Medication Reconciliation in Renal Clinic benefits patients

Friday, October 25, 2013 - 2:35pm

A new process to ensure patients living with kidney disease get the correct medication is already benefiting patients just one month after being launched.

The process is called medication reconciliation and it ensures the entire team of health care providers have the same information about a patient’s medication.

“Capital Health was one of the first places in Canada to implement this fully at admission and discharge,” says Anne Hiltz, director Renal Program and Pharmacy. “We’ve gone from a 30 to a 90 per cent accuracy rate at admission, which is the first, most important step.”

Capital Health began looking at medication reconciliation several years ago when Accreditation Canada made it a required organizational practice. In the past, medication histories were often inaccurate and based only on information from the patients.

Now, staff members take a full medication history from the patient on a form that records several copies at once and reconciles it. One copy stays with the clinic, while the others go to the kidney specialist, the patient’s record, the patient’s community pharmacy and his or her family doctor.

“This has opened up communications and put everyone on the same page at the same time to make sure there are no adverse reactions to the drugs,” says Cynthia Stockman, the health services manager of the renal clinic. “It was a real ‘aha’ moment for staff as soon as they saw the benefit of this when the pharmacy would call right away if they saw a discrepancy.”

“Some patients used to come in here and their medication was a mess,” says Cynthia Douglas, an RN at the clinic. “They’d miss doses or take too many doses. Now they are empowered, and they have one piece of paper that explains who is giving them what medication and why.”

The clinic targeted high-needs patients first. Staff members usually do one or two medication reconciliations each day. Each week the full team has a meeting to discuss how the new process is working.

“The staff really embraced it because it is all about patient safety and they were seeing a turnaround in patients’ health immediately,” says Stockman. “By giving them this kind of input we saw a lot of buy-in and staff were constantly coming up with improvements to make the process more user-friendly.”

Hiltz says three other factors contributed to the success in the renal clinic.

“We had a strong steering committee, strong administrative and physician (support) and (strong) organizationwide support,” says Hiltz.

For Barbara Hirtle, an licensed practical nurse at the clinic, the reason is simple.

“It’s not about us, it’s about the patients,” says Hirtle. “We don’t mind the extra work when we see results like this so quickly. I can’t wait until we do this hospital wide.”

The next step in the process is to skip paper and go directly to an online system. Medication reconciliation is already being completed on inpatient admission and discharge. Transfer has started from Neurology/Neurosurgery to Rehab with a plan for organizational wide implementation. As well, a plan for all ambulatory areas to go live over the next year has been developed.

In the picture are back row: (L-R): Norma Jean Martel, Nephrology Leader Clinical Operations; Cynthia Stockman, Health Services Manager ; Carolyn Bartol, Clinical Nurse Educator; Cindy Everett ,RN,  Renal Clinic; Michelle Poan,  Booking Clerk; Barbara Hirtle, LPN, Renal Clinic; Dr. Jo-Anne Wilson, Clinical Pharmacy Coordinator; Matt Phillips, Nephrology Quality Leader and Susan Betts, RN, Renal Clinic.