On-Demand Learning Lab: Engaging Your Pharmacy Team to Improve the Medication Reconciliation Process-Nov 2021 Learning Lab Handout

Nov 2021 Learning Lab Handout

Pdf Summary

This document summarizes a November 2, 2021 NAHQ webinar, “Engaging Your Pharmacy Team to Improve the Medication Reconciliation Process,” presented by Jeffrey L. Schnipper, MD, MPH (Brigham and Women’s Hospital/Harvard Medical School) and Missy Danforth (The Leapfrog Group). It frames adverse drug events (ADEs) as a major patient-safety problem, occurring in 5%–40% of hospitalized patients and 12%–17% after discharge, often driven by medication discrepancies during transitions of care. Discrepancies may affect up to 70% of patients at admission or discharge, with nearly one-third posing potential harm and contributing to longer stays, ED visits, and readmissions.<br /><br />The webinar explains Leapfrog’s publicly reported, NQF-endorsed medication reconciliation metric: “Number of Unintentional Medication Discrepancies per Patient” (NQF 2456). Hospitals collect data by sampling at least 30 medical/med-surg patients, having pharmacists or certified pharmacy technicians obtain a “gold standard” medication history via patient interview, then comparing that history to admission and discharge orders to count unintentional discrepancies. Free resources and survey materials are available via Leapfrog.<br /><br />A major focus is moving from measurement to improvement: building a safety and business case, engaging stakeholders (CMO, CNO, CFO) with role-clarity and ROI arguments, forming a multidisciplinary QI team, setting SMART goals, and mapping current vs. ideal workflows. Hospitals are advised to analyze whether errors stem from inaccurate histories (“history errors”) versus incorrect ordering despite correct histories (“reconciliation errors”), and to collect contextual encounter and intervention data.<br /><br />Interventions highlighted come from the MARQUIS medication reconciliation bundle and toolkit, including Best Possible Medication History (BPMH), discharge reconciliation and counseling, forwarding information to next providers, risk stratification (standard vs. intensive bundles), training, better access to medication sources, health IT enhancements, and patient-owned medication lists. MARQUIS2 results are referenced as showing improved discrepancy trends over time, especially when interventions are delivered. The session closes with guidance on sustainability/spread and a scalable MARQUIS Med Rec Collaborative offering tools, training, webinars, and an online community.

Keywords

medication reconciliation

adverse drug events

transitions of care

medication discrepancies

Leapfrog Group

NQF 2456

unintentional medication discrepancies per patient

Best Possible Medication History (BPMH)

MARQUIS toolkit

pharmacy team engagement