Decreasing Discharge Medication Reconciliation Errors: An Interprofessional Collaborative Quality Improvement Project

Abstract

Background: Medical errors are the third leading cause of death in the United States with an estimated 250,000 incidents occurring annually. Medication related errors are one of the most common medical errors which can result from unintended discrepancies that occur during times of transition of care. Baseline data obtained by nursing staff for the Cleveland Clinic Children’s Hospital general inpatient pediatrics team showed a discharge medication reconciliation error rate of 12%. Studies have shown that the most successful interventions to improve medication reconciliation process relies heavily on pharmacists. Thus, an interprofessional multidisciplinary general pediatrics team was identified to improve the discharge medication reconciliation process. Objective: Our aim was to reduce the medication errors identified by nursing staff at the time of discharge by 50% in 1 year. Methods: Three interventions were implemented on March, April and September 2019, including early identification of anticipated discharges within the upcoming 24 hours, standardizing discharge medication reconciliation review by the team pharmacist, and including a process checklist in the physician sign out tool for sustainability. Following quality improvement (QI) methodology, a process map was developed to identify waste, defects, and variation. One week out of the month, errors were recorded at the time of discharge by the nursing staff. These errors were documented and corrected by the team prior to discharge. Once pharmacy performed a review of the medication reconciliation with the residents, a note was placed in the electronic medical record, which was tracked by the team to ensure compliance with the process developed. Results: Following the interventions, the discharge medication reconciliation error rate was reduced to a mean of 2.4%. The new discharge medication reconciliation process has been incorporated in our Children’s Hospital, into the daily discharge planning process, as a best practice. Conclusions: We demonstrated that a process consisting of joint efforts of prescribers and pharmacists can reduce the number of medication errors at the time of discharge. It also demonstrates how interprofessional collaboration between physicians, nurses and pharmacists may influence the healthcare delivery process. Although this study was limited to general pediatrics inpatient team, the promising results acted as a catalyst for similar interventions in the other pediatric subspecialty inpatient teams. Future measurements to assess the impact of this project include clinician and patient satisfaction, adverse drug events and hospital length of stay.Percent of Discharge Medication Errors in General PediatricsInterventions 1: Standardizing discharge medication reconciliation review by the team pharmacist Intervention 2: Early identification of anticipated discharges within the next 24 hours Intervention 3: Process checklist in the physician sign out implemented