A nurse is performing medication reconciliation for a client who is being transferred

4. Medication Reconciliation and Quality Assurance

Why Medication Reconciliation is More Than Checking a Box

As your facility takes steps toward improving medication reconciliation, remember that it requires much more than checking items off on a list. To ensure you’re truly helping patients concerning medication reconciliation, here are a few tips to consider.

Don't Approach Patients with Preconceptions

Never assume anything about patients. Every individual will be different: some will speak different languages, others will have various religious backgrounds, and some will have a strong recollection of medications they take while others will not.

Commit More Resources to High-Risk Patients

Your organization should implement procedures to help flag those patients at greater risk for medication errors. High-risk patients may include:

• Those with low health literacy
• Those with multiple co-morbidities
• Those with cognitive impairment due to delirium, medication, or acute illness
• The elderly
• Patients who have been transferred
• Those taking multiple medications

Standardize Documentation

By using a standardized form, you can help reduce potential for unreconciled medications. Find examples of such a form through the Institute for Healthcare Improvement (free registration required), the Agency for Healthcare Research and Quality (AHRQ), and other organizations.

Before changing documentation, ensure staff is educated about the reason for the change and they undergo proper training on the new process.

Avoid Over-reliance on Electronic Records

It’s important that providers don’t rely on electronic records alone. Providers should have the skills, training, and knowledge to ask the right questions of patients and fellow providers to help avoid errors.

Monitor Performance

To maintain confidence that your organization’s medication reconciliation process works as intended, monitor adherence and measure its effectiveness. Develop methods for sharing results and implementing improvements.

Why Medication Adherence is Crucial for Your QI Program

As previously noted, patients don’t take their medicine as prescribed about half of the time. Beyond that, 1 in 4 new prescriptions are never filled.

Non-adherence is a huge hurdle to helping patients get healthy and stay healthy, especially since it significantly contributes to hospital readmissions.

When it comes to quality improvement (QI) initiatives, hospitals should leverage their staff and analytics to achieve meaningful results.

Better Adherence Requires Better Communication

While communication may seem like an obvious step for QI, it’s important that such communication with patients is consistent. A few examples of topics to discuss with patients are as follows:

• Which medicines are being prescribed and why
• Potential side effects
• Importance of immediately calling their provider if they experience anything out of the ordinary

In addition to these points of discussion, reiterate the importance of adherence in patients’ discharge plans. Through early identification of potential adherence mistakes and intervention, clinicians can help keep patients safe and prevent readmissions.

Improve Adherence with Better Stars Score

To motivate hospitals to improve the use of particular drugs, the Centers for Medicare & Medicaid Services (CMS), for its Hospital Compare overall hospital rating, assigned a triple weight to Part D of the scoring criteria for three classes of medicines: antihypertensives, antihyperlipidemics, and oral hypoglycemics for diabetic patients.

According to CMS data, these types of drugs have a significant impact on cost of care and rate of readmissions.

The benefit for hospitals is that if a patient has 80% of days covered or better, hospitals receive three times the benefit in their overall Hospital Compare stars score.

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Which of the following actions should the nurse take as part of the medication reconciliation process?

When should the nurse perform medication reconciliation for a patient?

What is the difference between medication review and medication reconciliation?

When should a patient's medication list be updated?