Presented to: AHRQ Attendees AHRQ 2007 Annual Conference September 27, 2007 By Kristine Gleason, RPh Quality Leader, Cli

1. Medications At Transitions and Clinical Handoffs (MATCH): Multi-disciplinary Team Approach to Medication Reconciliation Presented to: AHRQ Attendees AHRQ 2007 Annual Conference September 27, 2007 By Kristine Gleason, RPh Quality Leader, Clinical Quality and Patient Safety Supported by a grant from the Agency for Healthcare Research and Quality (AHRQ) 5 U18 HS015886

2. Discussion Overview Multi-Disciplinary Approach for Medication Reconciliation Designing a Process within Inpatient and Outpatient / Procedural Areas Education and Team Training – “Med Rec Roadshow” Measurements for Improvement Session Objectives - To describe patient-centered tools and re-engineering of processes to improve the effective and safe delivery of medications across the healthcare continuum.

3. What is Medication Reconciliation? Medication reconciliation impacts all patients at NMH who receive medications • A systematic process to decrease medication errors and associated patient harm by: • Obtaining, confirming and documenting the patient’s complete list of medications upon admission • Comparing and screening this list against the medications prescribed • Reconciling (resolving) unintended medication discrepancies • Communicating an updated medication list, highlighting any changes, to the patient and next provider of service upon discharge • The Joint Commission National Patient Safety Goal #8

4. Northwestern Memorial Hospital - Chicago, Illinois • 744-bed Academic Medical Center • Fiscal Year 2006: • 43,000 Admissions • 10,000 Deliveries • 74,000 ED Visits • 430,000 Outpatient Registrations • NMH Strategy: • Provide the Best Patient Experience • Recruit, Develop and Retain the Best People • Achieve Mission and Vision through Exceptional Financial Performance • Recipient of 2005 National Quality in Healthcare Award • New Prentice Women’s Hospital Opening October 20, 2007

5. Getting Started or Moving Forward • Organizational Risk Assessment • Operational Component • Research Component • Collaboration • Support

6. MATCH - Specific Aims • Aim 1:Implement the MATCH program utilizing an integrated, multidisciplinary process (NPSG – operational component) • Aim 2: Analyze the implementation and compliance of MATCH program (NPSG – operational component) • Aim 3: Determine the rate and etiology of medication reconciliation failures within the general medicine service after MATCH implementation (research question) • Aim 4: Identify risk factors frequently responsible for inaccurate medication reconciliation (research question) • Aim 5: Produce and disseminate a toolkit based on MATCH (implementation / research summary) Supported by a grant from the Agency for Healthcare Research and Quality (AHRQ) 5 U18 HS015886

7. Designing a Multi-Disciplinary Approach

8. Medication Reconciliation – Improvement Initiative Multi-disciplinary team approach - physicians, nurses and pharmacists • Increase accuracy and completeness of medication history • Create “one source of truth” (Med Profile) • Complete medication description (name; dose; route; frequency) • Validate home medications with patient, family and/or other sources • Prompt clinicians to complete medication reconciliation • Reconcile all medications (home and current medication orders) during transitions in care • Achieve >90% compliance at admission and discharge to meet The Joint Commission requirement

9. Medication Reconciliation: “One Source of Truth” for All Medications (Inpatient and Outpatient) Physician Medication Reconciliation Patient Interaction Nurse Medication Reconciliation Pharmacist Medication Reconciliation HEALTHCARE PROFESSIONAL PATIENT MEDICAL RECORD

10. Built in Forcing Functions - Admission Order Set Med Rec Integrated within Physician Admission Order Set

11. Built in Forcing Functions –Physician PowerForm Example

12. Built in Forcing Functions Cont. – Nurse / Pharmacist PowerForm Example

13. Standardized Process - Procedural Areas and the Emergency Department

14. Education, Training and Feedback

15. Medication Reconciliation “Roadshow” • Significant Technology Enhancements • 60+ Computer Classroom Training Sessions Conducted • 341 physicians trained (focused on residents) • 450 Nurses, APNs, NPs • 51 Pharmacists • Unit-by-Unit In-services • Prioritization and support reinforced by Medication Reconciliation Leadership Team • Weekly audits to identify areas for improvement and to provide feedback

16. Critical Thinking – Clarifying Discrepancies Identified During Reconciliation* *Adapted from Gleason et al. Am J Health-Syst Pharm. 2004; 61:1689-95.

17. Medication Reconciliation Results: Adherence to Process

18. Medication Reconciliation Results - Admission Mandatory Training Program Definition: Documented compliance with recommended Medication Reconciliation upon inpatient admission (physician, nurse, and/or pharmacist) Definition: Documented compliance with recommended Medication Reconciliation upon outpatient arrival (includes 20 departments) A M C D I

19. Medication Reconciliation Results - Discharge Definition: Documented compliance with recommended Medication Reconciliation at discharge (physician and nurse) Definition: Documented compliance with recommended Medication Reconciliation upon discharge (physician and nurse) A M C D I

20. Medication Reconciliation ResultsMulti-disciplinary Team Approach at Admission A M C D I

21. Continued Focus on Patient Safety

22. Assessing the Quality of Medication Reconciliation Goal: To eliminate avoidable adverse drug events and associated patient harm due to medication discrepancies. • Evaluation of the medication reconciliation process post-implementation to determine: • Frequency and causes of medication reconciliation failures • Type of discrepancies involved • Potential patient harm averted • Patient and/or medication-related risk factors frequently responsible for inaccurate medication reconciliation Supported by grant number 5 U18 HS015886 from the Agency for Healthcare Research and Quality (AHRQ).

23. MATCH Toolkit - www.medrec.nmh.org

24. Questions, Answers and Discussion Kristine Gleason, RPh Quality Leader, Clinical Quality and Patient Safety Northwestern Memorial Hospital, Chicago, IL kmgleaso@nmh.org MATCH Toolkit available at: http://www.medrec.nmh.org We acknowledge the supported of the Agency for Healthcare Research and Quality (AHRQ) 5 U18 HS015886