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Scheduled Conference Name: JCAHO's Medication Reconciliation Patient Safety Goal:

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JCAHO’s Medication Reconciliation Patient Safety Goal: Effective

Strategies, Tips, and Tools to Comply

A 90-minute interactive audioconference Friday, January 28, 2005

presents . . .

ii JCAHO’s Medication Reconciliation Patient Safety Goal In our materials, we strive to provide our audience with useful, timely information. The live audioconference will follow the enclosed agenda. Occasionally our speakers will refer to the materials enclosed. We have noticed that other non-HCPro audioconference materials follow the speaker’s presentation bullet-by-bullet, page-by-page.

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iv JCAHO’s Medication Reconciliation Patient Safety Goal Dear colleague,

Thank you for participating in J CAHO s Medication Reconciliation Patient Safety Goal: Effective Strategies, Tips, and Tools to Comply with Carolyn Ma, PharmD, David M. Benjamin, PhD, and Maureen Gibbs, RN, BSN, and moderated by Matthew Bashalany.

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Agenda . . . .vi

About your sponsors . . . .vii

Speaker profiles . . . .viii

Exhibit A . . . .1

Presentation by Carolyn Ma, PharmD Exhibit B . . . 7

Presentation by David M. Benjamin, PhD Case study: Medication reconciliation Form: Medication tracking Exhibit C . . . .12

Presentation by Maureen Gibbs, RN, BSN, part one Exhibit D . . . .16

Presentation by Maureen Gibbs, RN, BSN, part two Appendix . . . .28

Form: Medication reconciliation Resources . . . .30

Contents

vi JCAHO’s Medication Reconciliation Patient Safety Goal

I. Introduction

a. What is Patient Safety Goal #8 b. Interpretation and compliance

• Problems and challenges - Communicating problems - Ensuring continuity of care

• Different settings

- What you need to know c. Delivery of medications

• Key players and roles

- Finding appropriate personnel II. Medication reconciliation case study

III. Implementing medication reconciliation in your facility a. The medication reconciliation program “Massachusetts

Hospital Association” safety experience

• Design and implementation

• Practical methods and forms IV. Closing statements

V. Live Q&A

Agenda

About HCPro, Inc.

HCPro is the premier healthcare information and resource provider on compliance and regulatory issues faced by hospitals, home health organizations, nursing homes, physicians’ offices, and other healthcare facilities.

HCPro has launched a number of Web “supersites” that include tips, how-to information, “ask the expert columns,” free e-mail newsletters, and so much more.

About your sponsors

viii JCAHO’s Medication Reconciliation Patient Safety Goal

Speaker profiles

Carolyn Ma, PharmD

Carolyn Ma, PharmD, is an independent healthcare consultant at the Stanford Hospitals and Clinics with a focus on JCAHO preparation and project development and implementation. Ma’s professional interests focus on development, implementation, and evaluation of hospital and clinic programs, organization redesign, change and transition, and professional development.

David M. Benjamin, PhD

David M. Benjamin, PhD, is a clinical pharmacologist and toxicologist and a former clinical research director in the pharmaceutical industry. Benjamin has extensive experience in recognizing and reporting adverse drug reac- tions. He is currently adjunct assistant professor at the Tufts University School of Medicine and was the senior author of PEARLS for Medication Error Reduction, published by the American Society for Healthcare Risk Management.

Dr. Benjamin earned his BA in biological sciences from Boston University in 1968 and his MS and PhD in phar- macology from the University of Vermont College of Medicine in 1970/1972. Dr. Benjamin completed his post- doctoral specialty training in clinical pharmacology and toxicology at the University of Kansas Medical Center in the departments of medicine and pharmacology in 1972–1973. He served as the chair of the education com- mittee and the teaching forum sub-committee for the American College of Clinical Pharmacology for the past four years, where he is currently serving as a regent of the college.

Dr. Benjamin’s research and teaching interests include: drug development, reducing medication errors, and forensic pharmacology. He has over 180 presentations and publications listed on his full CV, including a book chapter entitled “Forensic Pharmacology” in the Forensic Science Handbook, Volume III.

Dr. Benjamin is a Fellow of the American College of Clinical Pharmacology, the American College of Legal Medicine, the American Academy of Forensic Sciences (Toxicology), and the American Society of Healthcare Risk Management.

