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Proper forms, follow-up are the keys to success
What are the critical factors to a successful medication reconciliation process? "For us, the keys have been ease of use of forms, staff education about the forms, and follow-up to make sure that things are getting done properly," says Ann Morrill, RN, a staff nurse in the ED at Massachusetts General Hospital (MGH) in Boston.
First, they put up posters that included copies of the actual form, including what physicians and nurses needed to fill in and what they were responsible for, she says. "Then, I went around to as many people as I possibly could, told them why we were using these forms, how they were different, and how the triage nurse was still responsible for initiating the process," she says.
In addition, Morrill sent out e-mail reminders to the staff. They inserviced nurses and physicians at the same time, Hughes says. "Ann is also on the hospital's collaborative practice committee, so she and the ED doc who is on it made sure we sent our people the same information so they would all 'hear' the same things," she says.
In terms of follow-up, Morrill goes around the department and checks random charts every day. If the form is not being used properly, she will take up the issue with the individual nurse. Mary Fran Hughes, RN, MSN, nurse manager of the ED at MGH, says, "We have 200 nurses and a lot of physicians. Any time you make a change like this, Ann and other staff nurses will do random audits."
Another key element in a successful medication reconciliation program is gaining "permission" from hospital physicians and nurses to recognize medication errors as one of the largest areas of risk for patients, says Andrew Jenis, MD, chairman, of the Department of Emergency Medicine at Cortland (NY) Memorial Hospital. You have to have a medication reconciliation program, Jenis says, "but if you do not have staff agreement, you can set up all the programs you want" and they won't work well.
To obtain the all-important buy-in, he says, get staff leaders on board. "In any organization you need leaders who truly believe in this and believe that you can actually do something good in this area," Jenis notes. "It may not seem that important when people are dying all around us, but there is real benefit for 99% of the people who come in here."
How does he deal with doubters? "If anyone looks at me askance, I give them my rationale: that this is where we can have some real impact on patient safety," Jenis says.