Medication Reconciliation Vendors

So my trip through Atlanta post Thanksgiving turned into an eight hour delay and a wonderful opportunity to witness frustration first hand.... and it wasn't pretty. Let's just say the airline employees should be considered for hazardous duty pay.

As mentioned in a previous post, I work for a company that specializes in developing clinical solutions for hospitals. We've been selling a medication reconciliation solution for almost 3 years which makes us the old man on the block and in my humble opinion, the best. Not so much because we have market share and a great solution but because we've already experienced the "gotchas" and "oh crap's" associated with deploying any new system. What is readily apparent as I go up against other vendors is their lack of understanding for what hospitals are trying to accomplish across the board. Vendors.... all Vendors, are trying hard to be the one stop shop for medication reconciliation when the truth is, it takes a great deal of buy in from all disciplines across the system. Anyone familiar with CPOE knows that it's not as easy as getting the docs to use it and med-rec has the same, albeit not as far reaching, symptoms of poor adoption and scope creep if not managed correctly. The blogger in me would like to tell you how to successfully implement a solution as an adjunct to your process but the salesman in me knows this is a public forum and let's face it, my bills don't get paid by writing this blog. Just to be fair, I will tell you there are a few viable solutions in the marketplace that everyone should be looking at. I'll list them in a moment. If you are in fact interested in a 3rd party solution to help you with medication reconciliation, make sure your check list is complete. Here's a few questions to ask.....

• How will your system work with our current process
• How customizable is your system to our needs
• How many data sources to you obtain data from
• How much does it cost
• Can i speak to a reference
• What can we expect to gain from this
• Does the system work across the continuum

These may sound like logical questions but I'll be honest with you, i don't hear them enough when I'm out there selling. Now, here's a list of a few vendors you may want to consider

• Health Care Systems
• Thomson
• Quovadx
• DrFirst
• Siemens
• Design Clinicals

You already know who I think the best is......

Ah yes, Thanksgiving is over and every one's back at work, including me. Unfortunately, I'm stuck in the Atlanta airport (apparently there's fog somewhere so just to be safe, the entire airport is at a standstill). Just gives me time to update the blog.

This week there's a new account going live with an automated medication reconciliation solution (designed by the company I work for). This group should be of particular interest because they are incredibly pharmacy centric. Based on my observations, hospitals that utilize pharmacists heavily for the medication reconciliation process tend to have higher success rates and much better error prevention. This is not to say nurses are doing a bad job, it's simply that pharmacists, for obvious reasons, understand medications and medication habits better than other specialties. So this group plans on utilizing our system for automated medication history retrieval which will be directed to a printer. Then, pharmacy technicians will perform the initial review and assessment followed by an overview from the pharmacist. All appropriate interventions will take place immediately and then the form is passed on to the next caregiver. At time of discharge, the original assessment document will be compared to the inpatient profile. The physician will then make recommendations for discharge medications and a discharge profile is created and discussed with the patient. Sounds simple huh......

Med-Rec 101

And so the process begins. Step one in medication reconciliation is to obtain the patients medication history. No small struggle indeed. Obtaining the history and reconciling meds upon discharge tend to be the two largest hurdles in the process. Trying to get an accurate medication history is part art and part science with a whole lot of resources tied to it. Over the past few years, there's been significant emphasis put on educating patients to either create and maintain a list of their medications and keep it with them at all times or the ever present "bring in your bottles" theory. These efforts certainly have merit and will continue but the number of patients that are "prepared" when they show up in your emergency department is inconsistent at best. Some key variations I've observed in how hospitals obtain the history.

Who

• Nurses perform the assessment 94% of the time
• Pharmacist perform the assessment 3% of the time
• Pharmacy technicians perform the assessment 2% of the time
• Physicians perform the assessment 1% of the time

How

• Hard copy document - 71%
• Hard copy document that also serves as an initial order - 24%
• Data entered electronically into clinical information system - 5%

more to come.....

Medication Reconciliation: It's a paper process, it's an electronic process, it's the physicians responsibility, it's the nurses responsibility, it's the patients responsiblity...... yes, it is in fact all of these things. The one constant i've observed in over 100 hospitals is that there is no constant. The core prinicipals still apply

• Obtain an accurate medication history
• Communicate with the next care giver
• Reconcile at each transition point
• Discharge the patient with the correct regimen

and the core issues still abound

• What is the best way to obtain a complete history
• What is the best process for communicating to the next care giver
• Who is performing the reconciliation
• Do we have enough resources to comply
• Am I making the most informed decisions

So far, i've been privy to many processes and many success stories. I've also seen an enormous amount of frustration. For the most part, there has been a shift in focus from "having" to do medication reconciliation because Joint Commission requires it to "Wanting" to do medication reconcilation because it really makes a difference in patient safety.

more to come......