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FRHS Kaizen Workshop #1. Medication Reconciliation (MRR) Admission / Discharge Only October 3-5, 2007. Kaizen #1: Medication Reconciliation Admit / Discharge. Mission: To improve the process of medication reconciliation to assure patient safety. Objectives:

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frhs kaizen workshop 1

FRHS Kaizen Workshop #1

Medication Reconciliation (MRR)

Admission / Discharge Only

October 3-5, 2007

kaizen 1 medication reconciliation admit discharge
Kaizen #1: Medication Reconciliation Admit / Discharge


To improve the process of medication reconciliation to assure patient safety.


1. Achieve a 50% improvement in accuracy of medication information upon admission.

  • Reduce nursing time spent by 12.5%/day.
  • Reduce delays in medication administration by 50%.
  • Reduce medical errors by 80%
  • Support the new hospitalist program.

Train-the-Trainer objectives

6. Learn Lean tools as process improvement method.

7. Diffuse improvement mindset throughout the hospital.

8. Reduce waste throughout all major processes.

kaizen team work
Kaizen Team Work

David, Beth, Steve, John, Rhonda, Beth H, Melissa, Carol, Mark, Missy, Vicky, Gloria, Alison, Patsy



Total Admission times:

Min: 97.2min

Max: 2.5 hr

Process Efficiency: 100% max, 31% min


Standardized process for FRHS physician offices in relaying med list.

Discharge form placed on each chart at each location


Create standing orders


and/or Give meds

Obtain list of current meds;

Contact physician

Contact external pharmacy

Contact admitting physician to identify meds

Reconcile meds

Direct Admit

How to get?

Review initial orders

Nurse write out med list (if needed);

Fax order to internal pharmacy

All pre-op meds discontinued when going tosurgery/transfer;

Pharmacyout of loop;

No auto discharge between units.

15 min

External Transfer

Review external facility list

Computer versus manual documentation system for meds (ED gets but another area enters)

Physicians don’t respond


Nursing making decisions outside scope of practice. Collaboration with pharmacy.

incomplete orders are not written and relayed to pharmacy – i.e. no dose, route.

1-2 hours

Physicians don’t write full admit med’s list;

Nurses act on med’s list

Nurses temp orders are cancelled and re-entered

20 sec to 15 min

Admit/PCP don’t agree on med list for patient

Education improvements for new people.

30 – 60 min




Process Efficiency for discharge: 56% Best 30% Worse Case



Physician discharge order form and signs

Print Discharge Instructions

Are meds complete?

Computer generated list of all home meds and meds taken while hospitalized.


Should list only meds active on day of discharge.

Complete separate forms as needed for transfers.

Calls physician to complete list

Physician task to write meds, activity, diet, etc.

Enter full info into CPSI

Incomplete physician meds;

Or continue home meds;

Physicians don’t respond till later.

Discharge order about not on all charts. Educate nurses and physicians on location.

Redo work to getting transfer forms completed.

Physicians not writing complete list of meds for patient to continue to take.


15 min

2 min

Total Time:

Min: 41 min

Max: 112 min

2 min to 1 hr

: Value Added

: No value added