Medication Reconciliation Ensures Staff, Patients Have Accurate Med List
BWH’s implementation team responsible for the electronic medication reconciliation process or PAML (pre-admission medication list) has made several modifications and improvements to the system since it was first implemented last year.
BWH is committed to ensuring staff have access to an up-to-date and accurate list of a patient’s home medications at admission and providing that same accurate and updated list to patients at discharge or transfer to another care facility. The Joint Commission requires this, and the PAML implementation team is working so staff can meet this safety standard efficiently.
The medication reconciliation system features a hard-stop at discharge to ensure that all patient records include a PAML that is reconciled at admission and discharge. In May, PAML was enhanced to enable providers to move medications directly from the PAML to BICS Order Entry to streamline the medication reconciliation and ordering process for clinicians. In August, another hard stop was implemented to prevent clinicians from inputting new orders for patients if the PAML has not been created and reconciled within the first 24 hours of admission.
With these enhancements, the PAML completion rate within 24 hours of admission increased from 45 percent to 70 percent, and the implementation team continues to explore additional enhancements to get hospital-wide medication reconciliation closer to 100 percent.
This makes the PAML available for the nurse at the bedside to print and review with the patient for accuracy. According to Ellie Bergeron, RN, a member of the implementation team, this reviewed PAML now serves as the accurate medication source for admission and discharge orders.
The implemtation team is working with the Emergency Department and ambulatory clinics and practices on medication reconciliation processes. The ED recently implemented a new process to ensure patients receive an updated list of their medications and leave with a better understanding of those medications. This also improves communication throughout BWH and involves the patient in their care.
“We have increased our compliance significantly in the few weeks since this new form was introduced, and are steadily improving as doctors and nurses incorporate the use of the form into their work flow,” said ED Nurse Manager Heidi Crim, RN.
The Office of Patient Safety has teamed up with care providers to launch medication reconciliation pilots tailored to each location, including BWH Primary Care at Faulkner, Newton Corner, Norwood and Jamaica Plain health centers.