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Applying DMAIC Methodology to Medication Reconciliation. Prepared For [Date] By. Define. Measure. Analyze. Improve. Control. Who are the customers and what is the problem from their perspective?. What are the most important drivers of poor performance?.

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Presentation Transcript
slide1

Applying DMAIC Methodology to

Medication Reconciliation

Prepared For

[Date]

By

process improvement methodology dmaic

Define

Measure

Analyze

Improve

Control

Who are the customers and what is the problem from their perspective?

What are the most important drivers of poor performance?

How do we ensure that we sustain the improved performance?

How is the process performing today and how is it measured?

How do we remove the drivers of poor performance?

Process Improvement Methodology (DMAIC)

DMAIC Provides An Easily Managed Systematic Process To Deliver Measurable Results and Accelerate Change

improvement teams
Improvement Teams

Proper Team Establishment Increases Probability For Success

Project Executive Sponsor

Clinical / Academic Sponsor

(As Required)

Project Sponsor

Improvement Leader

Process Owner

Improvement Team

slide4

Medication History, Reconcile

Order, Transcribe, Clarify

Dispense, Deliver

Administer

Monitor

Educate, Discharge

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Defining Problem: Analysis of Root Causes

  • Identified failure modes (FMEA)
  • Incomplete and/or incorrect medication orders on admission
  • Inadequate or missing information on the patient's admission profile
  • No formalized approach/process to obtaining and documenting a medication history
  • Identified root causes
  • Incomplete/inaccurate medication history (omission, different dose, route or frequency, look alike-sound alike)
    • Patient’s ability to recall, especially upon admission
    • Time constraints
    • Interview skills of clinician
  • Multiple locations to document (free text)
  • Pharmacist not formally integrated in process
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Defining Problem: Challenges to Obtaining Medication Histories

  • Patient’s and/or surrogate’s ability to recall medications, doses and/or frequency of use
  • Stress of transitioning through the healthcare system
  • Health literacy
  • Language barriers; cultural beliefs
  • Relationship with healthcare clinician obtaining history
  • Interview skills of clinician
  • Time constraints
  • Accuracy and completeness of medication histories obtained from other resources; accessibility
medication history reconciliation pilot results direct admits to med surg units n 204

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Medication History / Reconciliation: Pilot ResultsDirect Admits to Med/Surg Units*(N=204)
  • 54% of patients had at least one medication discrepancy
  • 42% of the discrepancies requiring intervention was complete omission of a medication
  • 35% of the discrepancies requiring intervention was a different dosage, route or frequency with what the patient reported taking before admission
  • Of the discrepancies requiring clarification, in the absence of a pharmacist intervention, 22% may have resulted in patient harm during hospitalization and 59% may have resulted in patient harm if continued beyond discharge

* Gleason KM, Groszek JM, Sullivan C, Rooney D, Barnard C and Noskin GA.Reconciliation of Discrepancies in Medication Histories and Admission Orders of Newly Hospitalized Patients. Am J Health-Syst Pharm. 2004; 61:1689-95

medication history reconciliation most effective interventions

Medication History, Reconcile

Order, Transcribe, Clarify

Dispense, Deliver

Administer

Monitor

Educate, Discharge

A

M

D

C

I

Medication History / Reconciliation: Most Effective Interventions
  • Single source of truth: Medication list with technology support
  • Reconciliation process with technology support
  • I/T design and continuous monitoring
    • Compliance, sustainability of new process
    • Identify rate, etiology and potential harm of medication discrepancies for process improvements
  • Active patient involvement
  • Active pharmacist involvement
match improvement initiatives

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MATCH Improvement Initiatives

Implement a system that achieves the below:

  • Increase accuracy and completeness of medication history
    • Create “one source of truth”
    • Complete medication description (drug name, dose, route or frequency – no free text)
  • Reconcile home medications with patient and/or family
  • Reconcile all medications (home and current medication orders) at admission, transfer and discharge
    • Multi-disciplinary approach with physicians, nurses and pharmacists

I

approaches to evaluate medication reconciliation process
Approaches to Evaluate Medication Reconciliation Process
  • Determining compliance rates
  • Type and etiology of medication discrepancies requiring interventions
  • Medications / medication classes involved in discrepancies requiring interventions
  • Potential harm averted through intervention
  • Retrospective v/s prospective review