Industry Spotlight: Medication Reconciliation ... What’s all the fuss?

By: Donna Carroll, Editor, The MEDITECH Community Bulletin

With patient safety initiatives in the forefront of most healthcare organizations’ strategic implementation plans, we decided to turn our Industry Spotlight on one of today’s most important patient safety standards – Medication Reconciliation.

Beginning January 1, 2006, all healthcare settings must be compiling medication lists for new and returning patients and for all patients entering a new level of care. This means each list of recently taken medications must be reconciled against the initial set of orders. For a hospital setting, this includes the admission phase, any intra-hospital transfers and the discharge phase. Finally, this complete medication list must be communicated to whoever is the next healthcare provider in the patient’s continuum of care.

The process of medication reconciliation involves three steps:

1. Verification - Collection of medication history, usually performed by prescriber and/or nurse;
2. Clarification - Ensuring that the medications and doses are appropriate, usually performed by prescriber and/or pharmacist; and
3. Reconciliation - Documentation of changes to orders or reason for differences, performed by pharmacist.

National Patient Safety Goals - Mandatory JCAHO Requirements

The Joint Commission (JCAHO) has developed a set of National Patient Safety Goals (NPSG) which outlines the specific requirements and implementation expectations for healthcare organizations. The purpose of the Joint Commission’s NPSG is to promote specific improvements in patient safety. The goals highlight problematic areas in healthcare and describe evidence and expert-based consensus to solutions to these problems. Recognizing that sound system design is intrinsic to the delivery of safe, high quality health care, the goals generally focus on system-wide solutions, wherever possible. The goals which specifically impact the medication reconciliation process are Goals 8A, 8B and 13, as described below.

Goal 8

Accurately and completely reconcile medications across the continuum of care.

Requirement 8A:

There is a process for comparing the patient’s current medications with those ordered for the patient while under the care of the organization.

Rationale for Requirement 8A:

Patients are most at risk during transitions in care (hand-offs) across settings, services, providers, or levels of care. The development, reconciliation and communication of an accurate medication list throughout the continuum of care is essential in the reduction of transition-related adverse drug events.

Implementation Expectations for Requirement 8A:

1. The organization, with the patient’s involvement, creates a complete list of the patient’s current medications at admission/entry.
2. The medications ordered for, administered to, or dispensed to the patient while under the care of the organization are compared to those on the list and any discrepancies (e.g., omissions, duplications, potential interactions) are resolved.

Requirement 8B:

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. The complete list of medications is also provided to the patient on discharge from the organization.

Implementation Expectations for Requirement 8B:

1. The patient’s accurate medication reconciliation list (complete with medications prescribed by the first provider of service) is communicated to the next provider of service, whether it be within or outside the organization.
2. The next provider of service checks the medication reconciliation list again to make sure it is accurate and in concert with any new medications to be ordered/prescribed.
3. The complete list of medications is also provided to the patient on discharge from the organization.

Goal 13

Encourage patients’ active involvement in their own care as a patient safety strategy.

Requirement 13A:

Define and communicate the means for patients and their families to report concerns about safety and encourage them to do so.

Rationale for Requirement 13A:

Communication with patients and families about all aspects of their care, treatment or services is an important characteristic of a culture of safety. When patients know what to expect, they are more aware of possible errors and choices. Patients can be an important source of information about potential adverse events and hazardous conditions.

Implementation Expectations for Requirement 13A:

1. Patients and families are educated on methods available to report concerns related to care, treatment, services and patient safety issues.
2. The organization encourages patients and their families to report concerns about safety.

Compliance with these requirements is assessed throughout the accreditation cycle, through on-site surveys, and the Periodic Performance Review. When an organization does not fully comply with a requirement, the organization will be assigned a requirement for improvement, and all requirements for improvement must be addressed in an Evidence of Standards Compliance (ESC) Report. Failure to resolve a requirement for improvement affects an organization’s accreditation decision, which could ultimately lead to a loss of accreditation.

Medication Reconciliation – A Solution

With these NPSG requirements in mind, and the severe penalty for non-compliance, many healthcare organizations are scrambling for an appropriate solution which is both cost-effective and easy to implement and maintain.

One such solution, MediRecon, a product of MediModules, Inc., is rising to the top of the solution list for many healthcare organizations. MediModules recently established a strategic partnership with CRH Consulting, Inc., a health IT consulting company in Massachusetts. We recently spoke with Drs. Abha Agrawal and Munish Khaneja of MediModules, and CRH Consulting’s President, Todd Babineau, to learn more about the MediRecon solution. Below is a summary of our conversation.

Q. What distinguishes MediRecon from other medication reconciliation products on the market?

A. First, and very importantly, is the fact that MediRecon was developed by physicians. Because medication reconciliation information systems can be challenging to deploy without clinician buy-in, it’s important to know that the chosen solution has not only been tested, but was actually designed by physicians who know the work flow process better than anyone else.

Furthermore, MediRecon was designed using a patient-centric approach. That is, the product ensures patients’ involvement in the reconciliation process via a bi-directional connectivity with a patient portal, MyMediList (http://www.mymedilist.org/). MyMediList is a free personal medication record offered by MediModules, Inc, free-of-charge to customers.

Q. What healthcare settings and provider types is MediRecon designed for?

A. MediRecon is an effective solution for medication reconciliation for all types of outpatient settings (including home care) and for all three stages of the inpatient process: admission, discharge, and transfer (ADT). It provides a secure, seamless workflow for all clinicians: physicians, nurses, and pharmacists.

Q. Specifically, how does MediRecon accomplish the Joint Commission’s NPSG requirements?

A. MediRecon provides extensive audit logs for all transactions, including medication edits, profile updates, and connectivity transactions. To ensure ease-of-communication with the next level of provider upon a patient’s discharge from the clinic or inpatient facility, MediRecon provides tools such as MediRecon-Fax and Secure E-mail.

According to NPSG Goal 13, the patient must be an active participant in their safety plan. MediRecon’s bi-directional connectivity with the patient portal fulfills this requirement. MediRecon provides patient-friendly printouts, which are also suitable for placing in paper records. In addition, MediRecon is built with easy-to-interface technology and is capable of interfacing with prescription claims data, as needed.

Q. How is MediRecon deployed and what resources are necessary to maintain it?

A. MediRecon is a web-based solution, so it is available anytime, anywhere. There is no need to install any software, and minimal hardware requirements. Our team will work with hospital personnel (IT and/or medical staff) during the initial deployment in order to ensure accurate setup. Alternatively, you may choose to install MediRecon on your own servers, if desired.

Q. What about interoperability with EMR/EHR or ADT systems, and security?

A. MediRecon’s use of standards, web-services technology, and XML ensure easy integration with any EMR/EHR product or ADT system. MediRecon’s multi-level security model provides strong security and ensures each record is secure, encrypted, and protects against unauthorized access.

MediRecon is a web-based medication reconciliation solution developed by Dr. Abha Agrawal (CEO) and Dr. Munish Khaneja (CMO) of New York-based MediModules, Inc. For additional information or to learn more about the MediRecon solution, please contact CRH Consulting Inc. at MediRecon@crhconsult.com This e-mail address is being protected from spambots. You need JavaScript enabled to view it .