Improve Medication Reconciliation Research Articles

From MedWreck to MedRec: A Call to Action to Improve Medication Reconciliation.

In moments that matter, clinicians frequently make treatment decisions based upon incomplete, inaccurate, and outdated medication histories. Poorly reconciled medications often lead to a series of unfortunate events - MedWreck. There is a need for a national, coordinated, strategic effort to widen important ongoing initiatives to improve medication reconciliation.

Improving medication reconciliation in the inpatient setting.

Improving medication reconciliation in the inpatient setting.

Improving Medication Reconciliation for Older Adults in Home Care

<p>目的：「提升用藥整合」列為醫療品質及病人安全工作目標之一，隨著進入高齡社會併多重慢性病，顯見整合用藥之重要性。材料與方法：實施對象為居家老年人，本專案期間為2020年1月1日至2021年3月31日。統計2020年1月至3月居家老年人用藥整合率僅11.8%，分析用藥整合不良原因：缺乏用藥整合指導工具、沒有窗口諮詢、缺乏居家用藥整合流程、住院期間無法得知用藥整合訊息，予介入策略：一、制定用藥整合宣導影片及衛教單張；二、提供地段專責護理師聯繫名片；三、建置用藥整合作業標準；四、制定用藥整合查檢表；五、辦理單位出院準備專責教育訓練。結果：經專案實施後，居家老年人用藥整合率由11.8%提升至84.6%，目標達成率151%。結論：專案持續執行策略6個月，效果維持期仍有82.3%。</p> <p> </p><p>Purpose: Improving medication reconciliation is listed as one of the goals for quality of care and patient safety, particularly in an aging society with multiple chronic diseases. Materials and Methods: This study enrolled older adults in home care, and the study period was January 1, 2020, to March 31, 2021. From January 1, 2020, to March 31, 2020, the medication reconciliation rate for older adults in home care was only 11.8%. After the collection of up-to-date data, Pareto charts and cause-and-effect diagrams were used to identify the following causes underlying the low reconciliation rate: lack of medication reconciliation guidance tools, lack of primary contact information, lack of implementation of home medication reconciliation procedures, and a lack of medication reconciliation information available during hospitalization. The following intervention strategies were implemented: (1) development of promotional videos on medication reconciliation and health education leaflets, (2) provision of contact cards for designated nurses in the region, (3) establishment of working standards for medication reconciliation, and (4) formulation of edication reconciliation lists. Results: By the end of the study period, the medication reconciliation rate for older adults in home care had increased from 11.8% to 84.6%. The goal achievement rate was 151%. Conclusion: At the 6-month follow-up after the end of the study, the reconciliation rate remained at 82.3%.</p> <p> </p>

Medication Reconciliation: Paperwork Saves Lives

Patients often transition health care settings, such as from hospital to SNF and SNF to hospital or home. When an older adult is admitted to a new health care setting (e.g., hospital or nursing facility) or transferring within a hospital setting, it is imperative that clinicians review prior medication lists along with new orders and plans for care and reconcile any discrepancies. Research has demonstrated that inaccurate communication of medical information at transitions of care is responsible for as many as 50% of all medication errors and up to 20% of adverse drug events in the hospital setting. This is especially true for older adults on psychiatric medications which may be altered for formulary reasons or treatment of acute delirium.This session will describe the importance of accurate medication reconciliation especially during transitions of care. We will describe our interventions to improve medication reconciliation as well as demonstrate the educational program we designed as an instructional method via PowerPoint to educate health care providers to perform an accurate medication reconciliation. We implemented the program in multiple grand rounds settings with students, trainees, and attending physicians. Our educational program was successful in improving learners' knowledge in every question we tested. We will include small workshop groups to demonstrate the importance of proper medication reconciliation and for participants to practice implementing the knowledge gained. Our session will show the important of accurate medication reconciliation as well as provide the tools for attendees to impart the knowledge and skills in their institutions to improve accurate medication reconciliation for better communication and transitions of care.Please note: A version of this presentation was presented at the Annual meeting of AMDA (Society for Post-acute and Long-term Care) in 2021 and research about the educational module was published in: Lester PE, Sahansra S, Shen M, Becker M, Islam S. Medication Reconciliation: An Educational Module. MedEdPORTAL. 2019 Nov 1;15:10852. doi: 10.15766/mep_2374-8265.10852. PMID: 31934615; PMCID: PMC6952281. The proposed presentation for AAGP will be unique because of its focus on geriatric psychiatry patients including medication reconciliation issues related to antipsychotics and the challenges faced by frequent transfers to/from medicine and psychiatry for older adults who are in the hospital setting.

