ISMP Survey on Medication Reconciliation

ISMP is interested in knowing how staff within healthcare facilities are progressing with the Joint Commission’s (JC) National Patient Safety Goal (NPSG) requiring medication reconciliation. Please take a few minutes to complete this survey and submit your responses by May 19, 2006.

About you 1. What is your profession? Select Nurse Pharmacist Physician/prescriber Other Other: 2. What is your staffing level? Select Staff Manager Administrator Other Other: 3. Are you familiar with the JC NPSG related to medication reconciliation? Yes No 4. Have you attended inservice education regarding your role in medication reconciliation? Yes No About your facility 5. In what type of facility are you employed? Select Hospital Outpatient/office-based facility Surgery center Assisted living Home care Long-term care Other 6. For admissions, how long has a medication reconciliation process been in place on your unit/in your department/facility?  Select 0 months 1-3 months 3-6 months 6-12 months More than a year Don't know 7. For transfers to a different level of care, how long has a medication reconciliation process been in place on your unit/in your department/facility?  Select 0 months 1-3 months 3-6 months 6-12 months More than a year Don't know 8. For discharges from your care, how long has a medication reconciliation process been in place on your unit/in your department/facility?    Select 0 months 1-3 months 3-6 months 6-12 months More than a year Don't know

About your process 9. Who is primarily responsible for the following (you may choose more than one category)… Nurse Pharmacist Physician/ Prescriber Medical Records Other Don’t Know a. Collecting an initial medication history b. Assuring the medication history is accurate c. Reconciling medications between the history and the admission orders d. Reconciling medications upon transfer of a patient to another level of care e. Reconciling medications at the time of discharge f. Sending the patient’s discharge medication list to the patient’s physician/next provider

10. After an admission medication history is obtained, your policy states all medications must be reconciled within how many hours? Select 12 24 36 48 Other Not Sure 11. Does your policy specify a different timeframe for reconciliation depending upon the critical nature of the drugs on the medication history list? Yes No Not Sure 12. Your medication reconciliation process is documented on which type of form? Select Paper chart Computer charting system Combination of both Not documented Not sure 13. Does the prescriber order medications directly on the same form or screen used to document the initial medication history? Select Yes No Sometimes Not Sure

14. Please rank the relative importance of success factors and barriers encountered during the implementation of the medication reconciliation program at your facility. Scale: 1=most important, 8=least important (use each number once in the ranking process).

a. SUCCESS FACTORS Rank b. BARRIERS Rank i. Teamwork among disciplines Select 1 2 3 4 5 6 7 8 i. Unreliable patient Select 1 2 3 4 5 6 7 8 ii. Clearly defined protocols Select 1 2 3 4 5 6 7 8 ii. Documentation from other sources Select 1 2 3 4 5 6 7 8 iii. Centralized history form/screen Select 1 2 3 4 5 6 7 8 iii. Lack of teamwork among disciplines Select 1 2 3 4 5 6 7 8 iv. History collection by pharmacist Select 1 2 3 4 5 6 7 8 iv. Extra burden Select 1 2 3 4 5 6 7 8 v. Easy communication with outpatient providers Select 1 2 3 4 5 6 7 8 v. Lack of frontline staff input into process Select 1 2 3 4 5 6 7 8 vi. Reasonable expectations for “complete” history Select 1 2 3 4 5 6 7 8 vi. Lack of administrative leadership  Select 1 2 3 4 5 6 7 8 vii. Awareness of the role of each contributor Select 1 2 3 4 5 6 7 8 vii. Lack of physician leadership Select 1 2 3 4 5 6 7 8 viii. Other: Select 1 2 3 4 5 6 7 8 viii. Other: Select 1 2 3 4 5 6 7 8

15. On a scale of 1 to 5, with 1=not valuable and 5=very valuable, please select a number below indicating your perception of the value of the medication reconciliation process to patient safety overall: Not Valuable 1 2 3 4 5 Very Valuable 16. Other comments: