By Kenneth Michek
Medication reconciliation continues to be a problem for hospitals and other healthcare facilities. Medication errors can occur during the transition of patient care because of miscommunication of drug information. We sat down with Molly Clark, PharmD, MHA, senior executive director of quality and safety at Sanford Health, and Megan Maddox, PharmD, BCPS, CDE, medication and safety officer at Sanford Medical Center, who offered information that can improve compliance in your facility and prevent negative patient outcomes.
Q: With the prevalence of electronic recordkeeping, why is a medication reconciliation team necessary?
MM: While it’s true that electronic recordkeeping can make a provider’s job easier, keeping a medication reconciliation list still requires human contact and communication to succeed. The interview process is the most important factor, and that requires a provider with the skills, training, and knowledge to ask the right questions and avoid errors.
According to the research conducted at Sanford, the med-rec team finds errors on electronic medication lists at an alarming rate; on average, the med-rec team found four discrepancies per patient. So, while it’s easier than ever to collect and share data, it is also easier than ever to make documentation errors that computers can’t catch.
Q: How do you convince your facility to make medical reconciliation a priority?
MC: A few years back, medication reconciliation was a hot topic because of the new regulations and guidelines. Unfortunately, many facilities treated the problem as a fix and forget; they thought that once a process was in place it would be fine. Medication reconciliation is on ongoing issue that changes regularly and requires constant monitoring.
To make sure that med-rec stays a priority, engage (and reengage) staff, from senior leadership to pharmacy interns. Collect and present data about the benefits of a med-rec team and how they can keep patients safe. It’s also important to tell individual stories; stories and case studies can be valuable tools to get your staff engaged in med-rec and put a face to the problem.
Q: When should medication reconciliation information be collected?
MM: The short answer is, as often as possible! But realistically, the two main focuses of the med-rec team should be admissions and discharge.
First, focus on patient entry points in your facility; for Sanford, this turned out to be the emergency department and the pre-operation area. The pre-op area in particular was interesting, because that typically means that in the last 30 days, the patient had contact with physicians and hospital staff, but still had significant discrepancies. As one surgeon at Sanford put it, the best way to make sure a patient’s medication list is up-to date is to have a planned procedure. Every facility is different, so it’s important that the med-rec team identifies the patient entry point in your facility and concentrate their efforts there.
Discharge medication reconciliation is another option for facilities; with this, pharmacy involvement is imperative, and they can often be the safety net for the facility. The safety net approach requires pharmacies to review all discharge medication lists to identify any issues and review medications with patients before leaving their care. Making sure there are no conflicts and that the patient knows how to properly use the medication could be a key factor in reducing readmissions.
Q: Do you have any tips for conducting patient interviews?
MM: Use all available resources at your disposal. In addition to the patient, consult with family or caregivers, the pharmacy, and the primary care provider. Prescription bottles, medication lists, and past medical records are all useful to consult when investigating discrepancies or incomplete records.
Collect the complete medication information: Include dose, route, frequency, and when the last dose was taken. Also, include why the patient is taking the medication.
Ask about the most commonly forgotten medications. Specifically, ask the patient about over-the-counter medication, inhalers, ointments, patches, eye drops, and vitamins. Ask about any weekly or monthly medications that the patient might use.
Use a combination of open- and closed-ended questions; this will hopefully create a dialogue and encourage communication.
Does the patient see other physicians. This could help the patient recall previous conditions or think about medication outside of their current concern.
Kenneth Michek is a contributing writer to Patient Safety & Quality Healthcare. He can be reached at firstname.lastname@example.org.