Participatory research to improve medication reconciliation for older adults in the community.

Medication reconciliation, a technique that assists in aligning a care team's understanding of an individual's true medication regimen, is vital to optimize medication use and prevent medication errors. Historically, most medication reconciliation research has focused on institutional settings and transitional care, with comparatively little attention given to medication reconciliation in community settings. To optimize medication reconciliation for community-dwelling older adults, healthcare professionals and older adults must be engaged in co-designing processes that create sustainable approaches. Academic researchers, older adults, and community- and health system-based healthcare professionals engaged in a participatory process to better understand medication reconciliation barriers and co-design solutions. The initiative consisted of two participatory research approaches: (1) Sparks Innovation Studios, which synthesized professional expertise and opinions, and (2) a Community Consultation Studio with older adults. Input from both groups informed a list of possible solutions and these were ranked based on evaluative criteria of feasibility, person-centeredness, equity, and sustainability. Sparks Innovation Studios identified a lack of ownership, fragmented healthcare systems, and time constraints as the leading barriers to medication reconciliation. The Community Consultation Studio revealed that older adults often feel dismissed in medical encounters and perceive poor communication with and among providers. The Community Consultation Studio and Sparks Innovation Studios resulted in four highly-ranked solutions to improve medication reconciliation: (1) support for older adults to improve health literacy and ownership; (2) ensuring medication indications are included on prescription labels; (3) trainings and incentives for front-line staff in clinic settings to become champions for medication reconciliation; and (4) electronic health record improvements that simplify active medication lists. Engaging community representatives with academic partners in the research process enhanced understanding of community priorities and provided a practical roadmap for innovations that have the potential to improve the well-being of community-dwelling older adults.

Impact of pharmacist-initiated educational interventions on improving medication reconciliation practice in geriatric inpatients during hospital admission in Vietnam.

Unintentional medication discrepancies (UMDs) are common in geriatric patients during care transitions, resulting in frequent undesirable consequences. Medication reconciliation could be a useful practice to prevent or ameliorate UMD. However, this practice in Vietnamese hospitals has not been well established or standardized. This study aims to determine the effect of pharmacist-initiated educational interventions on improving medication reconciliation practice. This prospective 6-month pre-and post-study was conducted in two internal medicine wards in a Vietnamese 800-bed public hospital. Pharmacists provided training and short-term support to physicians on medication reconciliation. Primary outcome measures were the proportions of patients with at least one UMD at admission. Secondary outcome measures were the proportions of patients with preventable adverse drug events (pADEs) score ≥0.1 due to these UMDs. Odds ratio and 95% confidence intervals were assessed based on a multivariate logistic regression model. One hundred fifty-two patients were recruited in the pre-intervention phase, and 146 in the post-intervention phase. Following the intervention, the proportion of geriatric patients with ≥1 UMD at admission significantly decreased from 55.3 to 25.3% (ORadj 0.255, 95% CI: 0.151-0.431). Similarly, the proportion of patients with a pADE ≥0.1 at admission reduced from 44.1 to 11.6% [ORadj 0.188, 95% CI: 0.105-0.340] post-intervention. Our pharmacist-initiated educational interventions have demonstrated the ability to produce substantial improvement in medication reconciliation practice, reducing UMDs and potential harm. Our approach may provide an alternate option to implement medication reconciliation for jurisdictions with limited healthcare resources.

Web Exclusive. Annals for Hospitalists Inpatient Notes - Improving Medication Reconciliation in Hospitals.

Web ExclusivesAugust 2022Annals for Hospitalists Inpatient Notes - Improving Medication Reconciliation in HospitalsJeffrey L. Schnipper, MD, MPHJeffrey L. Schnipper, MD, MPHHospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (J.L.S.).Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M22-1954 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Transitions of care into and out of the hospital are vulnerable times for patients, especially when it comes to medication safety. One type of medication error that occurs during care transitions is medication discrepancies, defined as unexplained differences among documented regimens across different sites of care. Discrepancies are the result of 2 different breakdowns in our care processes: history errors and reconciliation errors. History errors occur when ordered medications are incorrect because the preadmission medication history is incorrect (for example, failure to realize a patient was prescribed aspirin before admission). Reconciliation errors occur when ordered medications are incorrect despite an ...

