LEAN Implementation Improves Medication Reconciliation Accuracy, Efficiency
It is estimated that up to 50% of all medication errors throughout all hospitals and up to 20% of adverse drug reactions are a result of poor communication at transition points. A process excellence team at Avera McKennan is taking a close look at medication reconciliation and is working hard to make sure each of those numbers moves closer to zero.
"Medication reconciliation is one of the biggest hot button issues in medicine today. Nobody's getting it completely right," said Steve Petersen, Pharm.D., Director of Pharmacy at Avera McKennan.
While it is unrealistic to expect any health care setting to be completely devoid of medication reconciliation errors, Avera McKennan has instituted changes that ensure a higher degree of accuracy, accountability and patient satisfaction. They have used LEAN principles to improve the flow of information, decrease the probability for errors and contribute to greater safety and higher quality of care for Avera's patients.
Utilizing videotape data analysis to examine patient flow (each of the transitions a patient makes from admission to discharge), the team discovered several opportunities for improvement. In particular, much of the observed waste resulted from errors in the patients' drug lists which, in turn, contributed to extra time spent checking and rechecking incomplete entries or inaccuracies.
"We learned that the earlier that staff could get a complete drug list, the better. Most of the time, a patient's first contact with a health care professional is with a nurse. We decided it was vital to communicate to nurses the importance of immediately building an accurate medication list at that first point of contact," said Cheryl Wildermuth, a process excellence consultant who helped to spearhead LEAN implementation in medication reconciliation.
The process excellence team also suggested involving the pharmacy department earlier, thereby creating process in which the patient's list of medications underwent multidisciplinary review before it reached the physician.
Wildermuth explained that, like all organizational change, process improvement necessitated adopting a creative approach to strategic, effective communication. Information regarding improving and streamlining medication reconciliation reached staff members through a variety of channels, including internal publications, email updates, daily lineup, weekly ESP meetings, unit-specific presentations, interdisciplinary team meetings of all stakeholders and even posted messages in employee bathrooms "Before You Go . . . Did You Know".
This multi-faceted communication strategy has proved to be effective in several ways. It has not only ensured that staff had access to appropriate and timely information, but also encouraged the integration of LEAN principles into each department's culture. Internalization of LEAN principles makes it less likely that staff members will revert back to their previous habits and will instead help to perpetuate process excellence in all areas of their work.
The result is an organizational culture that defines itself through cooperation, shared responsibility, and most importantly, an environment in which patients can feel confident that the medications they are given are the correct drugs at the correct dosages from admission to discharge.
Wildermuth anticipates another round of process analysis to begin in later this year, with a follow-up and re-evaluation of medication reconciliation procedures later in the spring. The ultimate goal, Wildermuth noted, is to move toward a completely electronic medication list that can be accessed, reviewed and updated at any time by the appropriate health care professional.
