UMass Memorial Medical Center Medication Reconciliation Eric Alper, M.D., Patient Safety Officer

1. UMass Memorial Medical Center Medication Reconciliation Eric Alper, M.D., Patient Safety Officer

2. Our team: Team Leader: Eric Alper Faciliator: Jeanne Seligowski, Ellen Felkel-Brennan Pharmacy: Christian Hartman, Thomas Magnant, Denis Brown, Gerald Longencker Nursing: Anne Holland, Anne Smith, Gail Leger, Jacqueline Bergeron, Paulette Seymour-Route (CNO) Sponsor: Gerald Steinberg (CQO) 2

3. Medication errors based on chart review Source: Luther Midelfort Hospital -- Mayo Health System chart review “We found that the list of medications that details current drug use was either nonexistent or wrong more than 85% of the time” [Rozich/Resar 2004, p.8] 3

4. Examples of errors • No orders for needed home meds • Surgeon inadequately addressing meds for chronic conditions • Failure to restart meds at transfers • Doubling up (brand/generic combinations, formulary substitutions) 4

5. Problem identified • Home med lists not systematically collected • In multiple places in the chart, often incomplete or discordant • Inadequate processes to compare list of pre-admit medications to orders 5

6. “Reconciling Medications” A systematic process of creating the most complete & accurate list possible of every patient’s pre-admission medications and then comparing that list against the physician’s admission, transfer, and/or discharge orders. Discrepancies are brought to the attention of the physician and, if appropriate, changes are made to the orders. Any resulting changes in orders are documented. 6

7. Our Engagement with Medication Reconciliation • Began early ’03 • Joined IHI IMPACT • Mass Coalition convened Collaborative 7

8. Process • Designed pilot form • Designed pilot process • Multiple tests of change and revisions • Gradually increased scope • Broad education • Meetings • Internal Publications • Measurement 8

9. Process: • Wrote policy • Endorsement by Clinical Performance Improvement committee and Medical Staff Executive committee • Revised related documentation • Admission orders • Nursing Admission database • Reviewed Medication reconciliation form • Completed Medication reconciliation form • Discharge instruction module • Continued Measurement • Continued revision • Shared 9

10. 10

11. 11

12. 12

13. 13

14. 14

15. 15

16. 16

17. Percent ADE(s) Pilot and System Method 17

18. 18

19. Patient Discharge Instructions 19

20. 20

21. 21

22. 22

23. 23

24. Shared our form and our experience: • MA Coalition meetings • IHI 100K Lives calls • Visited local hospitals • Spoken directly to VHA members (in Northeast, Connecticut, Pennsylvania, Central, Central Atlantic, Pacific, Michigan, Southwest regions) 24

25. We (at UMass Memorial and MA Coalition) have led the country on this important means of improving patient safety

26. This project: • Crossed the whole organization • Required the knowledge and focus of thousands of individuals • Required repeated process redesign at multiple levels • Has helped to start changing culture around patient safety 26

27. In conclusion, • In this age of public reporting… • We all have “green dots” and “red dots”… • At UMass Memorial, we are always striving to deliver safe, high quality care and to be leaders where we can • Especially at this time, UMass Memorial genuinely appreciates this recognition as we try to continually improve health care for the people of Central MA and the Commonwealth 27