He is also a trained mediator and arbitrator, and he serves on the editorial board of the Journal of Healthcare Risk Management and the Journal of Clinical Pharmacology.

Maureen Gibbs, RN, BSN

Maureen Gibbs, RN, BSN, is a nurse manager at Milford-Whitinsville Regional Hospital in Milford, MA. Last March, her work there was officially recognized for development and implementation of an innovative system that has boosted reconciliation rates over 90%. Milford also has been recognized as “one of the nation’s 100 top hospitals” for superior clinical, operational, and financial performance, and it is one of only 20 medium-sized hospitals recognized as such nationwide. Gibbs has also actively worked on patient safety and medication rec- onciliation with the Massachusetts Hospital Association.

Exhibit A

Presentation by Carolyn Ma, PharmD

E

X H I B I T

A

Medication Reconciliation Medication Reconciliation

NPSG #8 NPSG #8

Carolyn Ma, Pharm.D., BCOP Carolyn Ma, Pharm.D., BCOP

Common Medication Common Medication

Order Oversights Order Oversights

Missed or duplicate medications, doses, Missed or duplicate medications, doses, frequency, route.

frequency, route.

Unknown last dose given Unknown last dose given

Medication orders drop-off upon transfer Medication orders drop-off upon transfer Failure to restart after surgery

Failure to restart after surgery

Brand/generic substitution mistakes Brand/generic substitution mistakes Missed non-prescription medications Missed non-prescription medications Unidentifiable medications

Unidentifiable medications

Failure to order medication upon discharge

Failure to order medication upon discharge

JCAHO’s Medication Reconciliation Patient Safety Goal 3

E

X H I B I T

A

NPSG #8 Defined NPSG #8 Defined

Reconciliation compares the medication Reconciliation compares the medication list the patient/client/resident is taking at list the patient/client/resident is taking at time of admission or entry to a new setting time of admission or entry to a new setting with what the organization provides from with what the organization provides from patient interview.

patient interview.

Intake assessment involves the patient Intake assessment involves the patient and if the patient is unable to provide the and if the patient is unable to provide the information, a process should be defined information, a process should be defined to acquire the information.

to acquire the information.

NPSG #8 Defined NPSG #8 Defined

The list will be updated with each change of The list will be updated with each change of setting and that the list reflect the medication setting and that the list reflect the medication orders that occurred during the episode of care.

orders that occurred during the episode of care.

The list will be documented in a identifiable The list will be documented in a identifiable means in the patient

means in the patient’ ’s record. s record.

The complete and current list is communicated The complete and current list is communicated to the next provider in a referral or transfer to to the next provider in a referral or transfer to another setting, service, practitioner, or level of another setting, service, practitioner, or level of care within or upon discharge.

care within or upon discharge.

E

X H I B I T

A

NPSG #8 NPSG #8

No specific form is required, Requirement No specific form is required, Requirement is fulfilled if the list is documented.

is fulfilled if the list is documented.

Organizations will define type of evidence Organizations will define type of evidence that determines that a reconciliation

that determines that a reconciliation process or comparison has taken place.

process or comparison has taken place.

Medication Defined Medication Defined

Prescription Prescription medications medications

Sample medications Sample medications Herbal remedies Herbal remedies Vitamins

Vitamins Nutriceuticals Nutriceuticals OTC OTC ’s ’ s

Vaccines Vaccines

Diagnostic and Diagnostic and contrast agents contrast agents

Radioactive Radioactive medications medications

Respiratory therapy Respiratory therapy treatments

treatments

Parenteral nutrition

Parenteral nutrition

Blood derivatives

Blood derivatives

IV solutions (plain, +/-

IV solutions (plain, +/-

electrolytes and drug)

electrolytes and drug)

Any product defined

Any product defined

by FDA as a drug

by FDA as a drug

JCAHO’s Medication Reconciliation Patient Safety Goal 5

E

X H I B I T

A

Compliance Timeline Compliance Timeline

Design, planning and initial Design, planning and initial implementation in 2005 implementation in 2005

Full implementation by January 2006 Full implementation by January 2006 Design auditing to assure compliance Design auditing to assure compliance