Factors associated with having home care physicians as an integrated source of medications for chronic conditions among homebound patients.

Inappropriate management of medications is a major threat to homebound patients with chronic conditions. Despite many efforts in improving medication reconciliation in ambulatory and inpatient settings, little research has focused on home care settings. In 2016, Taiwan initiated the Integrated Home Health Care programme, which was intended to reduce potentially inappropriate medication management and risks of uncontrolled polypharmacy through the integration of different medication sources for chronic conditions among homebound patients. This study investigated factors associated with having home care physicians as an integrated source of medications for chronic conditions among homebound patients. This retrospective cohort study enrolled 3142 community-dwelling homebound patients from Taipei City Hospital. Homebound patients' adherence to using home care physicians as an integrated source of chronic condition medications was defined as having all prescriptions for their chronic conditions prescribed by a single home care physician for at least 6 months. Both patient and home care physician characteristics were analysed. Multivariable logistic regression was applied. Of the 3142 patients with chronic conditions, 1002 (31.9%) had consistently obtained all medications for their chronic illnesses from their home care physicians for 6 months and 2140 (68.1%) had not. The most common chronic diseases among homebound patients were hypertension, diabetes mellitus, dementia, cerebrovascular disease and constipation. Oldest-old patients with poor functional status, fewer daily medications, no co-payment exemption and no recent inpatient experience were more likely to adhere to this medication integration system. In addition, patients whose outpatient physicians were also their home care physicians were more likely to adhere to the system. The finding suggests that building trust and enhancing communication among homebound patients, caregivers and home care physicians are critical. Patient and provider variations highlight the need for further improvement and policy modification for medication reconciliation and management in home care settings. The improvement in medication management and care integration in home care settings may reduce misuse and polypharmacy and improve homebound patients' safety.

Increasing Compliance of Deep Vein Thrombosis Medical Prophylaxis in Acute Inpatient Rehabilitation Setting.

To improve medication reconciliation and decrease the rate of deep vein thrombosis (DVT) after the transfer of brain-injured neurologically impaired patients from an acute hospital setting to an inpatient rehabilitation facility, a performance improvement strategy was put in place. Such a strategy consisted of adding the proper DVT prophylaxis medication and dosage in the preadmission screen to prevent a delay in receiving the appropriate medication. This resulted in a dramatic reduction of inappropriately discontinued medications from 14.2% of patients to 5.78% over six months (p-value: 0.03). However, after the intervention, we surprisingly observed an increased rate of DVT from 6.2% to 10.11% (p-value: 0.03). This increase may be attributable to a larger number of venous duplex studies performed because of increased awareness of venous thromboembolism (VTE).

Toward Zero Harm: Mackenzie Health's Journey Toward Becoming a High Reliability Organization and Eliminating Avoidable Harm.

In response to an organizational survey revealing low safety culture scores, we implemented a "zero harm" approach to eliminate preventable harm across a wide variety of clinical areas. We aimed to achieve this objective within 3 years. We developed a 5-part strategy for cultural and process redesign that included (1) engaging leadership; (2) developing an organization-specific patient safety framework; (3) monitoring specific quality aims based on high-risk, high-volume, high-cost, and problem-prone areas; (4) standardizing a 3-part review process that includes a root cause analysis for moderate and critical patient safety incidents; and (5) communicating progress to staff in real time via unit-specific electronic dashboards. In less than 1 year, we increased patient safety incident reporting by 37% while simultaneously decreasing falls with injury by 39%, pressure injury rates by 37%, and central line-associated blood stream infections by 34%. We also improved medication reconciliation rate by 3.3% and decreased our irretrievable specimen rate to 0. Finally, we noted increased awareness around patient safety within clinical teams, with open discussions about patient safety becoming a routine part of patient care. This study describes an initiative that sought to introduce system-wide changes to practice and patient safety culture in a rapid time frame. Results suggest that our 5-step approach to transformation may confer substantial gains in patient safety for peer institutions. Next steps include continuing to expand and monitor quality aims as we progress through our journey to eliminating preventable patient harm in our healthcare system.

