Initiatives
Instructions for Data Collection
- Select a multidisciplinary team of reviewers (a nurse,
a pharmacist, a physician)
- 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)
- Identify the home medications list
- 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)
- 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)
- 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.
- 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.
- Calculate Percent Medications Unreconciled: (Sum D)/(Sum C)
* 100
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