April 14, 2006

Be med smart: Reconciling medications across the continuum of care

With the rise of medication errors an alarming concern for health care organizations across the country, many hospitals — including the MGH — are putting into place or improving existing systems that monitor and track patients' medications throughout their health care experience. Ample evidence in medical literature shows that discrepancies exist between the medications that are documented by the health care providers and what patients actually use at home. Integrating these differences is a process called medication reconciliation.

Medication reconciliation includes obtaining a complete list of medications that a patient is taking prior to admission — including name, dosage, frequency and route — and comparing the admission, transfer and discharge orders for medications to that original list. The primary goal of this process is to reduce the risk of clinically important omissions, dosage errors or other types of discrepancies as patients travel through an often-complex path of care.

Studies have shown that poor communication about medications at transition points — such as hospital admissions, transfers to secondary care facilities or discharges Ð is responsible for up to 50 percent of all medication errors. Another goal of this process is for clinicians to review previous medication orders alongside new orders when patients move from one setting to another and reconcile any differences in the medications.

"Reconciling medications is essential to optimize medication safety at the MGH," says Gregg Meyer, MD, medical director for the Massachusetts General Physicians Organization and chair of the Signature Initiatives Committee. "We need all of our clinicians to work together and with our patients to make sure these medication lists are accurate and are maintained. While this is a JCAHO standard as part of the National Patient Safety Goals, more importantly, it is the right thing to do to keep our patients safe from medication errors."

The MGH will be introducing a new module in Provider Order Entry (POE) April 25 that will make the medication reconciliation process easier for all clinicians — physicians, nurse practitioners, physician assistants, nurses and pharmacists — who are responsible for maintaining these medication lists.

The new module in POE is an electronic version of a medication list. Called the
Pre-Admission Medication List (PAML), this list of all prescription, over-the-counter and herbal medications taken by the patient at home must be completed by the admitting or treating physician within 24 hours of a patient's admission. After the PAML has been created, any member of the care team may enter additional medication information. The PAML will be reviewed, verified and reconciled at various junctures of the patient's care such as before transfers or before discharge.

"This process is a vital partnership between our patients and our caregivers,
and it also is essential to have every member of the care team work together to keep the PAML accurate," says Jeanette Ives Erickson, RN, MS, senior vice president
for Patient Care Services and chief nurse. "We are confident this new electronic
system will streamline this process and make it easier for all of our clinicians to keep our patients safe."

For more information about the medication reconciliation initiative, contact Pat McCarthy at (617) 724-6771.

Medication Reconciliation Project rollout

April 25: General Medicine — White 8, 9 and 10, Ellison 16
May 1: General Medicine, Oncology
Bigelow 9, Blake 7, Ellison 14
May 8: Pediatrics — Ellison 17, 18 and PICU
May 15: Cardiology and Psychiatry
Ellison 9, 10, 11, Blake 11
May 29: Neurology and Burn Unit
Bigelow 12, White 12, Ellison 12, Bigelow 13
June 5: General Surgery, Vascular Surgery
SICU, Ellison 7, White 7, SICU, Bigelow 14
June 12: Orthopaedics, Gynecology and Transplant
Ellison 6, White 6, Bigelow 7, Blake 6
June 19: Medicine — Ellison 20, 21, Bigelow 11, White 11
June 26: General Surgery, Cardiac Surgery
Ellison 8, 19, 22 and Blake 8
July 10: Obstetrics Ellison 13, Blake 13, 14 and NICU