Medication Reconciliation Program in a Home Health Agency to Reduce Medication Errors

Abstract

Problem: The lack of a standardized medication reconciliation process on patient admission to home health agencies (HHA) poses a risk to patient safety with the potential for negative health outcomes. An internal review of patient medication treatment plans at an urban HHA revealed a medication omission and dosage error rate of 4.8%. This resulted in unintended medication side effects and poor health outcomes. Elderly patients admitted to HHAs are more vulnerable due to lack of incomplete medication treatment plan at admission and standardized medication reconciliation as a result of care fragmentation, poor communication and care coordination among providers. Purpose: The purpose of this quality improvement (QI) project was to implement a standardized evidence-based medication reconciliation tool, the Medication at Transitions and Clinical Handoffs (MATCH) process, to reduce medication omission and dosage errors upon patient admission to the HHA. Methods: The MATCH process served as the implementation model for the standardized medication reconciliation process at the urban HHA. Competency based training was developed centered on the MATCH process and delivered to all clinical and administrative staff, as well as referral sources. QI project impact was measured using structural and process measures: the percentage of staff trained on new reconciliation process, percentage of patients admitted using the MATCH process, and percentage of patients with omissions and dosage errors. Implementation tactics included the engagement of stakeholders and project champion, biweekly data sharing, weekly chart audits for compliance and development of run charts for data analysis and to monitor trends. Results: The project was successful in achieving its primary goals. In week 1, 100% staff training and competency was achieved, while reconciliation using the new MATCH process was 100% achieved in Week 2 and the achievement was sustained for the remainder of the project. The omission and dosage errors were reduced to 0% in Week 5 and sustained throughout the remainder of the project with one anomalous data point in Week 10. Conclusions: Standardized medication reconciliation based on MATCH process is effective in improving medication errors for homecare patients. Prioritization, management attention, and staff training/awareness of medication error problem were critical for successful implementation.