Test Plan For Medication Reconciliation
Test Plan for Medication Reconciliation
The best way to understand whether a medication reconciliation workflow is achieving the desired objectives is to test it. In the original flowchart, there was no feedback communication between physician’s office and home nurse nor coordination between specialist prescriber, the primary care, and the pharmacy. Additionally, there was no patient education about medication which increased their risk of receiving medications with potential drug interactions and adverse events (Mutair et al., 2021). The proposed workflow will have the capacity to address communication lapses by using an e-shared medication list which will allows the home nurse and the prescribing practitioner to update and share medication lists for enhanced patient safety. Before the change is introduced into a live system, it is imperative to test whether it is working well to address the existing problems in medication reconciliation (AHQR, 2022). The purpose of this assignment is to develop a plan to validate (test) the proposed information workflow change from the workflow diagram and analysis assignment week 1. The paper will include a description of the test plan, methodology, and evidence-base intervention for the test plan and the test method chosen.
The Test Plan
A test plan will guide the nurse informaticist to successfully assess the functionality of the proposed medication reconciliation flow chart. The plan describes what will be done at the time of admission and at the time of discharge as its main scope based in the nature of the new flow chart. The process will utilize patients’ data contained in the electronic health records system (Jarrett et al., 2020). Both human and non-human resources will be required to test the plan. For example, medication reconciliation at the facility will require collaborative efforts of the patient, the home nurse, the physician, and the pharmacist. Additionally, the providers will need hardware such as desktops and laptops that are protected from unauthorized access (Jarrett et al., 2020). Precisely, the home nurse, the physician, and the pharmacist will need a computer from where they can access, view, and share the patients’ medication list.
A number of key acceptable deliverables will be used to determine the success of the test plan. The most important one is provider training. The organization will begin by training the home nurse and the prescribing practitioner about medication reconciliation and how it is achieved in the organization based on the existing flow chart (AHRQ, 2022). It is after the training that the incumbents will be allowed to take part in the evaluation of the new flow chart. For example, when a patient is admitted to home care, the admitting nurse will create a medication profile for the patient on the electronic health records system. This will serve as a central location for accessing and viewing the shared medication list for the patient by the home nurse, the physician, and the pharmacy. Additionally, when the SOC registered nurse receives details of the new patient, he or she will create “One Source of Truth” that details the patient’s medication list to be shared by other providers. The nurse will create radio buttons to show whether the entered information is complete and accurate. Also important is creating a plan for each home medication considering the nature of the patient’s health and the expected therapeutic goals (AHRQ, 2022). The system will be designed in a manner that it will be able to prompt the nurse to prepare a medication list for the patient and send a notification regarding the patient’s next move to the physician.
The physician will review and verify information related to the patient’s home medication at this point and make a decision on the best ones to add to avoid drug reactions. It is important to verify the information in the electronic portal to ensure that the patient provided full details regarding home medications (Jarrett et al., 2020). During verification, the physician and the pharmacist will have an opportunity to educate the patient about the relationship between medications that are already use and those that the patient is ordering from the hospital. Educating patients helps them to understand issues related to medication reconciliation including their roles in the process (AHRQ, 2022). The nurse, the physician, and the pharmacist will play crucial roles in reconciling the patients home medication with those ordered during hospitalization.
On the -Shared Medication List (eSML) or electronic health records system, the provider will find details concerning home medications under the “Document Medication by Hx” button. In case a new home medication or unresolve discrepancies are identified, the pharmacist and the nurse should discuss this information with the physician before that drugs are given to the patient at the point of discharge (AHRQ, 2022). One possible risk that might affect the successful testing of the new workflow is patients presenting concern regarding the privacy of the data that they provide to the healthcare professionals. The providers will address such a risk and contingency by assuring the patient of the privacy and confidentiality of their data (Jarrett et al., 2020). The home nurse and the prescription providers will test the system’s compliance with relevant laws by aligning medication reconciliation process to the strategic goals of the organization.
Notably, the new flow chart will be considered fully validated when, in compliance with relevant regulatory requirements and laws, allows the patient, the home nurse, the physician, and the pharmacy to successfully and effectively communicate and share feedback on the eSML to ensure medication reconciliation (AHRQ, 2022). The healthcare professionals will clarify possible discrepancies including the resolutions to address them to ensure the effective performance of the flow chart. They will also comment on drug interactions and their plans of making modifications to ensure that no patient develops drug-related adverse events when the flow chart becomes fully operational (Jarrett et al., 2020). The organization should introduce the change into a live system only when it is able to allow sharing of reconciliation updates between the home nurse and prescribing practitioners.
Methodology
The Medications at Transitions and Clinical Handoffs (MATCH) Toolkit is the methodology that was used to develop the test plan. The Institute of Healthcare Improvement (2022a) lists a number of uses of MATCH in healthcare organizations. The agency indicates that the MATCH, in addition to other uses, is used by healthcare organizations to test and execute a fresh or improved medication reconciliation process within a practice setting or in the entire organization. MATCH is relevant for testing medication reconciliation processes in healthcare organizations because it integrates lessons and experiences of healthcare organizations that have implemented medication reconciliation (IPRO QIN-QIO Resource Library, 2022). MATCH, as a method of testing has enhanced the development of a test plan to validate a workflow change in the practice setting.
