Grace Cottage Hospital’s 2009 Hospital Report Card

2008 QUALITY IMPROVEMENT INITIATIVES

Patient Safety Project
Project Name: Medication Reconciliation
Time Frame: 2008 and ongoing

Project Description / Problem:
As part of the nationwide campaign “5 Million Lives” a comprehensive medication reconciliation practice was introduced at Grace Cottage Hospital to increase patient safety and eliminate medication errors. An electronic medication list, or “reconciliation” is compiled and recorded within the hospital’s computer system and a paper hard copy placed in the patient’s chart on admission. The list contains all of the medications a patient takes – including prescription meds, over-the-counter drugs, supplements and herbal preparations. Obtaining a patient’s accurate medication history is important for patient safety. Compiling the comprehensive medication reconciliation is often difficult to accomplish. There is no single best method to retrieve the information. We frequently rely on patient / significant other memory as well as contacting the patient’s pharmacy(s) and physician(s). Once the list is complete, the physician reviews it and adjusts his orders to reflect exactly what the patient should be taking.

Wallet medication cards are issued to each patient upon discharge from the hospital. The cards have the most current and complete listing of the patient’s medications. The wallet cards help when the patient returns to the hospital for another admission and does not remember the name or the dose of a medication. This helps the staff interpret what the patient is saying when they report only that they are taking “a green pill”.

Project Goals:
1. Gather a complete list of all medications - including all over-the-counter and herbal preparations - taken prior to the patient’s hospital admission and reconcile this list with current medications ordered in the hospital.
2. Introduce an electronic version of this list that can be easily updated and shared between providers and their patients.

Evaluation Process and Results:
1. As a result of the process introduced in 2008 Medication Reconciliation upon a patient’s admission at Grace Cottage Hospital is now recorded 100% of the time in the patient’s electronic record and a paper hard copy is placed in the patient’s chart.
2. Medication reconciliation is now a more of a collaborative process. In 2008, pharmacy time was added to assist in reviewing and verifying, within forty-eight hours, information provided at the patient’s admission. This includes contacting the patient’s pharmacy and physician regarding all prescribed medication, immunizations, etc.
3. The current medication reconciliation process works, but is more labor intensive than is desired. Grace Cottage Hospital is still investigating electronic forms that will integrate with the current software to streamline the process of communication between the hospital, the pharmacy and other health care providers.
4. In 2008 we continued to educate and provide patients with the medication wallet cards, and this ongoing process has proved successful. The question “Does the patient have a medication wallet card?” has been added to the hospital’s patient discharge flow sheet.