In 2007, The Joint Commission made an addition to Goal #8 regarding medication reconciliation: Along with compiling a list of medications upon admission, each patient must receive a list of his or her medications upon discharge.
Washington Hospital Healthcare System (WHHS) in Fremont, CA, embarked on a mission to comply with this goal by implementing a new admission and discharge process concerning medication reconciliation.
Kinzi Richholt, RN, MSN, clinical nurse specialist and chief of system operations and management support; Nasim Karmali, RPh, medication safety officer; and the medication reconciliation team began the process of changing the facility's medication lists from being handwritten to electronic lists that are easy to read and accessible to all physicians.
Since introducing the new electronic tool, more than 99% of patients at WHHS have a home medication list compiled upon admission.
The initial process
Richholt, Karmali, and the medication reconciliation team began reviewing the process for compiling a list of patient medications upon admission and found that there was little consistency across departments.
Nobody was designated to reconcile patient medications, and because the list was handwritten, much of the information was incomplete and difficult to read.
Richholt and Karmali first wanted to focus on helping physicians get accurate information on patients' home medications . The team felt the best way to do this was by introducing pharmacy technicians to the process and teaching them how to approach patients, take their medication histories, and where to find additional medication information.
The pharmacy technician performs the initial intake of information from patients, calls community physicians when there are questions or gaps in the information, and inputs this information into the application, which was designed to interface with the hospital's other computer systems and formulary. The pharmacy technician enters the home medications, a pharmacist reviews the list, and a physician writes appropriate orders based on this information.
After this initial assessment, the team decided to pursue an electronic solution and began developing an application that could process all of the necessary reconciliation information and generate a legible medication list.