medication reconciliation, errors, adverse drug events, quality improvement
Background: Medication errors are the most common errors occurring in hospitals. Preventable adverse drug events are linked with 1 in 5 injuries or deaths; 23% of medication errors in primary care occur due to inaccuracies in the medication list. Quality improvement projects designed to improve accuracy of outpatient medication reconciliations may decrease the number of medication errors and increase patient safety by preventing adverse drug events.
Purpose: To determine whether a unified workflow for medication reconciliation improves the accuracy of ambulatory, electronic medical record (EMR)-based patient medication records.
Methods: Retrospective study of random sample of patients from Aurora Family Medicine Residency Clinics before (prior to March 31, 2014) and after (December 10, 2014) improvements to the medication reconciliation process (n = 80 and n = 77, respectively). Aurora pharmacy medication lists were obtained and compared to that of the EMR. To preserve patient and caregiver confidentiality, charts were assigned arbitrary identifiers. Two-sample t-tests were used to compare pre- and post-medication reconciliation. An additional patient chart audit on pre- (n = 51) and post- (n = 45) workflow implementation to assess utilization of workflow was conducted; Fisher’s exact tests were used to gauge changes (P < 0.05).
Results: When comparing pre- and post-medication reconciliation implementation, there was a significant decrease in the number of EMR medications not on the pharmacy list (mean 0.475 vs. 0.208; P = 0.022). Number of providers reviewing the EMR medication record improved significantly by 30.4% (P = 0.045). A downward trend in the number of unintentional medication duplicates also was observed by a 13.3% decrease (P = 0.07).
Conclusion: Implementation of systematic workflow and care team education led to overall improvement in accuracy of EMR medication reconciliation. This quality improvement project led to identification of multiple barriers to accuracy. Future areas of focus would include continued education around current workflow and additional attention to medication compliance via out-of-date prescriptions.
Meyers K, Konarske J, Kram JJ, Baumgardner DJ. Assessing the effectiveness of implementation of unified workflow in improvement of medication reconciliation for Aurora St. Luke’s Family Medicine Residency outpatients. J Patient Cent Res Rev. 2015;2:203. doi: 10.17294/2330-0698.1220