Automation to Streamline Medication Reconciliation

By Jack Bond, RPh, MHS, and James Rosendale

Wesley Medical Center is a 760-bed acute care facility serving Kansas and Northern Oklahoma. In October 2007, we installed Iatric Systems’ medication reconciliation solution to reduce errors and streamline our end-to-end medication reconciliation process. Prior to the implementation, medication reconciliation at Wesley was disjointed and fraught with opportunities for error. Home medications were entered as free-text into our MEDITECH nursing system, from which reports were printed. Patients’ active in-house medications were stored independently in our pharmacy system.

Discharge medications were entered into additional free-text fields in the nursing system and then printed for each patient. Nurses had to use yet another system to print drug monographs manually.We needed a solution that would streamline processes, as well as provide more integration between our nursing and pharmacy systems. Furthermore, we needed a system that would produce drug monographs and provide automatic faxing of medications to patients’ primary care providers upon discharge. Iatric Systems’ solution fulfilled all of these requirements.

 Implementation and Current Processes
The implementation was relatively quick and easy. A multi-disciplinary team, with members representing nursing informatics, pharmacy, health information management, and information services, participated in the system selection, redesigned workflow processes, and quickly installed the program. The software was piloted on one nursing unit and then rolled out house-wide.

Now, nurses document patients’ medication histories in the Iatric program and can select medications directly from our pharmacy drug dictionary. This information is used as the admission order. Whenever reconciliation needs to occur thereafter, medication history and active in-house meds can be viewed on one screen in Iatric Systems, and a hardcopy report is printed containing this and additional information, such as dietary and respiratory orders.
At discharge, we provide our physicians with a report that sorts the medication history and in-house orders by drug class and lists them in a side-by-side format. The Joint Commission identified this as a best demonstrated practice during our most recent survey. Physicians simply select which orders should remain effective upon discharge and indicate any new medications to be added, and nurses then choose those medications within Iatric Systems. A finalized medication list is generated for the patient, and corresponding drug monographs print automatically. The system also automatically faxes a discharge medication list to the patient’s primary care provider.

System Benefits
The Iatric Systems solution is integrated with MEDITECH without the need for interfaces, so users never feel like they leave the MEDITECH system. Users can access Iatric routines from wherever they need to – from within the MEDITECH Data Repository system, user menus, and documentation screens. We believe we have closed the medication reconciliation loop with the installation of the Iatric Systems solution. Using dictionary-driven fields instead of free-text has decreased errors, and our physician report, sorted by drug class, has improved decision-making at discharge.
Finally, the ability to automatically fax discharge medication lists to primary care providers (PCPs) has proven to be a very powerful tool. PCPs have become champions of the new process. Because hospitalists assume primary care for patients while in-house, many PCPs had difficulty knowing exactly what medications had been sent home with their patients upon discharge. Numerous PCPs have indicated how helpful it is to discuss the exact medication profile with their patients in their offices immediately after discharge. 

 
Jack Bond, RPh, MHS, is the director of pharmacy at Wesley Medical Center, where he has worked for 31 years. Prior to assuming this role five years ago, he served as the pharmacy manager and a staff pharmacist. Bond earned a BS in pharmacy from Kansas University, and a master’s degree in health sciences from Wichita State University.

James Rosendale has been a pharmacy data architect at Wesley Medical Center for six years. Over the course of his 20-year career in pharmacy, Rosendale has served as a pharmacy system specialist, a pharmacy technician coordinator, and a pharmacy technician.

Where to Find It: Iatric Systems, Inc. www.iatric.com