Marin General created a med rec tech position to collect accurate home medication lists upon admission.
Medication reconciliation is a problem that every hospital faces and we weren’t any different. Patients were coming in with medication lists that didn’t match what they were actually taking or what their PCP had prescribed. Then they were being discharged with lists of medications that didn’t align with what they had at home. We used to have the admitting nurse or floor nurse collect the home medication lists, but those nurses didn’t have the time or expertise to collect accurate lists. If home medication lists are incorrect, then there’s a greater chance that the discharge medication lists will also be incorrect, causing patients to take the wrong medications or take them incorrectly, leading to a readmission.
Marin General is a non-profit hospital in Greenbrae, CA. It has 250 beds and serves a mainly affluent suburban/rural population with pockets of low-income Latinos, African-Americans, and state prison inmates. Their transitions program began in 2011 and is influenced by the Care Transitions Program and Project RED.
What We Tried
We used a grant to hire a pharmacist as a medication reconciliation technician for 10 hours a day, 7 days a week. The pharmacist reviews all of the home medication lists of patients coming in through the ED and calls outside pharmacies and physicians’ offices to validate them. That way the doctors at least have a good starting ground they can trust. We try to get the correct home medication lists before the patient is admitted so that the admitting orders from the physician are correct. In the case of direct admissions or off-hour admissions, the med rec tech will visit with the patient the following day.
Our staff’s confidence of accurate home medication lists has gone up significantly. This makes nurses more comfortable administering medication in the hospital and it enables physicians to issue better orders upon discharge. The program has been so successful that the hospital is pushing to make a med rec tech available 24/7.
Hiring a med rec tech was more cost efficient than training 400 nurses how to do better med rec. The nurses and doctors also really appreciate having the tech around because it gives them more time to care for patients.