Challenges Challenges

Finding and assigning appropriate personnel Finding and assigning appropriate personnel

Individual practitioner vs. team

Individual practitioner vs. team

Staff availability and ownership

Staff availability and ownership

Ensuring continuity of care Ensuring continuity of care

Communication

Communication

Linkage role

Linkage role

Quality Assurance Quality Assurance

Quantity

Quantity

Timeliness

Timeliness

Manpower

Manpower

E

X H I B I T

A

What Staff Need to Know What Staff Need to Know

Staff will be expected to understand the Staff will be expected to understand the reconciliation process even with an reconciliation process even with an electronic record

electronic record

Organization will define expected time Organization will define expected time frame for reconciliation to occur after frame for reconciliation to occur after admission records.

admission records.

When an exception may occur for When an exception may occur for reconciliation outside the organization reconciliation outside the organization defined timeline.

defined timeline.

Exhibit B

Presentation by David M. Benjamin, PhD Case study: Medication reconciliation Form: Medication tracking

E

X H I B I T

B

Case study in medication reconciliation

Maryann Jones is a nurse in a busy emergency room that is currently crowded with patients awaiting treatment, as well as those awaiting admission to inpatient units. She performs an initial evaluation on Mrs. Smith, a 75- year-old woman who fell at home and appears to have a fractured hip. Mrs. Smith was brought in by ambulance accompanied by a neighbor, Mrs. Rogers. Mrs. Smith is oriented but has received pain medication and is doz- ing. Maryann notes that that the paramedics have indicated that Mrs. Smith has a history of CHF, and that she is taking Digoxin and a “water pill.” Her neighbor, Mrs. Rogers, hands Maryann several vials of medications and says that the patient told her to bring these along. Maryann examines the vials and finds Digoxin (0.500 mg) and Lasix (40 mg OD), as well as atenolol (50 mg OD) and Celebrex (100 mg bid). She documents the names and doses of the medications on her nursing intake form. Maryann asks Mrs. Rogers if these are all of the medica- tions Mrs. Smith is on, and Mrs. Rogers answers that these were all the medications that she found in Mrs.

Smith’s kitchen and doesn’t know if there are others. Maryann makes a mental note to double-check with the patient later, since she is now being taken to radiology for a hip x-ray. When Mrs. Smith returns to the ED an hour later, Maryann is eating lunch in the nurses’ lounge. A bed has opened up for Mrs. Smith on the orthopedic unit, and the covering nurse, Sally, arranges for the transport. Maryann returns from lunch to find three new pa- tients that need to be evaluated.

Laboratory studies run earlier on the day of admission indicate the following:

• X-ray studies indicate no fracture and periosteal bone contusion is diagnosed

• Serum potassium: 2.7 meq (NR: 3.5–5.3 meq)

• Fasting blood sugar: 61 mg/dl (NR: 60-110)

• Creatinine clearance: 55 cc/min

The physical exam indicates the following:

• Apical heart rate: 47 BP 106/68

The medical team decides to make the following medication changes while the patient is on the floor:

• Reduce the Lanoxin from 0.250 mg to 0.125 mg

• D/C the Lasix 40 mg and replace with HCt 50 mg/triamterene 75 mg.

• Add 20 meq of potassium chloride 20 meq daily

• D/C Celebrex and replace with naproxyn 500 mg q 8 hrs p.rn. pain

• D/C atenolol

Following is the patient plan:

• Patient is to be kept overnight and discharged home tomorrow with adequate pain medication and OT and PT at home

• VNA to visit patient twice per week for the next two weeks

JCAHO’s Medication Reconciliation Patient Safety Goal 9

E

X H I B I T

B

In the evening, Mrs. Rogers come in to visit and informs the night nurse that Mrs. Smith usually takes St. John’s Wort for mild depression she has been feeling recently.

