Initiatives

Reconciling Medications

A Medication Safety Collaborative
Sponsored by the
MA Coalition for the Prevention of Medical Errors

*** Save-a-Date ***
The next collaborative learning session will be held
Monday, September 15, 2003

The Massachusetts Coalition for the Prevention of Medical Errors, together with the Massachusetts Hospital Association, has initiated a statewide patient safety collaborative to support hospitals in adopting safety practices focused on reconciling patients’ medications. The Reconciling Medications safety practices are designed to eliminate errors of communication and information transfer at patient handoffs. Evidence has shown that in 25-40% of patients entering the hospital, there are unintentional discrepancies between the medications prescribed on admission and those taken at home. Reconciling medication orders on admission has been shown to prevent these errors.

This initiative is funded in part by a grant from the Agency for Health Research and Quality (AHRQ) through the Massachusetts Department of Public Health (DPH). The first phase of the grant effort involved the selection of two priority areas for Coalition safety collaboratives. An Advisory Group of hospital representatives undertook a comprehensive assessment of possible topics, reviewing data on their frequency and severity, the existence of proven prevention strategies, and results from a statewide survey of healthcare professionals across Massachusetts. Two practices, Reconciling Medications and Communicating Critical Test Results, were the overwhelming choices of the Coalition’s Advisory Group because of their potential for making substantial improvements in patient safety. They address communication, teamwork, and information transfer issues, all fundamental system factors linked to patient safety.

Collaborative News

• Timeline
• Worksheets
• Reconciling Medications Team
• PDSA
• Example Checklist
• Blank Checklist

References

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