| 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? |
| 0 months |
98% |
| 1-3 months |
0% |
| 3-6 months |
0% |
| 6-12 months |
0% |
| Don’t know |
0% |
| 8. For discharges from your care, how long has a medication reconciliation process been in place on your unit/in your department/facility? |
| 0 months |
98% |
| 1-3 months |
0% |
| 3-6 months |
0% |
| 6-12 months |
0% |
|
|
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 |
5% |
3% |
4% |
3% |
3% |
3% |
| b. Assuring the medication history is accurate |
4% |
3% |
4% |
3% |
3% |
3% |
| c. Reconciling medications between the history and the admission orders |
4% |
3% |
4% |
2% |
3% |
3% |
| d. Reconciling medications upon transfer of a patient to another level of care |
4% |
3% |
4% |
2% |
2% |
3% |
| e. Reconciling medications at the time of discharge |
4% |
3% |
4% |
2% |
3% |
3% |
| f. Sending the patient’s discharge medication list to the patient’s physician/next provider |
4% |
3% |
3% |
3% |
3% |
4% |
|
| 10. After an admission medication history is obtained, your policy states all medications must be reconciled within how many hours? |
| 12 |
96% |
| 24 |
1% |
| 36 |
0% |
| 48 |
0% |
| Not Sure |
2% |
| 11. Does your policy specify a different timeframe for reconciliation depending upon the critical nature of the drugs on the medication history list? |
| No |
98% |
| Not Sure |
1% |
| 12. Your medication reconciliation process is documented on which type of form? |
| Combination of both |
1% |
| Computer charting system |
1% |
| Not documented |
1% |
| Not sure |
1% |
| 13. Does the prescriber order medications directly on the same form or screen used to document the initial medication history? |
| Always |
96% |
| Never |
2% |
| 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 |
| 1 |
97% |
| 2 |
1% |
| 3 |
0% |
| 4 |
0% |
| 5 |
0% |
| 6 |
0% |
| 7 |
0% |
i. Unreliable patient |
| 1 |
97% |
| 2 |
1% |
| 3 |
1% |
| 4 |
1% |
| 5 |
1% |
| 6 |
0% |
| 7 |
0% |
| ii. Clearly defined protocols |
| 1 |
97% |
| 2 |
1% |
| 3 |
0% |
| 4 |
0% |
| 5 |
0% |
| 6 |
0% |
| 7 |
0% |
ii. Documentation from other sources |
| 1 |
97% |
| 2 |
1% |
| 3 |
0% |
| 4 |
1% |
| 5 |
1% |
| 6 |
0% |
| 7 |
0% |
| iii. Centralized history form/screen |
| 1 |
97% |
| 2 |
1% |
| 3 |
1% |
| 4 |
0% |
| 5 |
0% |
| 6 |
0% |
| 7 |
0% |
iii. Lack of teamwork among disciplines |
| 1 |
97% |
| 2 |
1% |
| 3 |
1% |
| 4 |
0% |
| 5 |
1% |
| 6 |
0% |
| 7 |
0% |
| iv. History collection by pharmacist |
| 1 |
96% |
| 2 |
0% |
| 3 |
0% |
| 4 |
1% |
| 5 |
0% |
| 6 |
1% |
| 7 |
1% |
iv. Extra burden |
| 1 |
97% |
| 2 |
1% |
| 3 |
0% |
| 4 |
1% |
| 5 |
0% |
| 6 |
0% |
| 7 |
1% |
| v. Easy communication with outpatient providers |
| 1 |
97% |
| 2 |
1% |
| 3 |
0% |
| 4 |
1% |
| 5 |
1% |
| 6 |
1% |
| 7 |
0% |
v. Lack of frontline staff input into process |
| 1 |
97% |
| 2 |
1% |
| 3 |
0% |
| 4 |
1% |
| 5 |
1% |
| 6 |
1% |
| 7 |
0% |
| vi. Reasonable expectations for “complete” history |
| 1 |
97% |
| 2 |
0% |
| 3 |
1% |
| 4 |
1% |
| 5 |
0% |
| 6 |
1% |
| 7 |
0% |
vi. Lack of administrative leadership |
| 1 |
97% |
| 2 |
1% |
| 3 |
1% |
| 4 |
0% |
| 5 |
0% |
| 6 |
1% |
| 7 |
0% |
| vii. Awareness of the role of each contributor |
| 1 |
97% |
| 2 |
1% |
| 3 |
1% |
| 4 |
1% |
| 5 |
0% |
| 6 |
1% |
| 7 |
1% |
vii. Lack of physician leadership |
| 1 |
97% |
| 2 |
1% |
| 3 |
0% |
| 4 |
0% |
| 5 |
0% |
| 6 |
0% |
| 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:
| 1 |
0% |
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