The following day, after lunch, Mrs. Smith is discharged home on the following meds:

• Lanoxin 0.125 mg, one per day

• HCt 50 mg/triamterene 75 mg, one per day

• Potassium chloride 20 meq daily

• Naproxyn 500 mg q 8 hrs p.rn. pain

E

X H I B I T

B

Me di cat ion Trac ki ng Form

Intern:______________________ ____________ _____________________ _____________________ ______________________ ___ Meds Reviewed: [ ] Yes [ ] No Dosing/Frequency Condition Treated Date Discontinued Reason(s)______________________ ge:__/__/__ Dosing/Frequency Condition Treated _

Exhibit C

JCAHO’s Medication Reconciliation Patient Safety Goal 13

E

X H I B I T

C

Reconciling Medication

A Statewide

Medication Safety Collaborative

Massachusetts Hospital Association

Sponsored by:

Collaborative

To reduce the occurrence of adverse medication events in Massachusetts by having

hospitals throughout the state

adopt the reconciling process

E

X H I B I T

C

What Is Reconciling Medications?

A process that compares a patient’s best known list of current medications

against the physician’s admission, transfer and/or discharge orders.

Discrepancies are brought to the attention of the prescribed and, if appropriate, changes are made to the orders.

Examples of Errors

No orders for needed home meds

Missed or duplicate doses from inadequate records of frequency/last administration time

Surgeon inadequately addressing meds for chronic conditions

Failure to restart meds at transfers

Doubling up (brand/generic combinations, formulary substitutions)

Unresolved variances drug/dosage/frequency/route

JCAHO’s Medication Reconciliation Patient Safety Goal 15

E

X H I B I T

C

The Reconciling Process

1-medication history obtained at intake

Interviewing strategies to promote accuracy Input from patient/family/alternative sources Outreach: patients arrive with accurate list 2-medication orders written

Goal: work from accurate home med list 3-reconcile

4-order

(no omissions, no duplicated, right med/dose/frequency/route

Reconciling Process

Form used to bring patient’s medication information together in one place

Nurse or pharmacist/pharmacist technician compiles initial information

Unreconciled meds resolved in timely fashion (before next prescribed dose, w/in 4 hours for urgent

medications)

Physicians, nurses, pharmacists ALL use form as

reference throughout the patient’s stay

Exhibit D

JCAHO’s Medication Reconciliation Patient Safety Goal 17

E

X H I B I T

D

Reconciling Medications Collaborative

Aim

Improve rate of reconciled medications Improve rate of reconciled medications at admission and discharge from 77 % to at admission and discharge from 77 % to 85% by January 2004.

85% by January 2004.

By September of 2004 95% of patient By September of 2004 95% of patient medications will be reconciled on

medications will be reconciled on admission and discharge

admission and discharge. .

E

X H I B I T

D

Changes Tested

Baseline audit of 12 in-patient records Baseline audit of 12 in-patient records





87 Medication Transcriptions 87 Medication Transcriptions

Tested Pilot Form Tested Pilot Form



1 RN 1 RN





1 MD 1 MD





1 Unit (Telemetry) 1 Unit (Telemetry)

Revised data collection tool Revised data collection tool





2 RN’ 2 RN ’s s





2 MD’ 2 MD ’s s





1 Unit (Telemetry) 10 Patients 1 Unit (Telemetry) 10 Patients

Changes Tested

Process Initiated on 2 Process Initiated on 2

^ndnd

Unit (Medical) with 1 Unit (Medical) with 1 RN, MD Group Increased to 3, RN Group on RN, MD Group Increased to 3, RN Group on Telemetry Increased to 5

Telemetry Increased to 5





14 Patients in Study 14 Patients in Study

Process Introduced to ICU and Surgical Unit. Process Introduced to ICU and Surgical Unit.





Intensivists (2) On Board with project Intensivists (2) On Board with project





25 Patients in Study 25 Patients in Study

All Staff on Telemetry Trained in Process, 75% All Staff on Telemetry Trained in Process, 75%

of Patients in Project

of Patients in Project

JCAHO’s Medication Reconciliation Patient Safety Goal 19

E

X H I B I T

D

Changes Tested

Pharmacy completing Pharmacy completing “ “transfer reconciliation transfer reconciliation” ” on on ICU patients.

ICU patients.

Milford VNA faxing current medication list on Milford VNA faxing current medication list on admitted patients, MWRH faxing Medication admitted patients, MWRH faxing Medication Reconciliation Form to VNA at discharge.

Reconciliation Form to VNA at discharge.

