1. CITIZENS MEMORIAL HEALTHCARE MEDICATION RECONCILIATION JOURNEY 1

3. MIB (make it better) initiated

4. Team established by action plan owner, to include clinical leaders from all disciplines

5. Acute Care

6. Home Care/Hospice

7. Clinics

8. Long Term Care

9. Pharmacy

10. Physicians2

12. Clinical staff

13. Information Specialists or Technicians

14. Quality/Performance Improvement staff

15. A process flow diagram was drawn for each discipline

16. Informal FMEA (failure modes effects analysis) was applied to each process, to identify weak steps or steps lending to failure3

18. The first step included buy in by nurses and physicians to stop using and accepting: “resume all meds”.

19. IS focused on designing improvements in the listing of medications, and methods for electronic med rec for transfers within the system.4

21. To Acute care and physicians

22. An admission/discharge nurse was hired, med.rec. was part of this role’s responsibility

23. Clinics with each visit

24. Home Care – learning to work with a new software program

25. LTC is in initial process of rolling out for admission from home 5

28. Annual one/one competency for nurses

29. Interactive Healthstream courses for nurses

30. One/one education with physicians

31. Monthly news letters with bits of med rec education 7

33. Printable med list on website

34. Articles in CMH quarterly magazine

35. Brief articles in newspaper or on radio

36. Access to med list from electronic portals

37. possibly from Patient Friendly registration card8

38. ED view accessing Reconcile Meds

39. ED and Inpatient Nursing view of Reconcile Meds

40. “Reconcile Meds” with Patient

41. View of Reconciled Medications

42. Inpatient side of Accessing Reconcile Meds

43. Nurses View of being in the process of Med Reconciliation

44. Nursing Reconciled Meds

45. Medication Reconciliation Required Questions

46. Continue From Ambulatory

47. Transferable or Non Transferable Meds

48. Physician View of Discharge Med Reconciliation

49. LTCAdmission Medication process

50. List is printed and faxed to Physician

51. Nurse enters the orders for the Resident

52. Discharged Medication List

53. Medication List

54. Clinics Medication Reconciliation

55. Automatically Reconciles the Patients Medication List

56. Medications Reconciled

57. Medication Summary List

59. We can measure completion of med rec but it is very difficult to find the resources to track accuracy

60. Staff becomes dependent on the system to guide the process

61. Biggest Lesson Learned: We have a process now but if one person does not do their part completely the entire process is impacted and it is hard to identify errors.29

62. For More Information or Clarification Aileen Kelley RN,BC CMH Quality Coordinator akelle@citizensmemorial.com Michelle Cahow CMH IS Specialist michelle.cahow@citizensmemorial.com 30