The Pharmacy Executive Forum recently undertook research to identify best practices for designing an effective, scalable medication reconciliation process. Here are a few lessons for improving staff engagement and process accuracy.
1. Assume that basic education is needed when talking about medication reconciliation. The process is complex and involves two distinct activities which are often conflated: the gathering of a complete and accurate medication list (also known as a medication history), and the reconciliation of that list of medications against any orders. These connected but separate steps are typically performed by different people. Nurses and pharmacy technicians are usually responsible for collecting medication histories, while physicians and pharmacists make clinical decisions based on the list.
Misuse of terminology perpetuates not only the spread of incorrect information, it also undervalues the scope and complexity of the work, contributes to process inefficiencies, and prevents clear ownership of tasks.
2. Engage both frontline staff and leadership in advocacy efforts. Both stakeholder groups benefit from improved medication reconciliation processes and should be included in engagement efforts designed to foster strong process stewards and increase resource investment. While executive audiences will likely be most interested in understanding how the process impacts the bottom line and broader health system objectives, frontline staff will want to understand how better processes will benefit their patients and their workflow. Sharing patient stories and near misses, as well as time-study information from your organization, help personalize the message.
3. Deploy dedicated, well-trained staff with protected time to improve the accuracy and scalability of medication reconciliation processes. While leveraging pharmacists and pharmacy technicians for the various steps of medication reconciliation is ideal, such an investment may not be feasible for all organizations. Regardless of who is held responsible for the work, the success of those individuals will be dependent on whether they have the time, training, and specialization to devote themselves fully to the task.
Effective training outlines the intent of the medication reconciliation process and the desired delineation of roles and responsibilities. Additionally, staff responsible for gathering medication histories should receive hands-on training related to patient interviewing, source verification, and documentation.
4. Provide regular feedback and celebrate successes to promote ongoing engagement. Even with a wide-reaching and successful medication reconciliation program, it is important to not let staff lose sight of medication reconciliation's objectives. Poor communication and lack of feedback loops often make it challenging to sustain improvements.
Specifically, frontline staff usually do not receive any feedback on their performance or the impact of their work. Even if staff have adequate training and tools, they need to be made aware of successes and mistakes to foster ongoing improvement and engagement.
Additionally, most organizations are not tracking outcomes-based metrics that engage both frontline and leadership staff. According to the Pharmacy Executive Forum's survey, fewer than 10% of organizations track outcomes metrics. Tracking outcomes is time-intensive and no one measure fully captures the impact of medication reconciliation. Nevertheless, these data are essential for monitoring performance and justifying expanded investment.