Evaluation of an educational strategy to improve medication reconciliation in ambulatory care

BackgroundImproper medication reconciliation can result in inaccurate medication lists. When medication lists are inaccurate, it can result in drug-drug interactions, dosing errors, and medication duplication. Interventions targeting medication reconciliation have had varying levels of success. ObjectiveThis study aimed to describe the medication reconciliation educational program, its implementation in a health care system, pharmacist and clinic personnel perception of the program, and its impact on clinic personnel knowledge and practice. MethodsGuided by the Conceptual Model of Implementation Research, a partially mixed sequential dominant status evaluation of a pharmacist-led educational program on evidence-based practices for medication reconciliation implemented into all primary care clinic sites by examining implementation outcomes was conducted. The implementation outcomes measured include penetration, fidelity, acceptability, appropriateness, feasibility, and adoption. Data were collected through program data and direct observations, pre- and postsurveys, and semistructured interviews of pharmacists and clinic personnel. ResultsOf 46 primary care sites, 37 primary care sites (80%) implemented the pharmacist-delivered medication reconciliation education from April to June 2021 with representation from each of Geisinger’s regions. Ten clinic sites (27%) completed the medication reconciliation educational program as originally designed, with the remainder adapting the program. A total of 296 clinic personnel completed the presurvey, and 178 completed the postsurvey. There were no differences in baseline characteristics between clinic personnel who completed the pre- versus postsurvey. All clinic personnel interviewed felt satisfied with the educational program and felt it was appropriate because it directly affected their job. Clinic personnel felt the educational program was acceptable and appropriate; two major concerns were discussed: a lack of patient knowledge about their medications and a lack of time to complete the medication reconciliation. The adherence rate to the elements of the medication reconciliation that were covered in the education program ranged from 0% to 95% in the 55 observations conducted. ConclusionAn educational program for medication reconciliation was found to be acceptable and appropriate but was often adapted to fit site-specific needs. Additional barriers affected adoption of best practices and should be addressed in future studies.

An Integrated Model to Improve Medication Reconciliation in Oncology: Prospective Interventional Study.

BackgroundAccurate medication reconciliation reduces the risk of drug incompatibilities and adverse events that can occur during transitions in care. Community pharmacies (CPs) are a crucial part of the health care system and could be involved in collecting essential information on conventional and supplementary drugs used at home.ObjectiveThe aim of this paper was to establish an alliance between our cancer institute, Istituto Romagnolo per lo Studio dei Tumori (IRST), and CPs, the latter entrusted with the completion of a pharmacological recognition survey. We also aimed to integrate the national information technology (IT) platform of CPs with the electronic medical records of IRST.MethodsCancer patients undergoing antiblastic treatments were invited to select a CP taking part in the study and to complete the pharmacological recognition step. The information collected by the pharmacist was sent to the electronic medical records of IRST through the new IT platform, after which the oncologist performed the reconciliation process.ResultsA total of 66 CPs completed surveys for 134 patients. An average of 5.9 drugs per patient was used at home, with 12 or more used in the most advanced age groups. Moreover, 60% (80/134) of the patients used nonconventional products or critical foods. Some potential interactions between nonconventional medications and cancer treatments were reported.ConclusionsIn the PROF-1 (Progetto di Rete in Oncologia con le Farmacie di comunità della Romagna) study, an alliance was created between our cancer center and CPs to improve medication reconciliation, and a new integrated IT platform was validated.Trial RegistrationClinicalTrials.gov NCT04796142; https://clinicaltrials.gov/ct2/show/NCT04796142

Improving Medication Reconciliation with Comprehensive Evaluation at a Veterans Affairs Skilled Nursing Facility.

Unintentional medication discrepancies due to inadequate medication reconciliation pose a threat to patient safety. Skilled nursing facilities (SNFs) are an important care setting where patients are vulnerable to unintentional medication discrepancies due to increased medical complexity and care transitions. This study describes a quality improvement (QI) approach to improve medication reconciliation in an SNF setting as part of the Multi-Center Medication Reconciliation Quality Improvement Study 2 (MARQUIS2). This study was conducted at a 112-bed US Department of Veterans Affairs SNF. The researchers used several QI methods, including data benchmarking, stakeholder surveys, process mapping, and a Healthcare Failure Mode and Effect Analysis (HFMEA) to complete comprehensive baseline assessments. Baseline assessments revealed that medication reconciliation processes were error-prone, with high rates of medication discrepancies. Provider surveys and process mapping revealed extremely labor-intensive and highly complex processes lacking standardization. Factors contributing were polypharmacy, limited resources, electronic health record limitations, and patient exposure to multiple care transitions. HFMEA enabled a methodical approach to identify and address challenges. The team validated the best possible medication history (BPMH) process for hospital settings as outlined by MARQUIS2 for the SNF setting and found it necessary to use additional medication lists to account for multiple care transitions. SNFs represent a critical setting for medication reconciliation efforts due to challenges completing the reconciliation process and the concomitant high risk of adverse drug events in this population. Initial baseline assessments effectively identified existing problems and can be used to guide targeted interventions.

