1129 / Medication Reconciliation

ITALY
Classification of the PSP
Type of Patient Safety Practice Safe
 
Clinical Risk Management Practice (CRMP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Patient safety culture / Patient safety climate
Implementation of Patient Safety initiatives / Activities There is no specified text here
Topic of the reported practice
Patient safety system
Aim and the benefit of the Patient Safety Practice
 
Medication reconciliation is a systematic and comprehensive review of all the medications a patient is taking to ensure that medications being added, changed or discontinued are carefully assessed and documented. Endorsed by patient safety organizations around the world, medication reconciliation is intended to ensure accurate communication at care transition points, for example, when patients enter a hospital, transition to another service or provider, or are discharged home. Communicating effectively about medications is a critical component of delivering safe care and of reducing risks for patients. By identifying and resolving medication discrepancies, the likelihood of adverse events occurring within health care organizations across the continuum of care will be reduced. Using medication reconciliation, health care providers follow a formal process to work together with patients, families and care providers to ensure accurate and comprehensive medication information is communicated consistently across transitions of care. The aim of this practice is the promotion of the correct administration of drugs, in particular in hospitalized patients through the control of the different phases of the process. The main objective is, therefore, to reduce the clinical risk through the implementation of a specific procedure for the medication recognition and reconciliation at admission, transfer or discharge. Another objective is to enhance the safety culture, in particular the culture of prevention of errors in medication management. Specific objectives: 1 – To implement the procedure for the dissemination and consolidation of the medication recognition and reconciliation process. The medication recognition/reconciliation should be performed at the beginning, transfer and discharge, and in the future also at admission. 2 – To implement the procedure for the dissemination and consolidation of the medication recognition and reconciliation process in DH. 3 – To implement the procedure for the dissemination and consolidation of the medication recognition and reconciliation process in outpatients. 4 – To integrate, if appropriate, the record of the recognition/reconciliation in the medical sheet.
Description of the Patient Safety Practice
 
The practice originates from a recommendation on medication reconciliation recorded in the final report of Accreditation Canada (AC). At CRO, a working group was set up a to address this issue. It performed the following activities: - To examine and analyze the documents and forms developed by the Clinical Risk Management and Accreditation Unit (UGRCA); - To examine, evaluate and update the drafting of the procedure proposed by UGRCA on medication reconciliation, in particular with respect to the compliance tests requested by AC; - To define a Gantt chart for the adoption and implementation of the procedure and its monitoring; - To plan other initiatives, in particular information/training activities to foster the implementation of the project. The working group, through both formal meetings and remotely, pursued these objectives, approved the procedure and the related forms, scheduled the implementation of the program, proposed training events. On December 18th, 2013, a training curse (CME accredited) entitled "RECONCILIATION OF MEDICATION THERAPY" took place at CRO; the trainers were colleagues of the Veneto Region, which as part of the accreditation program of AC have already addressed the problems related to the topic in question.
The monitoring of the medication reconciliation at discharge and transfers took place 30 days after the implementation of the procedure (January 15, 2014). 5 random medical records for each unit were selected. The indicator used is the analysis of a sample of 5 random medical records from each unit: n of medical records with the form duly completed / total n of medical records for each unit. This survey will repeated after 3-5 months from the beginning of the program.

Medication Reconciliation - Results of monitoring
2014 – sample of 120 medical records
Medication anamnesis correctly done in 62.83%
Medication reconciliation correctly done in 30%
Attachment of relevant written information and/or photos, as appropriate
There is no specified text here
There is no specified text here
There is no specified text here
There is no specified text here
Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Institution level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Quantitative
Enclosure of a reference or attachment in case of published evaluation's results
There is no specified text here
There is no specified text here
Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
No
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
 
Physicians
Nurses
Health care assistants
Clinical manager
Quality manager
Risk manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
Yes
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
Patient(s)
Relative(s)
Point of time in which service user or their reprasentatives' involvement takes place
During the application of the Patient Safety Practice
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
No
Short description of the service users' level of involvement
Not known
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
Yes
List of sources where public information is accessible
http://buonepratiche.agenas.it/questionnaire.aspx?id=4610
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
Yes
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
Not sufficient financial resources available
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
There is no specified text here
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
There is no specified text here
Contact information
 
Name: Monica Masutti
Country: ITALY
Organisation: CENTRO RIFERIMENTO ONCOLOGICO
E-mail: mmasutti@cro.it
Phone: There is no specified text here
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