Effective medication management is dependent on structures and processes. Implementing or enhancing a medication management program should start with a gap analysis to examine how your organization is currently performing. The gap analysis provides insight into the needs for improvement. Medication Management Gap Analysis (1-page Word doc)
Tools and Resources
ISMP Medication Safety Self Assessment for Hospitals. The tool helps hospitals assess the safety of medication practices in their facilities, identify opportunities for improvement, and compare their experiences with the aggregate experiences of demographically similar hospitals. Produced by Institute for Safe Medication Practices, funded by the Commonwealth Fund, 2011. (56-page PDF)
Improving Care Transitions: Optimizing Medication Reconciliation. This white paper describes common barriers to the implementation of medication reconciliation and presents foundational concepts important to its adoption. It outlines how pharmacists can contribute to improving this process using a standardized framework of service delivery. Produced by the American Pharmacists Association (APhA) and the American Society of Health System Pharmacists (ASHP). (20-page PDF)
Improving Medication Reconciliation During Transitions. Eric Coleman, MD, director of the care transitions program at the University of Colorado in Denver, introduces the Medication Discrepancy Tool to characterize transition-related medication problems. He outlines patient-level contributing factors and system-level contributing factors. (5-page PDF)
Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation. This toolkit is based on the MATCH website developed by Northwestern Memorial Hospital in Chicago, Illinois, through the support of AHRQ and collaboration between Northwestern University Feinberg School of Medicine and The Joint Commission. It incorporates the experiences and lessons learned by health care facilities that have implemented the MATCH strategies to improve their medication reconciliation processes.
Safe Practices for Better Healthcare 2010 Update – Safe Practice 17: Medication Reconciliation. One of National Quality Forum’s endorsed 34 safe practices that have been demonstrated to be effective in reducing the occurrence of adverse health care events across a variety of environments. The health care organization must develop, reconcile, and communicate an accurate patient medication list throughout the continuum of care. (see pages 27 and 28 of 48-page PDF)
Medication Therapy Management
Medicare Part D Medication Therapy Management (MTM) Programs 2011. This fact sheet presents a summary of the MTM programs currently in place, with comparisons to previous report findings, and discusses additional steps that the Centers for Medicare & Medicaid Services is taking to analyze and implement best practices. (11-page PDF)
Medication Therapy Management in Pharmacy Practice – Core Elements of an MTM Service Model. This document focuses on the provision of MTM services in settings where patients or their caregivers can be actively involved in managing their medications. The MTM service model in pharmacy practice includes five core elements: medication therapy review, personal medication record, medication-related action plan, intervention and/or referral, and documentation and follow up. Developed by American Pharmacists Association and the National Association of Chain Drug Stores Foundation, March 2008. (24-page PDF)
Minnesota Department of Human Services Medication Therapy Management Services (MTMS). DHS service definition for reimbursement to qualified pharmacists for MTMS for Medical Assistance (MA), General Assistance Medical Care (GAMC), or MinnesotaCare recipients.
Medication Therapy Management in Pharmacy Practice. The Medication Therapy Management (MTM) service model in pharmacy practice includes five core elements: medication therapy review, personal medication record, medication-related action plan, intervention and/or referral, and documentation and follow up. This model focuses on the provision of MTM services in settings where patients or their caregivers can be actively involved in managing their medications. Speakers are Amanda Brummel, Fairview Health Systems and Haley Holton, Hennepin County Medical Center. (Recorded November 21, 2011) (47-minute podcast) Handout (25-page PDF)
Hennepin County Medical Center Medication Reconciliation at Discharge. Bruce Thompson, director of pharmacy, describes Hennepin County Medical Center’s award-winning medication reconciliation pilot project, plus the financial model behind it. (Recorded April 26, 2011) Part 1 (22-minute podcast), Part 2 (23-minute podcast) Handout (25-page PDF)
- Hennepin County Medical Center – Collaborative Medication Reconciliation Significantly Reduces Errors and Readmissions in Patients Discharged to Nursing Homes. Agency for Healthcare Research and Quality (AHRQ) profile on HCMC.
Medication Management in Ambulatory Care
This webinar introduces the pharmacist’s role in improving transitions in care and describes the preliminary outcomes of the Creekside pilot project The webinar speaker is Alison Knutson, PharmD Park Nicollet Creekside Clinic medication management pharmacist. (52-minute podcast) Handout (32-page PDF)
Reducing Hospital Readmissions by Transforming Chronic Care. This program describes Harold Miller’s work with the Pittsburgh Regional Health Initiative to reduce preventable hospital admissions and readmissions through improved care for chronic disease patients. A community hospital and two large primary care physician practices achieved significant reductions in readmissions for patients with chronic obstructive pulmonary disease (COPD). (Recorded August 22, 2011) (60-minute podcast) Handout (30-page PDF)
United Hospital – Postdischarge Follow-up Calls to Skilled Nursing Facilities Reduce Heart Failure Readmissions by Two-Thirds. AHRQ project profile on United Hospital. The program significantly reduced readmissions, generating cost savings of more than $33,000 annually.
Reduction of 30-day Postdischarge Hospital Readmission or Emergency Department (ED) Visit Rates in High-risk Elderly Medical Patients through Delivery of a Targeted Care Bundle. Koehler BE, Richter KM, Youngblood L, Cohen BA, Prengler ID, Cheng D, Masica AL. Journal of Hospital Medicine. 2009 Apr;4(4):211-8.PMID: 19388074.
Analysis of Pharmacist-Provided Medication Therapy Management (MTM) Services in Community Pharmacies Over 7 Years. Mitchell J. Barnett, PharmD, MS; Jessica Frank, PharmD; et.al. Journal of Managed Care Pharmacy. 2009;15(1):18-31.