COLLABORATIVE APPROACH TO IMPROVING MEDICATION RECONCILIATION

Lori Duncan, MD1, Kristen Wu, MSN, NP-C2, Margaretann House, DNP, RN, FNP-C2, Scott Christofferson, PharmD, BCPS2, 1UNC Rex Hospital, Raleigh, NC; 2Raleigh, NC

Meeting: Hospital Medicine 2019, March 24-27, National Harbor, Md.

Abstract number: 287

Categories: Hospital Medicine 2019, Innovations, Quality Improvement

Keywords: , , , ,

Background: Medication errors harm 1.5 million patients yearly, designating medication reconciliation a National Patient Safety Goal. The average hospitalized patient is subject to at least 1 medication error per day (IOM,2007), with 70% of patients experiencing a medication discrepancy at either admission or discharge(Leapfrog,2018). Medication Reconciliation, creating the most accurate list of medications patients take and comparing that list against the physician’s orders, is paramount in identifying and resolving discrepancies that impact outcomes.
Adoption of an EMR has improved the process, though the complexity of the system poses new challenges. Multiple caregivers entered the medication history into the EMR without a standardized process. This created confusion and set the provider up for errors when reconciling home medications on admission, carrying through to discharge.

Purpose: The purpose of this project was to standardize the process for capturing and entering in a patient’s medication history, optimizing the current EMR to improve accuracy and efficiency. Also, it aimed to utilize the Pharmacy Technician role to capture a comprehensive medication history to reduce discrepancies when admitting patients.

Description: An interdisciplinary team participated on a Kaizen event to analyze the current state, define the target, and perform a gap analysis to drive improvement. Guidelines outlining a standard approach to obtaining medication information were developed and tested to optimize the EMR. Verbal and electronic methods of communication were developed to drive Pharmacy Technicians to priority patients.

Conclusions: Baseline data revealed the median time from ED arrival to comprehensive medication history review by Pharmacy Technician was 186 minutes. Medication history was only documented in 16% of patients prior to ED Provider’s decision to admit and in only 73% prior to Hospitalist assessment. Intervention reduced the median time from ED arrival to comprehensive medication history review by Pharmacy Technician to 108 minutes. Medication history capture was improved to 60% of patients prior to ED Provider’s decision to admit and 85% prior to Hospitalist assessment.

IMAGE 1: ED Arrival to Medication History Review Time

IMAGE 2: Medication History Complete Prior to ADT9

To cite this abstract:

Duncan, LV; Wu, K; House, M; Christofferson, S. COLLABORATIVE APPROACH TO IMPROVING MEDICATION RECONCILIATION. Abstract published at Hospital Medicine 2019, March 24-27, National Harbor, Md. Abstract 287. https://www.shmabstracts.com/abstract/collaborative-approach-to-improving-medication-reconciliation/. Accessed January 21, 2020.

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