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A Chicago hospital overcomes its struggle to implement medication reconciliation by getting leaders truly on board.

"Get leadership buy-in" is the recommended first step in almost every patient-safety initiative. But gaining leadership's OK doesn't always guarantee a program's success. As Northwestern Memorial Hospital in Chicago learned, some initiatives require more than buy-in. They need actual participation.

In 2006, Northwestern Memorial's quality team had done all the recommended steps to meet The Joint Commission's medication reconciliation requirement, but the 621-staffed-bed hospital's compliance hovered around 40%. Kristine Gleason, RPh, clinical quality leader at Northwestern, and her team held focus groups to help identify the problems. The resulting feedback was that, although the process itself was sound, the communication around the process was inconsistent. Although Northwestern's chief medical officer was a staunch supporter of the initiative, medication reconciliation wasn't perceived as an organizational priority within individual departments.

"We needed touch points from every discipline. It means a lot to know the CMO is involved, but it means more to know each individual leader is involved," Gleason says.

They formed a medication reconciliation leadership team composed of the chief medical officer, the chief of surgery, the chief informatics director, the directors of nursing and pharmacy, three quality leaders, and the president of Northwestern's outpatient areas.

What came out of the team's meetings every two weeks was that, although Gleason and her team thought they had leadership's endorsement across the board, not all leaders prioritized medication reconciliation to the same degree. Gleason and her team spent almost six months collecting and sharing data, providing examples of medication reconciliation successes and failures, and teaching the leaders how medication reconciliation fits into medication management and other hospital initiatives.

Once they'd achieved true leadership buy-in, the leaders of the medication reconciliation effort retrained close to 850 employees through a multidisciplinary training that included nurses, pharmacists, and physicians. Today, Northwestern's medication reconciliation compliance ranks above 90%, and the goal for 2008 is to stay above 95%.

Molly Rowe

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