Adverse Drug Events (ADEs) are defined as any harm to a patient resulting from the use of a medication – whether the harms stem from medication errors, overdoses, or adverse drug reactions or interactions. ADEs negatively impact patient health in many ways and potentially cause unnecessary hospitalization or death. Yet despite the serious nature of ADEs, the good news is that most are preventable.
With this in mind, Telligen – the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Colorado, Illinois and Iowa – initiated a medication reconciliation project for members of its medication safety care collaborative in response to their feedback, which indicated that “medication reconciliation and communicating about patients’ medication lists” are some of their biggest challenges involving medication safety for their patients.
Medication reconciliation is a review of all the medications a patient takes, including doses and frequency of use. “Medication reconciliation should happen at every juncture in the [care] continuum,” says Katy Brown, Program Manager Lead and Clinical Pharmacy Specialist at Telligen. “Not just once, not just twice, but every time the patient interacts with a provider. Every time a med is changed, and every change in level of care demands an accurate list,” says Brown. Doing so significantly reduces the risk of ADEs and unnecessary hospitalizations, she says.
Telligen’s three-part project aimed to reduce ADEs by increasing the frequency of medication reconciliation in a variety of care settings, including hospitals, clinics and community pharmacies. The first part of the project involved gathering general medication reconciliation process data from care facilities. Telligen created a short online assessment that evaluated care facilities' current medication reconciliation process against best practices. The QIN-QIO then analyzed the collected data and assigned points to each step of the facility's medication reconciliation process to create an overall score. Using this data, a Telligen pharmacist gave feedback to providers to help them improve their processes.
“Medication reconciliation should happen at every juncture in the [care] continuum. Not just once, not just twice, but every time the patient interacts with a provider.
One important recommendation was granting community pharmacists access to discharge medication lists, as these health care providers typically have extensive contact with patients post-discharge. Initially care providers were reluctant to share their medication lists. Providers cited patient confidentiality and legal concerns, time constraints, problems with faxing and more. However, Telligen provided reassurance that medication lists were shared with virtually all other stakeholders in the care continuum, including home health agencies, nursing homes, primary care providers and specialists, among others. In the end, the providers who chose to participate in Telligen’s project saw immediate benefits in communication between patients and caregivers, as well as lower rates of ADEs through this more holistic care approach.
The project was developed and tested during the summer of 2015, implemented in the fall of 2015 and completed in June of 2016. At completion, 15 communities in Iowa and Colorado had used the assessment tool, and approximately 1,350 patient records had been analyzed. Each “community” is a care collaborative comprised of health care providers and social service agencies. Thus far, the project has helped prevent more than 440 potential ADEs.