involved in the medication reconciliation process, eliminating redundant tasks and improving the efficiency and accuracy of medication reconciliation. Specifically, the pharmacist now focuses on the tasks of obtaining and documenting a medication history, identifying discrepancies, and alerting physicians that the discrepancies need to be resolved.

"Placing pharmacy at the front end of the admission process has decreased problems with medication reconciliation," says Nicola Pyburn, RPh, MBA, Pharmacy Supervisor. "Pharmacists use their expertise to review orders from the acute care hospital; identify concerns about any missing medications, dosages, duplication, scheduling, interactions, allergies, and routes of administration; and bring these concerns to the attention of the ordering physician for reconciliation before errors reach the patient."

Knowledge Transfer Case Study Identifier: KT-CQuIPS-89
AHRQ Products: QIO Learning Network, MATCH Toolkit
Topic(s): Prescription Medications
Scope: Massachusetts

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