1. Applying DMAIC Methodology to Medication Reconciliation
Prepared For
[Date] By 4 2

2. Process Improvement Methodology (DMAIC)
DMAIC Provides An Easily Managed Systematic Process To Deliver Measurable Results and Accelerate Change
Who are the customers and what is the problem from their perspective?
How is the process performing today and how is it measured?
What are the most important drivers of poor performance?
How do we remove the drivers of poor performance?
How do we ensure that we sustain the improved performance?
Define
Measure
Analyze
Improve
Control

3. Proper Team Establishment Increases Probability For Success
Improvement Teams
Proper Team Establishment Increases Probability For Success
Project Executive Sponsor
Clinical / Academic Sponsor
(As Required)
Project Sponsor
Improvement Leader
Process Owner
Improvement Team

4. Medication History, Reconcile Order, Transcribe, Clarify
Defining Problem: Analysis of Root Causes
Administer
Medication History, Reconcile
Order, Transcribe, Clarify
Dispense, Deliver
Monitor
Educate, Discharge
Identified failure modes (FMEA)
Incomplete and/or incorrect medication orders on admission
Inadequate or missing information on the patient's admission profile
No formalized approach/process to obtaining and documenting a medication history
Identified root causes
Incomplete/inaccurate medication history (omission, different dose, route or frequency, look alike-sound alike)
Patient’s ability to recall, especially upon admission
Time constraints
Interview skills of clinician
Multiple locations to document (free text)
Pharmacist not formally integrated in process D M A I C

5. Defining Problem: Challenges to Obtaining Medication Histories
Patient’s and/or surrogate’s ability to recall medications, doses and/or frequency of use
Stress of transitioning through the healthcare system
Health literacy
Language barriers; cultural beliefs
Relationship with healthcare clinician obtaining history
Interview skills of clinician
Time constraints
Accuracy and completeness of medication histories obtained from other resources; accessibility D M A I C

6. Medication History / Reconciliation: Pilot Results Direct Admits to Med/Surg Units* (N=204)
54% of patients had at least one medication discrepancy
42% of the discrepancies requiring intervention was complete omission of a medication
35% of the discrepancies requiring intervention was a different dosage, route or frequency with what the patient reported taking before admission
Of the discrepancies requiring clarification, in the absence of a pharmacist intervention, 22% may have resulted in patient harm during hospitalization and 59% may have resulted in patient harm if continued beyond discharge
* Gleason KM, Groszek JM, Sullivan C, Rooney D, Barnard C and Noskin GA. Reconciliation of Discrepancies in Medication Histories and Admission Orders of Newly Hospitalized Patients. Am J Health-Syst Pharm ; 61: D M A I C

7. Medication History / Reconciliation: Most Effective Interventions
Administer
Medication History, Reconcile
Order, Transcribe, Clarify
Dispense, Deliver
Monitor
Educate, Discharge
Single source of truth: Medication list with technology support
Reconciliation process with technology support
I/T design and continuous monitoring
Compliance, sustainability of new process
Identify rate, etiology and potential harm of medication discrepancies for process improvements
Active patient involvement
Active pharmacist involvement D M A I C

8. MATCH Improvement Initiatives
Implement a system that achieves the below:
Increase accuracy and completeness of medication history
Create “one source of truth”
Complete medication description (drug name, dose, route or frequency – no free text)
Reconcile home medications with patient and/or family
Reconcile all medications (home and current medication orders) at admission, transfer and discharge
Multi-disciplinary approach with physicians, nurses and pharmacists D M A C I

9. Approaches to Evaluate Medication Reconciliation Process
Determining compliance rates
Type and etiology of medication discrepancies requiring interventions
Medications / medication classes involved in discrepancies requiring interventions
Potential harm averted through intervention
Retrospective v/s prospective review

10. Questions and Discussion