| QUALITY
IMPROVEMENT INITIATIVES
Project Name: Brattleboro Memorial Hospital
Patient Safety Initiative focusing on Medication Reconciliation
Time Frame: Beginning January 2006
and ongoing
Aim Statement:
Brattleboro Memorial Hospital endeavors to improve outcomes
and ensure the quality of care our patients receive
with an emphasis on safety. It is our goal to provide
safe, quality evidence-based care to our patients throughout
the continuum of care.
Description
In 1996 the Institute of Medicine (IOM) launched a concerted,
ongoing effort focusing on assessing and improving the
nation’s quality of care. According to the Institute
for Healthcare Improvement (IHI), 46 percent of all
medication errors occur at the so-called care transition
points when patients are admitted, discharged, and transferred
between units or facilities
The purpose of the Joint Commission on Accreditation
of Healthcare Organizations (JCAHO) National Patient
Safety Goals is to promote specific improvements in
patient safety. The JCAHO Patient Safety Goals highlight
problematic areas in health care and describe evidence
and expert-based solutions to these problems. Sound
system design is intrinsic to the delivery of safe,
high quality health care, the JCAHO Patient Safety Goals
focus on system-wide solutions, wherever possible. Brattleboro
Memorial Hospital support and commit to implementation
of the JCAHO Patient Safety Goals
The development, reconciliation and communication of
an accurate medication list throughout the continuum
of care are essential for the reduction of transition-related
adverse drug events (medication errors). The JCAHO has
introduced a patient safety goal describing medication
reconciliation.
Goal: Accurately and completely reconcile medications
across the continuum of care
- Implement a process for obtaining and documenting
a complete list of the patient’s current medications
upon the patient’s admission to the organization
with the involvement of the patient. This process
includes a comparison of the medications the organization
provides to those on the list.
- A complete list of the patient’s medications
is communicated to the next provider of service when
a patient is referred or transferred to another setting,
service, practitioner or level of care within or outside
the organization.
Goals and Measures
Brattleboro Memorial Hospital’s goal is to prevent
medication errors with concentrated focus on those transition
points recognized as prone to error. BMH also strives
to provide patients with the knowledge required to become
a partner with the health care team in the prevention
of medication errors. Those measures reviewed included:
- Medication reconciliation sheet sent to pharmacy
- Last dose of medication taken noted
- Allergy information noted
BMH has also made available on their webpage a form
patients can use to record a list of their medications.
Click here to get
more information on medication safety and a copy of
the medication form.
Interventions
- The admitting nurse obtains the best possible information
on home medication use by interviewing the patient
or patient advocate, from a patient list brought from
home, by contacting others (primary care physician
or pharmacy, if patient consistently uses the same
pharmacy), or checking actual medicine containers.
- A copy of the list is sent to the pharmacy. A pharmacist
reviews home medication use and physician orders to
detect and avert any medication errors in dosing or
other problems such as potential drug interactions.
- The admitting physician reviews the admission medication
list and considers these medications when making treatment
orders, reconciling them to medications provided here.
- The admission medication list and the patient pharmacy
profile are reviewed by the physician upon each transfer
between nursing units within the hospital and on discharge
from the hospital. Subsequent orders will be in consideration
of previously taken meds.
- A computer-printed form lists all hospital ordered
medications as well as home medications obtained for
physician review. This computer generated form can
be requested by the physician at any time during the
patient’s stay.
- On discharge, the physician directs the patient
regarding meds taken on admission, as well as any
new or changed medications for discharge
Results:
Opportunities Identified for Continued
Improvement:
Brattleboro Memorial Hospital’s long term goal
is to prevent medication errors by simplifying the process
of medication reconciliation and involving the patient
throughout the process. BMH encourages the active participation
of patients in the medication process: reconciliation,
ordering, and administration. We are continually looking
for ways to simplify the process and have reduced the
paperwork required to reconcile medications to only
three (3) forms: one for each transition point. The
Institute for Healthcare Improvement (IHI) has recognized
our effort to include the patient in the process and
has identified this as a best-practice approach.
Contact
Quality Management Department
Brattleboro Memorial Hospital
17 Belmont Avenue
Brattleboro, VT 05301
Mary L. Morgan
VP Quality Patient/Safety
mmorgan@bmhvt.org
802-257-8355 (phone)
802-257-8813 (fax)
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