Standardizing Medication Reconciliation in a Pediatric Emergency Department.

Abstract

Medication errors are common during transitions of care, such as discharge from the emergency department (ED) or urgent care (UC). The Joint Commission has identified medication reconciliation as a key safety practice. Our aim was to increase the percentage of patients with completed medication reconciliation at discharge from our pediatric ED and 4 UCs from 25% to 75% in 12 months. Key stakeholders included ED and UC physicians and nurses, informatics, and quality management. The baseline process for medication reconciliation was mapped and modified to create a standard process for nurses and physicians. An Ishikawa diagram was created to assess potential failures. Electronic health record interventions included adapting an inpatient workflow and using a clinical decision support tool. Educational interventions included just-in-time training, physician education via division meeting presentations, video tutorials, and physician-specific and group feedback using funnel plots. The secondary process measure was the proportion of patients discharged from the ED and UCs with completed home medication nursing review. We used statistical process control to analyze changes in measures over time. In the UCs, home medication nursing review increased from 91% to 98% and medication reconciliation increased from 35% to 82% within 4 months. In the ED, home medication nursing review increased from 2% to 83% within 8 months and medication reconciliation increased from 26% to 64% within 18 months. We successfully increased the proportion of UC and ED discharged patients with completed medication reconciliation.