Pharmacy Program Helps Ensure Safety, Quality and Outcomes Excellence

Patients who come to us for care are typically already taking one or more medications. Sometimes we know about those meds. Sometimes we don’t. But delivering safe, excellent care depends in part on knowing and understanding every patient’s entire medication regimen.

For the past five years, our Pharmacy team has been implementing and expanding a medication reconciliation program across Cincinnati Children’s to ensure we have that knowledge for every patient. The process entails compiling a complete and accurate list of current home medications and adding the physician’s admission, transfer and/or discharge orders to that list.

Ensuring an accurate medication list means speaking to patients and families, contacting outside pharmacies, and then cross-referencing information in the patient’s chart and electronic medical record. Studies demonstrate a positive impact on clinical outcomes with pharmacy-led medication reconciliation, and so far, our results show great promise as well.

“Early on, we started collecting data about how many medication discrepancies we were finding per patient,” said Mike Crotty, PharmD, pharmacist II. “The results were pretty staggering. We found an average of three discrepancies per patient (see table below). It’s important to note that discrepancies are not the same as medication errors, which would mean a patient got the wrong medication or dose. Discrepancies are about the records we keep, not necessarily the administration of doses. It’s about ensuring we have a complete medication picture for each patient.”

Despite the distinction between discrepancies and errors, the team learned that focusing on reconciliation can help reduce errors that directly affect patients. Said Mike, “Recently we have seen a 60% reduction in med-rec-related medication errors that reach a patient. Our department was amazed because of the gravity of patient impact.”

From Humble Beginnings ... and Plans for Growth

The team began with a three-member pilot program in 2018 at Burnet Campus and expanded it in 2022. In April 2023 they expanded to Liberty Campus.

“We now perform med recs within 24 hours on any patient who's admitted through our emergency departments,” said Mike. “We start the process at admission to ensure we’re working with the most accurate data during the patient’s stay.”

The team takes special care with mental health patients because their medications change so rapidly.

“Mental health patients are often seen by numerous providers both here and elsewhere,” said Mike. “They often lack the structure and support that typical medical patients have, such as having a parent or guardian with them. They often have very diverse medication regimens, and it's really important for the patient to take the medication every day at the same time, so that the drug levels in their body stay in their effective range.”

The team is working on improving their processes to further enhance their effectiveness.

“I recently finished up a quality improvement class, and I used the med rec program as my project for that class,” said Mike. “Going in we had a baseline capture rate for our mental health patients at 66%. After implementing some quality improvements learned in this class, we were able to get that capture rate up to 87%.”

The team also has plans to grow so they deliver their service to all patients.

“Currently, we do not target direct admits or patients who transfer from the emergency department to critical care units,” said Mike. “We started with EDs since most of our patients are admitted there. We are looking for ways to expand to all admissions. One idea is to have a telemed reconciliation service that would be remote. There is room for growth, and we are actively pursuing that growth.”

In addition to improving process, quality and care, Mike said the program has had benefits for the team.

“It has really brought together our division and reinforced just how important this work is to help change the outcomes and improve the lives of our patients throughout our department,” he said.

Medication Reconciliation (Burnet and Liberty) – June 2023

This table demonstrates the impact of the med rec program in just one month. Each discrepancy that is identified and corrected reduces the risk of an error that reaches the patient.