Directed intervention to improve the rate of admission medication reconciliation in an acute care hospital

[摘要] Introduction Electronic medication reconciliation systemsare known to reduce medication errors. We hypothesisedthat refinement of the electronic medical record (EMR) andprovider education could improve adherence to completionof admission medication reconciliation, thereby potentiallylimiting prescribing errors. Our goal was to improve thepercentage of patients with medication reconciliationcompleted within 24 hours of admission to at least 90%.Methods A prospective interventional study wasconducted at a university-affiliated community hospitalbetween 1 January 2017 and 30 September 2018.We determined the baseline percentage of medicationreconciliations performed within 24 hours of admission,and those completed at any time prior to dischargefrom the hospital. Three plan-do-study-act cycles werethen performed, with interventions including live andemail reminders to complete medication reconciliationand addition of a column to EMR patient lists indicatingwhether reconciliation had been completed.Results The percentage of medication reconciliationscompleted within 24 hours of admission was lowest for thepre-intervention cycle (62.4%) and was highest for Cycle3 (80.9%). The percentage of reconciliations completedany time prior to discharge was higher and increased ina similar stepwise fashion from 71.1% to 88.4% throughCycle 3. There was a post-intervention trend toward ahigher rate of reconciliation completion for patients aged18–40. Male patients were also more likely to have theiradmission medication reconciliations completed prior todischarge.Conclusion Our interventions resulted in a statisticallysignificant 18.5% increase in the rate of admissionreconciliation completion. Though this increase fellshort of our goal, this study demonstrates that providereducation and optimisation of the EMR can sustainablyimprove adherence with medication reconciliation, therebyfostering improved patient care. Further improvementcould be achieved by focusing on the medication lists ofour older patients and female patients.

[学科分类] 药学