CME presentation at MWRH to 78 physicians, CME presentation at MWRH to 78 physicians,

“ “Medication Safety/Medication Reconciliation. Medication Safety/Medication Reconciliation.” ”

Staff on 4 Staff on 4

^thth

and 5 and 5

^thth

floors trained in process floors trained in process

Medical Records assisting with data retrieval of Medical Records assisting with data retrieval of med reconciliation on discharge patients

med reconciliation on discharge patients

Results

-R econciled Medications at Admission

90%

91%

92%

93%

94%

95%

96%

97%

98%

June July Aug Sept

June: 10 Patients, 123 medications,June: 10 Patients, 123 medications, 95% reconciled rate

95% reconciled rate

July: 14 Patients, 117 medications,July: 14 Patients, 117 medications, 98% reconciled rate

98% reconciled rate

August: 25 Patients, 215August: 25 Patients, 215 medications, 95% reconciled rate medications, 95% reconciled rate

September: 57 Patients, 847September: 57 Patients, 847 medications transcribed, 93 % medications transcribed, 93 % reconciled rate

reconciled rate

E

X H I B I T

D

Reconciled Medications at Admission

Oct: 57 Patients, 847 Oct: 57 Patients, 847 medications, 93%

medications, 93%

reconciled rate.

reconciled rate.

Nov: 246 Patients, Nov: 246 Patients, 2997 medications, 94%

2997 medications, 94%

reconciled rate.

reconciled rate.

Dec: 226 Patients, Dec: 226 Patients, 2740 medications, 98%

2740 medications, 98%

reconciled rate.

reconciled rate.

90%

91%

92%

93%

94%

95%

96%

97%

98%

Oct Nov Dec

Reconciled Medications at Admission

95%

96%

96%

96%

96%

96%

97%

97%

97%

Jan Feb March

Jan: 152 Patients, 2266 Jan: 152 Patients, 2266 Medication

Medication

Transcription, 97%

Transcription, 97%

Reconciled Rate Reconciled Rate

Feb: 310 Patients, 3211 Feb: 310 Patients, 3211 Medication

Medication

Transcription, 96%

Transcription, 96%

Reconciled Rate Reconciled Rate

March: 516 Patients, March: 516 Patients,

96 % Reconciled Rate

96 % Reconciled Rate

JCAHO’s Medication Reconciliation Patient Safety Goal 21

E

X H I B I T

D

Reconciled Medications at Admission

89%

90%

91%

92%

93%

94%

95%

96%

97%

98%

April May June July

April: 727 Patients, 96% April: 727 Patients, 96%

Reconciled Rate.

Reconciled Rate.

May: 625 Patients, 92% May: 625 Patients, 92%

Reconciled Rate.

Reconciled Rate.

June: 572 Patients, June: 572 Patients, 98 % Reconciled Rate.

98 % Reconciled Rate.

July: 461 Patients, 96% July: 461 Patients, 96%

Reconciled Rate Reconciled Rate. .

Reconciled medications at Admission

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Aug

August: 605 Patients, August: 605 Patients,

92% Reconciled Rate

92% Reconciled Rate. .

E

X H I B I T

D

Results

-R econciled Medications at Discharge

May: pilot unit (telemetry) 1 RN, 1 MD, 3 patients, 31 medication transcriptions, 90 % reconciled rate

June: pilot unit (telemetry) 2 RN’s , 2 MD’s, 123 medications transcribed, 100 % reconciled rate

July: 2^nd unit added with 1 RN, telemetry with 5 RN’s, 3 MD’s, 14 patients, 183 medications transcribed, 97% reconciled rate

August: same two units, 5 MD’s 25 patients, 328 medications transcribed, 90% reconciled rate

