Table 1 Intervention components and scoring system

Definition of Medication Reconciliation

Definition exists, is widely disseminated and can be articulated by staff involved in the medication reconciliation process

0-24 points in 8-point increments, depending on whether definition exists, is widely implemented, and can be articulated by >80% of staff involved in the medication reconciliation process

Assigning roles and responsibilities to clinical personnel

Roles and responsibilities are well defined for each phase of medication reconciliation and can be articulated by staff involved in the medication reconciliation process; process owner (e.g., attending physician) is well defined and known by those who own the process

0-12 points in 4-point increments, depending on whether roles are well defined, defined for each phase of the medication reconciliation process, and can be articulated by >80% of staff

0–12 points in 4 point increments, depending on whether process owner is well defined and what proportion of staff in that role can articulate that they in fact own the process

Improving access to preadmission medication sources

All sites improve exchange of medication information across settings, e.g., community pharmacy prescription information, outpatient medication lists, and inpatient discharge medication orders to all clinical settings

0-24 points in 6 point increments for electronic access to outpatient pharmacy information, access to outpatient medications, access to discharge medication orders from prior hospitalizations, and access to patient personal health records.

(can get up to 12 points if have facilitated paper access to these sources)

Encouraging patient-owned medication lists

All sites develop (on paper or

0-24 points in 6 point increments, depending on whether a standard medication form exists, to what extent patients use it, whether a system is in place to keep it updated, and whether the form is universally accessible

electronically) a universal instrument to capture the current medication list, based on steering committee guidelines

Educating providers on how to take a best possible medication history

Providers receive training in taking a best possible medication history, receive feedback on their skills, and have time to perform it well

0-12 points in 4 point increments, depending on whether clinicians are trained to take a medication history, whether time is available to take an adequate history in >80% of patients, and what portion of the staff have ever received feedback in their history taking

Implementing discharge counseling that includes patient education and teach back

Providers counsel patients regarding discharge medications using a standard script that accommodates patients with low health literacy

0-12 points in 4 point increments, depending on whether a standard script is available for discharge counseling, whether health literacy tools are used, and whether >80% of staff is trained in discharge counseling, including patient centered communication

Identifying patients as high vs. low-intermediate risk by stratification

Sites use established risk factors to identify patients at high risk for medication errors, and patient risk drives the type of intervention received

0-24 points available by calculating the product of the two below areas:

0–4 points available depending on whether there is a standard tool available to identify high risk patients and is used in >80% of patients

0–6 points available depending on whether the tool drives the intervention intensity, and >80% of eligible patients receive the high-intensity intervention

Implementing intense vs. standard bundle

High-risk patients receive a high-intensity medication reconciliation bundle by providers who are trained and have time to carry it out

0-24 points in 6 point increments depending on whether definition exists for standard and intense intervention, is embraced widely, staff are well trained, and are given adequate time to carry out the intensive bundle in high-risk patients

Implementing and improving electronic medication reconciliation applications where possible

Where possible, take advantage of electronic health record infrastructure and electronic medication reconciliation products to facilitate bidirectional transfer of medication information across settings, compare regimens across settings, and electronically document the reconciliation process

26 maximum points available based on electronic medication reconciliation tools having the following features: ability to compare various sources of preadmission medication information, access to medication adherence information, ability to document and verify a medication history, facilitation and verification of admission and discharge medication reconciliation, facilitation of admission and discharge order-writing, facilitation of patient/caregiver education, tools to facilitate communication with post-discharge providers, features to improve the reliability of the medication reconciliation process, and tools to identify high risk patients

Implementing components using phased approach

Sites implement medication reconciliation improvements in a phased manor using best practices for continuous quality improvement

0-24 points in 6 point increments, depending on whether a plan exists to modify the intervention over time, to expand the intervention beyond the initial pilot sites, whether a time frame for expansion has been established and if the QI team has all the right personnel

Utilizing social marketing and engaging community resources

Sites identify, cultivate, and improve relationships with community resources such as local or regional QI organizations, dominant local pharmacies and payors, and local public health agencies with a goal of working together to improve patient education, transfer of information, and aligning financial incentives

0-24 points in 3 point increments, depending on usage of community resources and a patient safety advisory board in medication reconciliation, and usage of social marketing techniques with patients and providers