A Customized Software Solution for Medication Reconciliation

By Thomas Jacob Wessel, Jr, MD, ABFP

In 2005, Spartanburg Regional Medical Center’s medication reconciliation committee drafted a paper document for medication reconciliation, which the admitting nurse would use to manually record a patient’s home medications. Physicians would then use this form to reconcile inpatient medications and generate orders. The proposed transfer and discharge processes were similar. However, after giving it further thought, we judged this paper-based process to be too time-consuming and error-prone, due to the potential for copying mistakes and illegibility. To address these concerns, we sought a computerized process that would preserve our existing nursing workflow, reduce copying, eliminate handwriting, and decrease prescribing errors. At the time, we were unable to identify a commercially available solution to meet our needs and decided to create a custom software solution with the help of Healthtek, an established health care software vendor. We asked Healthtek to avoid HL7 interfaces, if possible, in order to reduce system complexity and maintenance. Instead, Healthtek developed the RxReconcile application, a Web-based front end to our McKesson clinical system.

Current Processes
For the past two years, we have used RxReconcile throughout Spartanburg Regional Medical Center (SRMC). Our rehab hospital, Spartanburg Hospital for Restorative Care, has also elected to deploy RxReconcile house-wide. While nursing is primarily responsible for reconciling home medications, RxReconcile is flexible enough that we could change our process to allow pharmacists or pharmacy technicians to take the lead role in medication reconciliation. The admission reconciliation proceeds as follows:
• The admitting nurse updates and confirms home medications in McKesson’s Horizon Clinicals system.
• The physician logs into RxReconcile and performs admission
reconciliation.
• The system flags potential duplicates and allergies.
• The physician prints the documentation of reconciliation and medication orders – one copy for the chart and another copy to be faxed to pharmacy.

The process is similar at transfer and discharge, except at discharge, prescriptions can be generated and the patient gets a universal medication form to take with them. All reconciliation reports are scanned into the online medical record, which is available remotely to providers with appropriate roles and security credentials.

System Benefits
Using RxReconcile, nurses save about 10 minutes per patient discharge, and medication regimen legibility has improved significantly. Because Rx Reconcile is easy
to use, physician participation in the medication reconciliation process has improved. Furthermore, our rehab hospital clinicians have found the new system to be fast and easy to use, and have noted that it promotes improved quality of care.

 
Thomas Jacob Wessel, Jr, MD, ABFP, is currently the medical information officer for the Spartanburg Regional Medical Center. He received a BS in chemistry from Furman University and a MD from the Medical University of South Carolina.

Where to Find It: Healthtek Software Solutions www.rxreconcile.com

To Find Other Medication Reconciliation Solutions go to www.findit.pppmag.com