The following outlines the key steps for getting started on the implementation of Medication Reconciliation (modified from the „Medication Reconciliation in Acute Care Getting Started Kit“, ISMP Canada 2011). More detailed information can be found within the tools included in this tool box (e.g. Getting Started Kits of ISMP Canada).
1. Secure senior leadership commitment
Implementing a successful Medication Reconciliation process requires clear commitment and direction from the highest level of the organisation.
2. Form a team
Teamwork is an integral part of the Medication Reconciliation process. Medication Reconciliation is not owned by one discipline. Clinical champions can contribute significantly to successful implementation.
Representation of the coordination team could include:
- Senior Administrative leadership (executive sponsor)
- Clinical leaders representing physicians, nursing and pharmacy staff
- Front line caregivers from key settings of care, and from all shifts
- Representatives from other work units or committees whose responsibilities/mandates include the improvement of patient safety (e.g. Patient Safety Officer, representatives from Quality Improvement/Risk Management, Patient Representatives, Pharmacy and Therapeutics committee)
- Patient and/or family member
3. Define the problem
Set aims (goals and objectives)
The aims/goals should be SMART – specific (e.g. regarding the population of patients that will be affected), measurable, accepted, reasonable and timebound.
Collect baseline data
It is critical to collect baseline data to get a sense of what some of the issues are, at each interface of care, in the facility. “Baseline data” reflects the types of discrepancies that exist prior to the implementation of the Medication Reconciliation process and will provide the information the team needs to build the case for Medication Reconciliation, and help to identify areas of focus.
4. Start with small projects and build expertise in reconciling medications
Initially implement a Medication Reconciliation process on a smaller scale with selected groups of patients, on selected units or during a specific point in the continuum of care to develop forms and tools that work in your organisation and to gain expertise in the Medication Reconciliation process.
Although Medication Reconciliation can occur at any of the transition points in care (e.g., admission, transfer, discharge), it is suggested that one starts at the admission process. If Medication Reconciliation is not done right at admission, the process could be continued using inaccurate information. As patients may be admitted to the hospital from a number of points, select one area (e.g. preoperative screening or the emergency department).
Map the current and ideal process
Use process flow diagrams to outline the current process in place and a new ideal process that can be trialed and tested using a model for improvement (plan-do-check-act).
Adapt and test a Medication Reconciliation form
The purpose of these forms is to aid in the collection of a BPMH, to share the information with prescribers, and to facilitate reconciliation (the documentation of prescriber decisions about medication orders). Examples for forms can be found within the tools included in this tool box (e.g. in the Getting Started Kits of ISMP Canada).
5. Evaluate improvements being made – collect data
In order to determine if the implementation has been successful, measurements should be made on an ongoing basis (e.g. monthly). Tracking a few key measures over time is the single most powerful tool a team can use and will help it to see the effects of the changes it is making (see the tools included in this tool box, e.g. the Getting Started Kits of ISMP Canada, for detailed measurement tips).
As experience develops and measurement of the success of your Medication Reconciliation process reflects sustained improvement the process can be implemented for more patients in more areas. Evaluate at each new step before adding more units to the process.
Organise information and communication activities around the initiative at the different stages of implementation:
- For the staff involved
- For other staff in the unit
- For patients and families