Effectiveness of an educational intervention in improving the patient medication reconciliation in the emergency department

This study aimed to evaluate the effectiveness of an educational intervention in improving the patient medication reconciliation process. This was a cross-sectional study that was conducted at St. Jude hospital, California (CA), United States. An educational intervention was provided to the healthcare team working in the emergency department (ED) to explore its effectiveness in improving their patient medication reconciliation practices. A survey was administered to explore the healthcare staff's views on where responsibility lay in their team concerning the fulfilment of appropriate medication reconciliation procedures. Additionally, we identified the barriers facing the completion of appropriate medication reconciliation using open-ended question provided to healthcare staff at the hospital. In the pre-intervention phase, the percentage of patients who received medication reconciliation was statistically significantly higher during the day shift (71.0% compared with 51.3%). In the postintervention phase, the percentage of patients who received medication reconciliation was statistically significantly higher during the night shift (96.7% compared with 75.8%). Overall, the percentage of patients who received medication reconciliation was statistically significantly higher in the postintervention group (81.3%) compared with the pre-intervention group (64.7%) (P<.001). Educational intervention is an effective tool in improving medication reconciliation practices in inpatient settings. The process of medication reconciliation should be conducted based on shared responsibility between healthcare providers and aimed at reducing medication errors and improving patient safety.

Twelve-week project to improve medication reconciliation at hospitals in Wellington, New Zealand

Inaccurate prescribing of medications on admission to hospital exposes patients to significant risk, both during the admission and at discharge. Initial data at Capital and Coast District Health Board (CCDHB,...

Diabetes Medication Reconciliation at Hospital Discharge

Background: During hospital discharge, patients are at high risk for medication discrepancies as they transition from hospital to home. This study aims to evaluate the prevalence of medication errors at hospital discharge for diabetes medications in patients who received an endocrinology consultation for diabetes and explore interventions to improve the accuracy of discharge medication reconciliation. Methods: All patients (n=3018) who received an endocrinology consultation for diabetes at a tertiary care medical center from October 2017 to December 2019 were included. A retrospective chart review was performed to collect the following information on each patient: primary service from which the patient was discharged, hospital site, month and year of discharge date, and whether each patient’s medication reconciliation for diabetes medications at hospital discharge was in agreement with the inpatient diabetes team’s recommendations. Patients who were discharged on medications discordant from those recommended by the inpatient diabetes service were subcategorized into three groups: 1) one medication incorrect 2) more than one medication incorrect and 3) the primary service did not notify the consult team of patient’s discharge or request final recommendations for diabetes medications prior to discharge. Based on the findings of this study, an educational intervention was implemented in November 2019 to the Hospital Medicine services regarding diabetes discharge medication reconciliation. Results: Of the 3018 patients who received an endocrinology consultation for diabetes at a tertiary university medical center, 2279 patients (76%) were discharged on correct medications, 165 patients (5%) were discharged with one incorrect medication, 443 patients (15%) were discharged with more than one incorrect medication, and 121 patients (4%) were discharged without final discharge recommendations from the diabetes service. There was no significant variation based on discharging service or month of the year. After an educational intervention was implemented in November 2019 to the Hospital Medicine service on the existence and use of a comprehensive diabetes discharge order set, the percentage of patients discharged on correct medications improved to 92% (11/12 patients) compared to prior 81% (44/54 patients). Conclusion: Despite detailed discharge medication recommendations including patient education detailing the recommended regimen by the endocrinology diabetes service, a significant number of patients were discharged by providers across all services on diabetes medications discrepant with the diabetes service’s recommendations. Educational efforts improved the rate of correct medications at discharge on the Hospital Medicine service, and additional educational interventions with other services may be helpful in improving medication reconciliation accuracy.

Medication Discrepancy Risk Factors for Pediatric Patients With Epilepsy at Hospital Admission.