The MATCH toolkit utilizes guided questions to facilitate the development of a new flow chart or redesigning of a new one to capture processes and activities during admission, patient transfer, and discharge. The admission-related aspects captured by the MATCH include medication history, comparison (reconciliation), orders, and resolution. The toolkit further describes key issues that should be addressed under each concept to enhance flow chart review (AHQR, 2022). For instance, under each area, the toolkit descries the “who, what, when, where, and how” in relation to the concept. These key issues were effectively applied when testing the new flow chart for the home care to collect medication history. For instance, in the new flow chart of medication reconciliation, the home nurse, physician, and pharmacy ate charged with the responsibility of obtaining the patient’s medication history. The specific data that is captured during a medication history interview concerns the types of medications that the patient is currently using at home (AHRQ, 2022). The medication history is obtained at the time the patient visits the facility and periodically during the care process as the patient continues to encounter different providers along the process of care. When developing the test plan, it was clearly indicated that the patient’s medication history is recorded and stored in the electronic health records (EHR). In EHR, the provider will find details concerning home medications under the “Document Medication by Hx” button. The data is entered either as a structured paper form or as an electronic entry (AHQR, 2022). In order to establish whether medication histories are collected and documented appropriately, every healthcare provider asks the patient about home medications and compares the information with what is already documented in the “One Source of Truth.”
Again, the “who, what, when, where, and how” as outlined in the MATCH toolkit were used to achieve medication reconciliation in the test plan. Precisely, the physician and the pharmacist are charged with the responsibility of comparing the medication ordered during hospitalization to the patient’s medication histories. The process of comparing medications is known as reconciliation. When developing the test plan reconciliation occurred when a patient is ordering medications from the hospital (AHQR, 2022). Information about medication history already documented in the health record, also know an “One Source of Truth.” Discrepancies that require clarification are identified when the client mentions a new home medication that was not captured when collecting medication history at the point of admission (AHQR, 2022). The provider monitors and measure that reconciliation is occurring when the medications that are ordered during admission at the hospital match home medications.
The test plan has further applied the “who, what, when, where, and how” of the MATCH framework to evaluate medication orders in the test plan. As indicated in the test plan, the physician is charged with the role of placing medication orders. The new flow chart has placed the physician at the center of medication ordering where the physician updates orders and sends them to the nurse. The process ordering medications is influenced by the patient’s needs. The physician usually order medications that will note cause adverse drug reactions with the home medications discovered when collecting medication history (AHQR, 2022). Ordering decisions are usually recorded in the electronic health records and discrepancies are resolved by adding a given medication to the patient’s medication list to be captured as a home medication.
The “who, what, when, where, and how” in relation to resolution were utilized in the test plan. For example, the physician and the pharmacy are the professionals who follow up when they notice unintended discrepancies in a patient’s medication. The best approach to resolve such issues is to ensure that there is consistency in the types of home medications listed in the medication list (AHRQ, 2022). Follow-up usually occurs after a patient has been discharged from the hospital. The physician and the pharmacist should indicate clearly in the EHR that discrepancies were resolved. Similarly, they need to identify the specific outcomes generated by an intervention. In order to establish whether discrepancies were actually resolved, the prescribing providers must show evidence of documentation in the EHR and of uniformity in the medication list (AHQR, 2022). Generally, the MATCH provided a framework that facilitated the developed of a test plan for the proposed medication reconciliation flow chart.
The MATCH toolkit has some advantages and disadvantages. One of the major advantages of the toolkit is that it provides a systematic methodology for improving medication reconciliation in healthcare settings (Jarrett et al., 2020). It also empowers prescription providers to maintain accurate medication lists. However, the toolkit is disadvantageous in that errors can easily occur during its adoption to a clinical setting, and this might lead to false outcomes (Jarrett et al., 2020). Other alternatives to MATCH that could be uses are the Medication Reconciliation Tracking Tool, Medication Reconciliation Review, Medication Reconciliation Flowsheet, and Health and Safety Passport among other tools (Institute for Healthcare Improvement, 2022b). The choice of tools depends on the types of patients and the types of data that one wants to collect at any given time.
Evidence-Based Test Plan Development/ Testing Method
The MATCH toolkit has been chosen because its effectiveness in improving medication reconciliation is supported by research. For example, Jarrett et al. (2020) conducted a study to assess the impacts of MATCH toolkit on improving medication reconciliation in a rural-based health clinic. The researchers found that MATCH improved medication reconciliation in the clinic. Additionally, the toolkit empowered patients to work closely with their healthcare providers to improve medication reconciliation. Similar findings are supported by the Agency for Healthcare Research and Quality (AHRQ). According to AHRQ (2022) and IPRO QIN-QIO Resource Library (2022). According to AHRQ (2022), MATCH is an effective tool of improving medication reconciliation in healthcare settings. Evidence documented in IPRO QIN-QIO Resource Library (2022) indicates that MATCH is relevant for testing medication reconciliation processes in healthcare organizations because it integrates lessons and experiences of healthcare organizations that have implemented medication reconciliation. IHI (2022a) further recommend the use of MATCH to test workflow for medication reconciliation in healthcare settings.
Conclusion
The lack of medication reconciliation can cause patients to develop adverse events thereby preventing the achievement of positive health outcomes. Healthcare organizations can make changes to their workflows in order to improve medication reconciliation and promote patient safety. However, it is important to test a medication reconciliation flow chart before introducing it into a live system. The MATCH toolkit is an evidence-based methodology for testing medication reconciliation flow charts in healthcare settings.