The Challenges of Integrated Medication Reconciliation

BlogHeather McKenzie                                                                                                   Nurse Informaticist, Westat                                                                                 Co-Chair, HIMSS Continuity of Care Task Force                                             Member, HIMSS Ambulatory Committee 

The other day I picked up the phone and was greeted by a voice filled with angst. An assisted living facility (ALF) resident had been recently hospitalized, and during the transition, an outdated medication list had been sent with the patient’s record.  As a result of being notified of medication changes that occurred while the resident was at the ALF, this family member recognized the discrepancy and was frantic to get an updated list to the hospital and nurse on duty.

How could this happen in today’s digital world? Although the ALF may not have a comprehensive electronic medical record (EMR), it does have technology—computers, laptops on carts, tablets, printers, copiers, scanners, wireless phones—all connected in a networked environment to support the use of electronic record systems for pharmacy, demographic profiles and activities of daily living documentation. However, the most up-to-date medication information for the resident was in the electronic pharmacy software system and the medication reconciliation process did not occur.  As a result, the “latest and greatest” medication list was not extracted from the information technology tool.

As I sifted through the paper chart, printed the medication list from the pharmacy system, and dialed the fax machine number to transmit the requested data, I reflected on what triggered the transfer of old data. It was quite simple and vexing. Within all of the required paperwork for transfers there was no formal policy or process that was consistently implemented and supported by a standard set of procedures and tools to ensure that medication reconciliation occurred at every care transition (e.g., admissions, discharges, and transfers to and from other facilities and providers of care).

If these procedures had been implemented at the time of the resident’s initial admission into the ALF, the previous medication list would have been marked as old and reviewed and the staff member would have been visually prompted to print an updated list. This would have prevented potentially adverse events and streamlined the work of the staff member caring for the resident during the stressful emergent situation.

Though medication reconciliation may seem so simple, when it is not fully supported by policy, processes, procedures, tools and training, it is one of the first breakdowns that occur at the time of care transitions. Combined with the intensity of performing a care transition during a highly stressful urgent or emergent situation, you can all but guarantee that something will be missed. Now more than ever, medication reconciliation toolkits are needed to support every aspect of this process—from policies, procedures, and processes to tools and trainings—to help every provider type achieve 100% compliance with care transition leading practices.

HIMSS has just launched its Electronic Medication Reconciliation (Med Rec) Resource Libraryto help providers and organizations understand and develop the needs, processes, procedures and importance of electronic medication reconciliation.  This vetted repository of health IT and electronic medication reconciliation for care coordination provides an analysis of and links to publically-available industry resources, tool and case studies.

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