This story originally appeared in IHI's 2008 Annual Progress Report.
Like many people his age, Deryl Jenson, 70, takes about 10 medications. His health history includes a heart attack, bypass surgery, and a brain injury and surgery on both knees from a bad fall down the stairs 20 years ago. Those injuries led to the loss of his job as a boiler engineer, and depression. He also has high blood pressure.
Nonetheless, Jenson, who sometimes works seasonally as Santa Claus, says “I feel fine.” He enjoys spending time with his wife, Carol, and their “four beautiful daughters, and seven beautiful grandchildren.”
When he visits his primary care doctor at Fairview Oxboro Clinic in Bloomington, Minnesota, part of Fairview Health Services, Jenson says “we go over the list of my medications every time. They keep good track of me.” Medication reconciliation, the process of making sure there that medications and dosages are accurate at all transition points, may seem easy to do one patient at a time, but is far more complex on a system level, particularly as patients move in and out of the hospital.
“To do it well, you really need three important elements: good tools, the right processes, and accountability,” says Steven Meisel, PharmD, Director of Medication Safety. And he should know. Using a combination of electronic medical records, inpatient pharmacy systems, and pharmacy technicians, Fairview does it very well, recently posting an average 90.6 percent success rate for outpatients in its 60-some clinics, and an average success rate of 74.1 percent for inpatients across its seven hospitals. This latter measure is an all-or-nothing metric that includes reconciling every medication
for every patient on admission, transfer and discharge.
Fairview Lakes Medical Center in Wyoming, Minnesota, routinely achieves a 100 percent success rate for inpatients. Pharmacy Director Mark Nelson, RPh, knows that improved patient safety is not the only benefit. Through medication reconciliation, his hospital reduced inaccurate patient records by nearly 31 percent between 2004 and 2006. “We calculate that we averted 95 adverse drug events in 2006, which, at an average cost of $2,500 per event, theoretically saved $237,500 in adverse drug event costs for the year.”