Children with epilepsy are at increased risk of medication errors due to disease complexity and administration of time-sensitive medication. Errors frequently occur during transitions of care between home and hospital, a time when accuracy of medication history lists is difficult to ascertain. Adverse events likely from medication discrepancies underscore the importance of improving medication reconciliation upon inpatient intake. This quality improvement project was designed to evaluate and optimize the current medication history process in epileptic patients upon hospital admission at a pediatric academic hospital. A retrospective chart review was conducted on 30 patients with epilepsy admitted in during April, July, and October 2018 to identify unintentional medication discrepancies among 6 sources: documented medication history, inpatient orders from the electronic medical record, outpatient clinic notes, inpatient history and admission document, phone message records, and external insurance claims. A total of 63% percent of patients had at least 1 unintentional medication discrepancy. Most discrepancies occurred with daily maintenance anticonvulsants (63%). The most common types were omission of medication history (31%) and inpatient order omissions (27%). The number of medication histories completed with at least 1 discrepancy varied across pharmacists, nurses, and physicians, yet differences were not statistically significant. Our study found a higher incidence of anticonvulsant discrepancies compared with previous studies. This quality improvement initiative identified the absence of a standardized process as the root cause for the high incidence of anticonvulsant discrepancies in pediatric patients with epilepsy at hospital admission.

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

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

Improving medication reconciliation in ambulatory cancer care.

224 Background: Adverse drug events are common in ambulatory oncology where care spans multiple providers and medication documentation is often poor. We undertook a QI project with the aim of having 30% of patients have a best possible medication history (BPMH) or medication reconciliation (MedRec) documented within 30 days of starting systemic therapy. Methods: An Electronic Medical record-Integrated Tool (EMITT) was developed to facilitate documentation. 2 Plan-Do-Study-Act (PDSA) cycles have been completed to date; PDSA 1 consisted of piloting EMITT in 3 clinics run by physician champions. PDSA 2 which consisted of expanding pharmacy support and addition of a 4th clinic was impacted by care changes related to COVID. The proportion of patients with BPMH/MedRec documented in EMITT was calculated monthly for each period (PDSA 1, PDSA 2 pre-COVID and PDSA 2 post-COVID). The balancing measure of time to complete an entry was evaluated through a time motion study. Results: Between 9/9/2019 and 31/5/2020, 9.4% (233/2488) of patients had BPMH/MedRec completed; Table shows proportion of patients by month. BPMH and MedRec were most frequently performed by pharmacists followed by pharmacy students and nurses. On average, it took 5.5 minutes to complete an entry (n = 10; median number of medications per patient = 12.3). Conclusions: BPMH was documented more often than MedRec. While some usage was sustained, the changes to care as a result of COVID-19 negatively impacted ambulatory medication reconciliation. Future PDSA cycles will involve engaging patients in MedRec and extending EMITT to all ambulatory cancer clinics where medication management is a major component of care. [Table: see text]

Team-based approach to improving medication reconciliation rates in family medicine residency clinics

ObjectiveThe objective of this quality improvement project was to design and implement a systematic team-based care approach to medication reconciliation, with a goal of physician-documented medication reconciliation at 70% of all patient office visits. SettingAmbulatory clinics located in urban, underserved communities in Minneapolis and St. Paul, MN. Practice descriptionFour family medicine residency clinics, with pharmacists integrated at each site. All clinics use the Epic electronic medical record (Epic Systems Corporation). Practice innovationA team-based care approach to medication reconciliation was designed and implemented involving medical assistants (MAs), physicians, and pharmacists. The MAs did an initial review with patients, the physicians addressed discrepancies, and difficult situations were escalated to the pharmacist for a detailed assessment. EvaluationThe percentage of visits with physician-documented medication reconciliation was measured preintervention and then for 18 months postintervention in 6-month intervals involving more than 118,000 patient visits. Satisfaction surveys of team members were done pre- and postintervention. ResultsThe percentage of visits with physician-documented medication reconciliation improved significantly from 6.5% preintervention to 58.7% (P < 0.001) postintervention, and was sustained and further improved to 70.3% (P < 0.001) 1 year later. The team members had a statistically significant improvement in their ability to articulate the medication reconciliation process. Satisfaction improved significantly for physicians, but MAs did not experience a statistically significant change. ConclusionA team-based care approach to medication reconciliation was successfully implemented and sustained at 4 family medicine clinics. There was significant improvement in physician-documented medication reconciliation. Future studies need to address whether this process improves medication-list discrepancies, completeness, and accuracy.