School of Medicine and Health Sciences Poster Presentations

Poster Number

319

Document Type

Poster

Status

Medical Resident

Abstract Category

Quality Improvement

Keywords

Patient Safety, Medication Errors, Hospital Admission

Publication Date

Spring 2018

Abstract

Background: Medication errors represent a major cause of adverse events in hospitalized inpatients. 27-83% of hospitalized patients will have at least one discrepancy in their medication history at admission, with 11%–59% of errors having clinical importance. Current processes for completing admission medication reconciliations are ill-defined, further increasing the risk of errors. Implementation of a standardized medication reconciliation process has led to a reduction in medication errors. Aim Statement: To increase the number of admission medication reconciliations completed within 48 hours of admission to GW Hospital by 25% over three months. Methods: From September 2017 until December 2017, an educational intervention was delivered to internal medicine residents rotating on the wards at GW Hospital and refined over three PDSA cycles. The intervention included an educational presentation on proper completion of an admission medication reconciliation, given at resident noon conference and to the night float team, a video by hospitalists reinforcing principles of proper medication reconciliation, and creation of a signoff checklist to assess interns for proper completion of medication reconciliations. The number of properly completed admission medication reconciliations within 48 hours of admission for patients admitted to one general medicine day team and to the night float team was assessed. Completion was denoted by green checkmarks next to “Document Medications by History” and “Medication Admission Reconciliation” in Cerner. Data was collected for all new admissions every post-call day and was expanded to an additional daytime team with PDSA Cycle 3. Results: Baseline data revealed that admission medication reconciliations were completed on 20% and 77% of new admissions to the daytime and night float teams, respectively. Completion rates by the day team varied from 16% to 100%, but with a clear trend towards improvement with over 50% completed on the days reviewed. Little change was observed on the night admission team. Expanded data from the additional daytime team showed improved completion rate. Discussion: Our study demonstrated that early provider education, adherence to a standardized process, and reinforced education are ways of improving admission medication reconciliation completion. There was an overall increase in admission medication reconciliation completion in the daytime medicine team, but not in the night float team, likely owing to the more frequent turnover of night float residents. Data collection was expanded to a second daytime medicine team and is ongoing with possible extension to all medicine wards teams. Limitations include provider turnover throughout our interventions, the inability to assess accuracy of completed medication reconciliations, and the varying experience with admission medication reconciliation completion among providers. Future interventions include education at intern orientation, reinforced with successful completion of a signoff checklist, and involvement of pharmacists.

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Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

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Presented at GW Annual Research Days 2018.

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Improving Admission Medication Reconciliation Completion at GW Hospital

Background: Medication errors represent a major cause of adverse events in hospitalized inpatients. 27-83% of hospitalized patients will have at least one discrepancy in their medication history at admission, with 11%–59% of errors having clinical importance. Current processes for completing admission medication reconciliations are ill-defined, further increasing the risk of errors. Implementation of a standardized medication reconciliation process has led to a reduction in medication errors. Aim Statement: To increase the number of admission medication reconciliations completed within 48 hours of admission to GW Hospital by 25% over three months. Methods: From September 2017 until December 2017, an educational intervention was delivered to internal medicine residents rotating on the wards at GW Hospital and refined over three PDSA cycles. The intervention included an educational presentation on proper completion of an admission medication reconciliation, given at resident noon conference and to the night float team, a video by hospitalists reinforcing principles of proper medication reconciliation, and creation of a signoff checklist to assess interns for proper completion of medication reconciliations. The number of properly completed admission medication reconciliations within 48 hours of admission for patients admitted to one general medicine day team and to the night float team was assessed. Completion was denoted by green checkmarks next to “Document Medications by History” and “Medication Admission Reconciliation” in Cerner. Data was collected for all new admissions every post-call day and was expanded to an additional daytime team with PDSA Cycle 3. Results: Baseline data revealed that admission medication reconciliations were completed on 20% and 77% of new admissions to the daytime and night float teams, respectively. Completion rates by the day team varied from 16% to 100%, but with a clear trend towards improvement with over 50% completed on the days reviewed. Little change was observed on the night admission team. Expanded data from the additional daytime team showed improved completion rate. Discussion: Our study demonstrated that early provider education, adherence to a standardized process, and reinforced education are ways of improving admission medication reconciliation completion. There was an overall increase in admission medication reconciliation completion in the daytime medicine team, but not in the night float team, likely owing to the more frequent turnover of night float residents. Data collection was expanded to a second daytime medicine team and is ongoing with possible extension to all medicine wards teams. Limitations include provider turnover throughout our interventions, the inability to assess accuracy of completed medication reconciliations, and the varying experience with admission medication reconciliation completion among providers. Future interventions include education at intern orientation, reinforced with successful completion of a signoff checklist, and involvement of pharmacists.

 

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