September: 57 patients, 847 Medications transcribed, 97 % reconciled

reconciled 84%

86%

88%

90%

92%

94%

96%

98%

100%

May June July Aug Sept

Reconciled Medications at Discharge

96%

97%

97%

98%

98%

99%

99%

Oct Nov Dec

Oct: 57 Patients, 847

Oct: 57 Patients, 847

medication transcriptions,

medication transcriptions,

97% reconciled rate

97% reconciled rate

Nov: 246 Patients, 2997

Nov: 246 Patients, 2997

medication transcriptions,

medication transcriptions,

97% reconciled rate

97% reconciled rate

Dec: 226 Patients, 2740

Dec: 226 Patients, 2740

medication transcriptions,

medication transcriptions,

99% reconciled rate

99% reconciled rate

JCAHO’s Medication Reconciliation Patient Safety Goal 23

E

X H I B I T

D

Reconciled Medications at Discharge

Jan: 152 Patients, Jan: 152 Patients, 2266 medication 2266 medication transcriptions, 97%

transcriptions, 97%

reconciled rate reconciled rate

Feb: 310 Patients, Feb: 310 Patients, 3211 medication 3211 medication transcriptions, 98%

transcriptions, 98%

reconciled rate reconciled rate

March: 516 Patients, March: 516 Patients, 98% reconciled rate 98% reconciled rate

96%

97%

97%

97%

97%

97%

98%

98%

98%

Jan Feb March

Reconciled Medications at Discharge

92%

93%

94%

95%

96%

97%

98%

April May June July

April: 98% Reconciled April: 98% Reconciled Rate

Rate

May: 94% Reconciled May: 94% Reconciled Rate Rate

June: 98% Reconciled June: 98% Reconciled Rate Rate

July: 96% Reconciled July: 96% Reconciled Rate

Rate

E

X H I B I T

D

Reconciled Medications at Discharge

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Aug

August: 92% August: 92%

Reconciled Rate Reconciled Rate

Keys to Success and Lessons Learned

Close working relationship between MD Close working relationship between MD leader/RN leader

leader/RN leader

MD’ MD ’s involved ( s involved (hospitalists hospitalists ) cover 18 ) cover 18

MD’ MD ’s s

JCAHO’s Medication Reconciliation Patient Safety Goal 25

E

X H I B I T

D

Keys to Success and Lessons Learned

Identify “ Identify “Ambassadors Ambassadors” ” for Medication for Medication Reconciliation, key to Success is RN/MD

Reconciliation, key to Success is RN/MD “ “ Buy In” Buy In ”





Initiating project-start with 2 RN’ Initiating project-start with 2 RN ’s in each area s in each area



Poster board presentation Poster board presentation





“Trigger “ Trigger” ” to initiate medication reconciliation to initiate medication reconciliation





Keep on agenda at every staff meeting Keep on agenda at every staff meeting

Next Steps

Changes Aiming at Goals Changes Aiming at Goals





Opportunities in ICU and Surgical Unit Opportunities in ICU and Surgical Unit



Surgeon acceptance-utilize Surgical PA’ Surgeon acceptance-utilize Surgical PA ’ s s



Expand number of staff trained in Expand number of staff trained in

medication reconciliation on medical unit medication reconciliation on medical unit





Goal of 11/1 for printing of medication Goal of 11/1 for printing of medication reconciliation tool on INDB (admission reconciliation tool on INDB (admission assessment form

assessment form) )

E

X H I B I T

D

Next Steps

Changes Aiming at Goals Changes Aiming at Goals





Medication reconciliation committee comprised Medication reconciliation committee comprised of nursing, pharmacy, physician, to meet

of nursing, pharmacy, physician, to meet monthly and report out finding to medication monthly and report out finding to medication safety

safety





Report out findings to Performance Report out findings to Performance Improvement Committee, Pharmacy and Improvement Committee, Pharmacy and Therapeutic Committee

Therapeutic Committee



Medication reconciliation to be completed on Medication reconciliation to be completed on all in-patients

all in-patients

Next Steps

Meeting Scheduled with IATRIS to review Meeting Scheduled with IATRIS to review software

software PDRx PDRx for computerized medicine for computerized medicine history.

history.

ED to be trained in process. ED to be trained in process .

JCAHO’s Medication Reconciliation Patient Safety Goal 27

E

X H I B I T

D

Our Team

-Maureen Gibbs, RN, Nurse Manager Telemetry

-Adrienne Walton, RN, Staff nurse

-Tina Robakiewicz, MD, Hospitilist

-Susan Otocki, RPH, Director of Pharmacy

-Glenn Focht, MD, Medical Director of Quality Care &

Education

-Jean Masciarelli, Director of VNA

Appendix

JCAHO’s Medication Reconciliation Patient Safety Goal 29

A

P P E N D I X

Medications Upon Admission: check one (1) a) NO Medications brought to hospital: ______.

b) Medications sent to Pharmacy: ____date/time_______

c) Medications brought to hospital sent home:_____; if so, date/time_______.

