New American Medical Association president Nancy Nielsen, MD, vowed at the organization's annual meeting to use "all of the power" of her presidency and the clout of the AMA "to let the nation know that we must cover America's uninsured." Nielsen is only the second woman to become president of the 161-year-old AMA. She also has worked as a medical educator and health insurance executive.
A mobile emergency room that arrives on a tractor trailer and can be set up within 30 minutes will open for business next to Columbus, IN's flood-damaged hospital. The Carolinas MED-1 unit will provide intensive care beds, operating rooms and other resources so hospital staff can resume treating patients. Columbus Regional Hospital has been closed since it was flooded June 7, causing damage estimated at more than $125 million.
Private health consultants are trying to fill a gap in healthcare created by overworked primary care doctors who have less time to coordinate patient care. Consultants, many of whom are registered nurses, social workers, or physicians, help clients find specialists and also will make calls to ensure that a patient's various doctors are communicating with each other. The trend also caters to the desire of a growing number of patients to take charge of their healthcare.
"Hopkins," a follow-up to the acclaimed "Hopkins 24/7" from 2000, takes television viewers inside the Baltimore hospital. Johns Hopkins Hospital officials said after the mostly positive feedback they received following the first documentary they had few reservations about opening their corridors for a second time. Executive producer Terence Wrong, who also produced the first documentary, said he wanted to revisit Hopkins because of changes that had taken place since the first series. More women and international staff members and improved technology were some of the changes that Wrong wanted to explore in the new series.
A foreign company is breaking into the heavily regulated Chinese healthcare system by targeting the elite who are willing to pay premium prices for premium care. Chindex has opened Western-style hospitals and clinics in Beijing, Shanghai and Guangzhou to cater to affluent expatriates and wealthy Chinese. Staffed by foreign doctors and some of China's top physicians, its fees are too high for most Chinese.
CEOs, while they care about patient safety, aren't always involved in the in-the-trenches work that goes on with different patient-safety initiatives. Oh sure, occasionally I'll hear a CEO say he worries about hand-washing and infection control, but usually patient safety is left to the various departments—until something goes wrong.
Except with medication reconciliation.
Med rec is one of the few patient-safety topics that senior leaders mention all the time. At a conference I attended recently, one CEO presenter started his presentation (on an unrelated topic) by asking the room of senior leaders who of them had mastered medication reconciliation. Not one hand went up.
Organizations have struggled to implement a process for reconciling patient medications since The Joint Commission began requiring it in 2004. Four years later, most hospitals have a process in place but few have consistent compliance.
As I've researched and learned about this initiative, I've found that, while every organization approaches med rec differently, there are usually a few commonalities:
1) There's some sort of med rec form used to document the reconciliation.
2) There's a med rec leader who oversees the process.
3) There's a lot of finger-pointing when it comes to noncompliance.
Although medication reconciliation is a hospitalwide initiative at almost every hospital, most organizations isolate oversight and responsibility for the process to one department: nursing, pharmacy, or, occasionally, the medical staff. This sounds good in theory because it makes one person/discipline the medication reconciliation gatekeeper. However, it can also foster blame and reduce accountability. Why, for example, should nursing be responsible for a process that relies on physicians and pharmacists to succeed? How can pharmacy really make sure that the entire nursing staff is properly trained in the med rec process?
Northwestern Memorial Hospital knows the challenges of medication reconciliation first-hand. In 2006, the organization's quality team had done all the recommended steps to meet The Joint Commission's medication reconciliation requirement but their compliance hovered around 40%. That's when they changed their process.
They created a medication reconciliation leadership team that included hospital leaders from all departments (the chief medical officer; the chief of surgery; the chief informatics director; the directors of nursing, pharmacy, and quality; and the president of Northwestern's outpatient areas).
And they restructured their staff training process from one that was done in the "train the trainer" format, separated by discipline, to a multidisciplinary training that included every applicable staff person (nurses, physicians, and pharmacists) all in one room. This ensured that every discipline involved in Northwestern's medication reconciliation process got the exact same message and eliminated the usual blame game that goes along with med rec.
Once leaders were on board, the staff was retrained, and the process was up and running, they took the multidisciplinary approach a step further by looking at compliance data by discipline. This way, Northwestern's quality team can track how groups of nurses, pharmacists, and physicians are doing in terms of compliance, and they can identify any weaknesses without a lot of the unjustified finger-pointing that goes on in a lot of hospitals.
"When we say hospitalwide priority, we don't mean hospitalwide priority for this one physician, we mean hospitalwide priority for physicians, nurses, and pharmacy divisions," said Kristine Gleason, RPh, Northwestern's Clinical Quality Leader, whom I talked with last week.
Today, Northwestern's medication reconciliation compliance ranks above 90%, and the goal for 2008 is to stay above 95%.
If you're one of those senior leaders who is still desperately trying to figure out why your organization can't fully grasp medication reconciliation, you may want to consider a multidisciplinary model like the one at Northwestern. Because, while it's nice to have one med rec leader, it's better to have a whole lot of them.
Molly Rowe is leadership editor with HealthLeaders magazine. She can be reached at mrowe@healthleadersmedia.com.
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