How do you Reduce Medication Reconciliation Errors Within Your Home Health Care Agency?

The trio of an increasing older adult population, polypharmacy and multiple comorbidities places home health agencies in a position to place added attention to their medication reconciliation processes or risk patient safety. Despite improved electronic medical record transparency and improved sharing of medication lists between organizations, an upwards of 80% of adults experience a discrepancy in one or more medications when transferring from hospital to home.

How can leaders of home health agencies ensure they are safeguarding clients from medication errors at start of care and beyond? This blog will cover several proven strategies to incorporate into the process of medication reconciliation to support agency success.

The Scope of the Problem

Readmissions due to medication errors are more common in patients recently discharged from the hospital. The delicate time period immediately after discharge places patients in a vulnerable position, a time when patients are most likely to utilize home health services and have increased medication use and error. The problem also arises when patients do not know what their medications are for, how to take them correctly, lack money to buy them or have access to a pharmacy. The direct impact can be dire. Home care agencies trying to extract the truth from discharge medication lists often struggle due to:

• Higher rates of polypharmacy in the older adult contributing to piecing together medications from multiple sources,
• A well-known lack of Communication amongst healthcare workers, including discharge education given to patients in an often rushed manner not taking into account the need of a caregiver be present, or incomplete information shared with agencies.

Improving Agency Medication Reconciliation Processes

Improving medication reconciliation practices has been a topic of research for years, and some progress has been made to improve safety. If agencies can evaluate their current method of reconciliation and incorporate some best practices, rates of medication errors should steadily fall.

Home health agency leaders can follow some proven steps in better medication reconciliation from such reliable organizations such as the Agency for Healthcare Research and Quality (AHRQ). The Medications at Transitions and Clinical Handoffs (MATCH) offers a toolkit with suggestions that include such recommendations as:

• Promoting buy in from leadership and front-line staff on safe medication reconciliation practices, emphasizing the importance of restructuring the process for medication reconciliation for a widespread organizational culture of safety as a foundational value,
• Detailing to staff the consequences of inaccurate medication lists, potentially including personal stories of negative patient experiences or near misses within the organization. Emphasize the potential life and cost savings benefits. Explain how an accurate medication list will set up the agency for a successful survey and compliance,
• Identifying the various roles necessary for obtaining and reconciling medication lists with patients at start of care, resumption of care and regular revisits. Roles should be clearly defined and flow easily into the processes already in place. This can include resource or quality improvement nurses that become familiar with outside organizations to request records request multiple outside records, including discharge paperwork, provider notes and contacting the patient’s pharmacy,
• Ensuring in home nurses verify medication lists at start of care through visualizing all medication containers and having direct conversations with patients and caregivers on which medications they are actually taking and how, as well as reviewing the medication lists at each visit for updates or changes,
• Having dedicated time during staff meetings to revisit the expectations of each role as well as a thorough orientation program outlining the specific steps the agency takes to ensure accurate medication reconciliation to improve staff compliance and awareness of others’ shared responsibilities. Consider being creative, randomly survey staff a few pop-up questions about the process or create short games to have staff identify incorrect medication reconciliation items, etc. to engage and incentivize staff that answer correctly.

The MATCH program also strongly supports one centralized medication document for all disciplines to work from. The document should be easy to understand and track changes, make edits and share.

Ensuring your agency has a home care software that offers every needed functionality within one platform will support easy integration of a successful medication reconciliation process. Explore all possibilities of the agency’s electronic medical record to identify if the agency can set up scheduled pop-up reminders, embed checklists of signing off various tasks and automatically communicate any gaps found during the entire cycle from intake to end of service.

The Take-away

Patient centered care has taken center stage in health care the last several years. Getting patients and their loved ones involved in care promotes adherence and shared responsibility. This is established by creating a routine and standardized process involving the patient. With continued reinforcement of these principles, for example, the patient or caregiver often begins to expect reviewing medications with each visit, may start to place all medications out for the nurse prior to a visit or scheduled “medication meeting” phone call. They may begin keeping track of their own medications if the agency can share the current medication list easily with the patient through a secure portal and be more able to find discrepancies. Overall, consistency in practices regularly involving the patient will promote a more accurate medication reconciliation process.

Agencies that place a major focus on safe practices to close the gap in errors will build trust in their patient populations and promote satisfaction amongst staff. Working for an employer that is dedicated to safety helps staff also feel they have the support and tools they need to provide the best care. Established systems and processes support staff transitioning into an organization. Making some changes to the medication reconciliation process within the agency creates a shift from medication risk to reassurance. 

References:

1. Joint Commission medication tips article
2. Increased medication uses and error
3. The increasingly higher rates of polypharmacy
4. Examining communication amongst healthcare workers
5. The Medications at Transitions and Clinical Handoffs (MATCH)
6. The MATCH program

Author’s Note: Views, information, and guidance in this resource are intended for information only. We are not rendering legal, financial, accounting, medical, or other professional advice. Alora disclaims any liability to any third party and cannot make any guarantee related to the content.

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2. Home Health Marketing Strategies
3. Financial Management in home health agencies