MWRH-Medication Reconciliation Form

Patient Name: ___________________MRN# ___________Physician: ___________Admission Date: _______D/C Date:________

Patient Pharmacy:_____________________________ Phone/address:(if known)___________ ________________________________________

**terminology instruction key on next page*** Rev 4-5/22/03 DateTime

initials

Drug Name, Dose, Schedule Last

Taken

Amount of NON compliance

Info Source

Ordered on admission?

Ordered @ D/C?

Reconciled

@ transfer?

Reconciled

@ D/C?

Comments:__________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

Signature/initials:

1. __________________ 4.__________________

2. __________________ 5.__________________

3. _______________ 6._______________

A

P P E N D I X

Reconciliation Form

Terminology Instructions

Date. Time, Initials of

interviewer Record date & time information was gathered and initials/credentials Drug Name, Dose,

Schedule

Record full name, dose, and patient’s actual usage pattern. Record deviation from l instructions in Comments section. Include OTC medications.

Last Taken Record date and time patient took last dose Amount of NON-

compliance Record number of scheduled doses missed in one week.

“0” = patient takes every dose as scheduled. Record number of “prn” doses taken in

“4 per day” or “6 times per week”

Information Source Record source of information:

Pt = patient interview Fam = spouse, family member Clinic = clinic records

H & P = recent history & physical Trans = transfer records from another facility Rx = prescription vials or pharmacy call Other = data source explained in commen Ordered on Admission?

Reconcile MD’s initial medication orders with medication history. Y = continued on Held = MD does not want medication given at time of admission

Changed = same medication but different dose or schedule

Replaced -= different medication with similar action ordered instead Ordered at Discharge? Reconcile discharge orders with medication history.

Y = continue same medication and dose

Changed = same medication but different dose or schedule

Replaced = different medication with similar action ordered instead

D/C’d = medication stopped during hospitalization, not appropriate at discharge Patient’s Pharmacy Document name(s) of pharmacy(ies) that maintain a patient profile for this patient a

as a reference. Inc. city & phone number

Comments

Record deviations from labeled instructions. Record any pertinent observations or a you feel important in understanding patient’s therapy and/or ability to self medicate special requirements for discharge prescriptions.

Reconciled @ Transfer?

(if applicable)

The medication was: a) ordered @ transfer, same as upon prior nursing unit, b) ord transfer different dose-and documented change of dose, c) not ordered @ transfer a reason= YES/reconciled

If no reason documented for omitted or changed dose-reconciliation is failed=NO/n Reconciled @ Discharge? The medication was: a) ordered @ discharge, same as upon admission, b) ordered @ different dose-and documented change of dose, c) not ordered @ discharge and do reason= YES/reconciled

If no reason documented for omitted or changed dose-reconciliation is failed=NO/n

Resources

R

E S O U R C E S

Other sites

Carolyn Ma, PharmD 691 Hakaka Street Honolulu, HI 96816

David M. Benjamin, PhD 77 Florence Street

Suite 107

Chestnut Hill, MA 02467 Phone: 617/969-1393

E-mail: [email protected]

Maureen Gibbs, RN, BSN

Milford-Whitinsville Regional Hospital 14 Prospect St

Milford MA 01757

E-mail: [email protected]

HCPro sites

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With more than 17 years of experience, HCPro, Inc., is a leading provider of integrated information, education, training, and consulting products and services in the vital areas of healthcare, regulation, and compliance. The company’s mission is to meet the specialized informational, advisory, and educational needs of the healthcare industry and to learn from and respond to our customers with services that meet or exceed the quality they expect.

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JCAHO’s Medication Reconciliation Patient Safety Goal 33

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TIFIC A T E O F A TTEND ANCE

attended

s Medication Reconciliation P atient Safety Goal: Effecti ve Str ategies, Tips, and Tools to Comply a 90-minute audioconference

on

January 28, 2005

Suzanne Perney HCPro, Inc., 2005

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