Tackling medication reconciliation

Howard J. Anderson, Executive Editor
Health Data Management Magazine, May 1, 2009

For many hospitals, medication reconciliation is a paper-intensive process. That’s because using information systems to track all prescribed and over-the-counter drugs a patient takes before, during and after a hospital stay has proven challenging. But some hospitals are taking steps to automate some, or all, of the steps involved to help improve patient safety.

For example, 25-bed Citizens Hospital in Bolivar, Mo., has eliminated all paper records in medication reconciliation by using a module in its clinical system from Meditech Inc., Westwood, Mass. If a newly admitted patient has been treated at one of Citizen’s clinics, the module is pre-populated with outpatient medications that a nurse verifies with the patient, says Kim Maples, R.N., clinical application specialist.

Otherwise, the nurse creates a list of medications from scratch using the module. A physician then uses the module to indicate which medications should be continued during the hospital stay. Upon discharge, doctors use the module to select drugs the patient should continue to take at home.

Arnot Ogden Medical Center in Elmira, N.Y., follows a similar process. Patients treated at its affiliated clinics have medication histories stored in an outpatient record from Allscripts-Misys, Chicago. Using a data repository from the vendor, the hospital grabs that information and displays it in its inpatient clinical system from QuadraMed Corp., Reston, Va., to start a reconciliation record, says Gregg Martin, CIO. At discharge, clinicians use the reconciliation record to indicate the drugs a patient should continue at home, he adds.

Some hospitals are making a gradual transition from paper-based to electronic medication reconciliation processes.

At three-hospital Tanner Health System in Carrollton, Ga., nurses use an electronic medication administration record to enter patient’s historical medications upon admission, says Melissa Robertson, director of nursing at one of the hospitals. The medication history is then printed, and doctors then check off which drugs to continue. The form is then faxed to the pharmacy. In August, Tanner expects to automate these paper-based steps, Robertson says.

When a patient is being discharged, doctors now review a printout of medications from the EMAR, which is in a clinical system from Meditech. The hospitals are automating that process so instead of checking off on the printout what drugs should be continued, doctors will make the selections on the computer, Robertson says. Then patients will be sent home with a printed version of the updated medication list.

But many hospitals, even those that have automated medication administration, still handle the bulk of their medication reconciliation chores on paper.

The 252-bed Springhill Medical Center in Mobile, Ala., for example, has relied on paper while waiting for its core clinical software vendor to develop specific enhancements for reconciliation, says Pam Shedd, R.N., manager, clinical applications. Nurses fill out a paper form upon admitting a patient and then fax it to the pharmacy. Upon discharge, a list of medications the patient was on at the hospital is printed out, and clinicians mark which ones the patient should continue to take. “We’re hoping to automate all this eventually,” Shedd says.

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