Initiatives

Instructions for Data Collection

1. Select a multidisciplinary team of reviewers (a nurse, a pharmacist, a physician)
2. Select random set of 20 closed patient records
   (minimum stay of 3 days as a general rule)
   Baseline: select from all hospital records; Ongoing: select from pilot unit(s)
3. Identify the home medications list
   1. If there is a reconciling form in the chart (ongoing measurement only)
      Use patient’s home med list on reconciling form.
      Also enter Yes in Column A for that patient and enter Yes in Column B if the form is in the proper location (optional measures)
   2. If there is no reconciling form (baseline or ongoing measurement)
      Compile patient’s home medication list on a blank copy of a patient medication verification/reconciling form (Coalition version or one built from your own form)
      Record every med, dose, frequency, and route

   Remember: goal is to create a “good enough” home medication list for the audit
   Potential sources for home medications: nurse’s intake assessment, physicians H&P and progress notes, patient’s lists (see more detailed instructions in baseline measurement protocol)

4. Add up total number of home medications
   For each patient, count the total number of home medications listed and enter in
   Column C of the summary tally form

   Decide on your team’s rules for what medications to consider, write them down and stick to them.
   Many teams have decided that if the patient takes a medication on a regular basis, it should be listed. A few have deemed some medications insignificant for the purposes of this evaluation and note those as N/A in this review. These meds may include, but are not limited to, OTC drugs such as Tylenol, vitamins, herbal therapies, stool softeners or laxatives.

5. Add up total number of unexplained variances
   For each patient, compare each medication ordered with the home medication list, and put the sum of all unexplained variances in drug, dose, frequency and route in Column D
   • If there is any discrepancy in the drug, dose, frequency, or route without evidence of clarification, count it as unreconciled
   • If a home medication is omitted, without evidence of clarification, count it as unreconciled
   • Do not count the obvious variances (e.g. patient admitted for bleed due to warfarin”, warfarin should not be ordered; medication ordered that substitutes for a home medication (generic or formulary substitution); patient is NPO, home medication to be given in IV form)

   Again, decide on your rules and stick to them. The goal is to spotlight unresolved variances in medication information; each discrepancy implies a potential medication error.

   Use the notes column to keep a running list of the nature of discrepancies identified to share with leadership; in particular, note any orders changed, clear examples of successfully preventing harm reaching patients. LT goal is to move back upstream to prevent these discrepancies from occurring.

6. Calculate Percent Medications Unreconciled: (Sum D)/(Sum C) * 100

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