Medication Reconciliation

1. Medication Reconciliation Dept of Family Medicine and Community Health Bethesda, Broadway, Phalen, Smileys Clinics Nov 8, 2018

2. Disclosures • No funding disclosures

3. Quality Gap • Patient safety • Medication reconciliation seldom done • <5% of visits with documented medication reconciliation • MIPS measure

4. Aim / Measures Aim By Sept 30 2018, implement a systematic medication reconciliation process and document provider or pharmacist medication reconciliation* on 70% of patient visits. * Med reconciliation defined as the process of identifying the most accurate list of medications that a patient is taking. This includes name, dosage, frequency, and route. The list should include all known prescriptions, OTC, herbals, and vitamin/mineral/dietary(nutritional) supplements. Measures • % visits with med rec documented by provider or pharmacist (outcome) • % visits with attempted med rec documented by PCS staff (process) • % staff/providers able to articulate med rec process (process) • % staff/providers satisfied with med rec process (balance)

5. Interventions • Design a team-based med reconciliation process (June-Oct 2017) -- Multiple PDSAs -- Process flow diagram -- Pilots (Aug-Oct 2017) 2. Training and implementation (Nov/Dec 2017) 3. Re-education / training (July 2018) 4. Satisfaction surveys (June 2017, May 2018, Sept 2018)

6. Intervention - Process Flow Diagram (1)

7. Intervention - Process Flow Diagram (2)

8. Interventions – Examples of PDSAs Medication review methodology by PCS – PDSAs • Paper method • EMR – Meds section • EMR – Orders section • EMR – Home meds section

9. Outcomes Re-education Training Pilots

10. Sustain / Spread Sustain • Standard work written • Supervisor audits for PCS • Monthly data • Review data quarterly at FaMQIC • Intervene if needed Spread • Presenting at STFM Practice Improvement Conference (Dec 2018)