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:
Medication Reconciliation (MRR)
Admission / Discharge Only
October 3-5, 2007
To improve the process of medication reconciliation to assure patient safety.
1. Achieve a 50% improvement in accuracy of medication information upon admission.
6. Learn Lean tools as process improvement method.
7. Diffuse improvement mindset throughout the hospital.
8. Reduce waste throughout all major processes.
David, Beth, Steve, John, Rhonda, Beth H, Melissa, Carol, Mark, Missy, Vicky, Gloria, Alison, Patsy
Total Admission times:
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 external pharmacy
Contact admitting physician to identify meds
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.
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.
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.
Min: 41 min
Max: 112 min
2 min to 1 hr
: Value Added
: No value added