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Improved Efficiency and Accuracy in Collecting Home Medication Lists

by Steven Wade, RPh and Shondra Sholar, PharmD  

Prior to November 2007, Brookwood Medical Center in Birmingham, Alabama, used a shared, manual process, which included nurses, physicians, and pharmacists, to perform medication reconciliation. The core of the medication reconciliation process was the manual compilation of home medications through an interview of patients and their families upon admission to the hospital. Since it was a time-consuming process that involved several disciplines, few were willing to take responsibility for completing it. Furthermore, circumstances often hindered our ability to obtain a complete and accurate list of home medications: Patients and families were often anxious and omitted items; did not think that all items required disclosure; and, in some cases, may have been too embarrassed to include certain therapies. In addition, patients and family members regularly omitted drug allergy information. A review of our medication reconciliation process was performed as part of our quality assurance program to provide increased emphasis on the Joint Commission’s expectations. 

Identifying and Implementing the Solution
In researching solutions that could aid us in obtaining complete home medication lists from our patients, we discovered HealthCare Systems’ medication reconciliation solution, which extracts information from a database of
third-party payer prescription information to create a report of patients’ past and current home medications that can be used to facilitate the admission interview.
While pharmacy served as the contact for HCS, our information systems department coordinated the mechanics of the installation of the software. Once the initial set-up was completed with our server, pharmacy handled the changes in forms and processes.

Medication Reconciliation Now
Our actual medication reconciliation process is unchanged, however we now use the HCS report as a tool to compile a complete home medication list for each patient. When a patient is admitted, an automated request is sent to HCS with appropriate patient identifiers. HCS queries their database sources and returns a report per our pre-set data elements in about 30 seconds. Our home medication form is then populated with that information and prints to the nursing unit where the patient has been admitted. A copy of the data elements is stored on the local server, in case a second report is requested. 

Using the form as a tool, the health care professional interviews the patient to attempt to gain a more complete record of home medication use. Some medications may be discontinued, and some – such as over-the-counter medication and herbal supplements – may not be associated with third-party payers. The medication history interview allows us to identify these items and is crucial to validating the information on the list provided by HCS. The information obtained from HCS is of particular value in caring for our elderly population and patients with mental health issues. These patients are not always the best historians and their omissions of home medications during the interview process can result in interrupted therapies. Because the HCS list is generated from an extensive database, it is a useful starting point for the medication history interview process. 

Results
Using the HCS system has helped us standardize our process and provides a consistent method for gathering home medication lists across the hospital. The prescription history reports help us identify products that patients may have omitted, either accidentally or intentionally, during their admission interview – products that could conflict with newly prescribed therapies and lead to adverse drug events. The computer-generated forms have also improved the legibility of our home medication lists. The HCS system has improved the efficiency of our medication reconciliation program and the accuracy of our home medication lists.

 Steven Wade, RPh, has been the director of pharmacy at Brookwood Medical Center since June 2007. Prior to assuming his current post, he worked for the Department of Veterans Affairs for 30 years.

Shondra Sholar, PharmD, currently serves as the pharmacy manager for quality assurance at Brookwood Medical Cener. She graduated from the McWorter School of Pharmacy in Birmingham, Alabama.

Where to Find it: HealthCare Systems www.hcsinc.com