Medication Reconciliation (NQF 0097)

eMeasure Name Medication Reconciliation eMeasure Id 2D31B98E-DD84-4F02-AA4B-F27D4AA0BBF9
Version number 1 eMeasure Set Id EE5C977E-E61A-4411-BEA6-42FFE2C8410C
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward National Committee for Quality Assurance
Endorsed by National Quality Forum
Description Percentage of patients aged 65 years and older discharged from any inpatient facility (e.g. hospital, skilled nursing facility, or rehabilitation facility) and seen within 60 days following discharge in the office by the physician providing on-going care who had a reconciliation of the discharge medications with the current medication list in the medical record documented.
Copyright
© 2010 American Medical Association and/or National Committee for Quality Assurance. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
No trials of the effects of physician acknowledgement of medications post-discharge were found.  However, patients are likely to have their medications changed during a hospitalization.  One observational study showed that 1.5 new medications were initiated per patient during hospitalization, and 28% of chronic medications were canceled by the time of hospital discharge .  Another observational study showed that at one week post-discharge, 72% of elderly patients were taking incorrectly at least one medication started in the inpatient setting, and 32% of medications were not being taken at all .  One survey study faulted the quality of discharge communication as contributing to early hospital readmission, although this study did not implicate medication discontinuity as the cause . (ACOVE) 

First, a medication list must be collected.  It is important to know what medications the patient has been taking or receiving prior to the outpatient visit in order to provide quality care.  This applies regardless of the setting from which the patient came—home, long-term care, assisted living, etc.

The medication list should include all medications (prescriptions, over-the-counter, herbals, supplements, etc.) with dose, frequency, route, and reason for taking it.  It is also important to verify whether the patient is actually taking the medication as prescribed or instructed, as sometimes this is not the case.
Clinical Recommendation Statement
Improvement notation
Higher scores indicates better quality
Measurement duration
12 month(s)
Reference
Annals of Internal Medicine. 2001;135 (Suppl.):641-758 is devoted to the ACOVE indicators. Articles cover the project overview, methods for developing the indicators, and the evidence supporting the quality indicators for 11 of the topics.
Reference
Beers MH, Sliwkowski J, and Brooks J.  Compliance with medication orders among the elderly after hospital discharge.  Hosp Formul.  1992;27:720-724.
Reference
Becker MH and Maiman LA. Sociobehavioral determinants of compliance with health and medical care recommendations. Med Care. 1975;13:10-24.
Reference
Williams EI and Filton F. General practitioner response to elderly patients discharged from hospital. BMJ. 1990;300:159-161.
Reference
Wenger NS and Young R. Working paper: Quality Indicators of Continuity and Coordination of Care for Vulnerable Elder Persons. Rand: August 2004.
Reference
Institute for Healthcare Improvement. Reconcile Medications at All Transition Points: Reconcile Medications in Outpatient Settings. Available at: http://www.ihi.org/IHI/Topics/PatientSafety/MedicationSystems/Changes/IndividualChanges/ReconcileMedicationsinOutpatientSettings.htm. Accessed August 2006.
Definition
Initial Patient Population(s): All patients aged 65 years and older during the measurement period.
Definition
Denominator(s): Patients in the initial population discharged from any inpatient facility (eg, hospital, skilled nursing facility, or rehabilitation facility) during the measurement period and seen within 30 days following discharge in the office by the physician providing on-going care.
Definition
Denominator Exclusion(s): N/A
Definition
Numerator(s): The number of patients who had a reconciliation of the discharge medications with the current medication list in the outpatient medical record documented within 30 days of the discharge
Definition
Denominator Exception(s): N/A
Guidance
Medication reconciliation is the process of comparing a patient's medication orders to all of the medications that the patient has been taking. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. 

Medication Reconciliation Process

The medication reconciliation process is comprised of five components:
1. Update a list of current medications;
2. Develop a list of medications to be prescribed;
3. Review and compare the medications on the two lists
4. Make clinical decisions based on the comparison
5. Communicate the new, updated list to appropriate members of the care team and to the patient."

It is the responsibility of the clinician/pharmacist to review the medication profile with the patient to assure it is correct and up-to-date.
1. Discontinue all non-active medications
2. Renew all expired medications
a. If the patient already has these medications, the pharmacist places them on hold
3. Update all new medications not on the medication profile including OTC, herbal, and traditional medications (All prescriptions will contain the indication for prescribing)

Patients MUST receive a printed copy of their medication profile which contains all medications with the status of active, hold, or returned to stock. Medications that are expired and not current therapy and discontinued should not appear on the profile. The medication profile is to be reviewed with the patient prior to transition to another care team.
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012