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The reconciliation process requires verification with the patient regarding their use of the prescribed medications. Additionally, there is much benefit to cultivating relationships with healthcare providers and care settings that patients frequently transfer to and from . This relationship-building can lead to standardized forms being developed and used across settings, or at a minimum, streamlined communication for as-needed consultations and clarification of information (ASHP & APhA, 2013). Home care providers can begin this relationship by regularly transmitting a reconciled list of medications to the patient's primary care provider and community pharmacist (ASHP & APhA, 2013). While the majority of discussion and examples within this toolkit focus on inpatient settings, post-acute care facilities can adapt the same concepts to strengthen or implement a medication reconciliation process.
Numerous barriers continue to inhibit effective medication reconciliation in home healthcare. Accurate medication information is necessary to allow first responders to deliver appropriate care on-scene. The lack of readily available data for unresponsive patients can lead to a poor understanding of a patient’s situation and inaccurate treatment decisions. This chapter provides information on what education patients need to support self-management of their care. Some patients with cognitive impairment may require a higher level of support for medication supervision, such as assisted living.
Medication Reconciliation: CMS Quality Measures to Know
The Institute of Medicine report Preventing Medication Errors1 found that currently most of the studies reported in the literature have small sample sizes and are single-site quality improvement projects. Multisite studies across the continuum of care are needed to assess the scope of the problem. Intervention studies using a variety of approaches, both paper based and electronic, are needed to determine the accuracy, feasibility, and simplicity of maintaining accurate lists of a patient’s medication history. In inpatient facilities, there are several situations where medication reconciliation is needed.
Miller and colleagues,10 upon examining patient records of an ambulatory family practice, found that while 76 percent of patients had prescribed medications, 87 percent of charts had incomplete or no documentation of those medications. Three years following institution of a reconciliation process, which included a form on the chart listing all medications ordered for a patient, 82 percent of charts had complete prescription medication documentation. Similar findings were noted in a study of cardiology and internal medicine practices11 and in a group of patients receiving dialysis.12 Whether patients used the prescribed medications as originally prescribed or if their medications were changed by another physician was not reported.
Accomplishing Medication Reconciliation
According to the Centers for Disease Control and Prevention , 3.8 billion prescriptions are written each year in the United States. One of every five new prescriptions are never filled, and of the ones filled, only about 50% are taken correctly. Non-adherence to medication regimens results in approximately 125,000 deaths due to cardiovascular disease each year. It’s also estimated that about 23% of nursing home admissions and 10% of hospital admissions could be avoided if patients took their medicines as directed. Effect of medication reconciliation at hospital admission on medication discrepancies during hospitalization and at discharge for geriatric patients.
Start the process by assessing the patient’s perspectives and goals about their medications. Providing the patient/family with written information on the medications the patient should be taking when discharged from the hospital, or at the end of an outpatient encounter. Often, the flowchart is the primary process that encompasses the most high-volume entry points into the facility. Sample flowcharts by practice setting are provided for reference in the Appendix. HEDIS is a widely used set of performance measures for managed care.
Geriatric medication reconciliation in the home setting
Medication reconciliation is an important component of the management of a homecare patient and should be conducted at regular intervals throughout the patient’s care. In this chapter, we will discuss the process of guiding a patient through the medication reconciliation process. As CMS notes, potential and actual medication errors are prevalent among post-acute care settings and often occur during transitions in care. Medication regimen review is designed to improve patient and resident safety by identifying and addressing potential and actual clinically significant medication issues at the time of admission and throughout the stay.
Duplicate Drug Therapies - Some patients require multiple prescriptions for the same condition. This can place them at an increased risk of experiencing severe side effects. It’s critical that you note examples of duplicate drug therapies and how it might be affecting the patient during your assessment. Be sure to specifically ask for non-prescription medications like headache relief pills, vitamins, and other supplements as some of these drugs can interact with other medications they might be taking.
Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation
PharmiWeb.com is Europe’s leading industry-sponsored portal for the Pharmaceutical sector, providing the latest jobs, news, features and events listings. The information provided on PharmiWeb.com is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician. If you’re not already participating in medication education, I hope this article provides enough information and resources to help you get started. We can learn about the many tools that are available for medication management systems. We can work with the patient, family, nurse, OT, and PT to determine which system may work best.
I have taken out literally bucket fulls of medications from some homes. It is one of the best ways to do good and potentially save a life. As you say, there are annoying parts, like multiple calls to providers and convincing people to keep meds in labelled containers.
But improving medication reconciliation and adherence isn’t just a systems issue. As a frontline healthcare professional, you can take steps to minimize drug therapy problems. Articles that describe various components of the reconciliation process were found. Studies tended to be about one of the steps in the handoff process, such as admission from home to an acute care facility. No studies were identified that described the reconciliation process along the entire continuum of care from admission to an acute care facility, transfer from one level of care to another , and discharge back to the community to the primary care practitioner or skilled care facility.
Concerning the subject of this blog about medication reconciliation and CMS, we wanted to note that there are HEDIS measures that address or relate to medication reconciliation, a few of which overlap with CMS quality measures discussed above. We've already discussed medication reconciliation post-discharge . As NCQA notes about its MRP HEDIS measure, "Medication reconciliation is a critical piece of care coordination for all individuals who use prescription medications." Patients are living at home longer than ever before and managing multiple chronic illnesses. Many times, this means they are on several medications and require frequent titrations or drug regimen changes.
If a patient can’t hear the discussion about how and why they’re taking a medication, adherence may diminish. Take steps to help the patient get the medical care to address these deficits. The Agency for Healthcare Research and Quality lists patient-centered care as one of the six dimensions of healthcare quality. On your next visit, have a focused conversation with your patient and their caregivers.
Several studies have also investigated the role of enhanced patient engagement in medication reconciliation in the outpatient setting and after hospital discharge. These efforts are promising but also lack evidence regarding the impact on medication error rates. Medication discrepancies in outpatient records were addressed in three studies. Ernst and colleagues9 found discrepancies in 26.3 percent of charts of patients requesting prescription renewal. Of the charts with discrepancies, 59 percent omitted medications from the electronic medical record medication list.
Gathering medication history for reconciliation is a cornerstone of excellent patient care. Gaps in medication history can delay optimal treatment, put patients at risk, and contribute to higher readmission rates. With MedHx℠ and SmartSuite™ automating your process, staff can save as much as 80% of the time they currently spend researching a patient’s medication – time that can be re-invested in diagnosis and care delivery. Medication reconciliation process design should center on the concept of a single list to document patient's current medications. This will be referred to as "one source of truth." This list should be shared and utilized by all physicians, nurses, pharmacists, and others caring for the patient.
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