System Improvement

Topics: Health care provider, Health care, Adverse drug reaction Pages: 9 (2805 words) Published: December 8, 2013

Standardizing the Process of Electronic Medication Reconciliation Lorraine Le Stephens
Eastern Kentucky University

Electronic medication reconciliation is defined as a process in which a complete and accurate list of current medications is generated into a database and is stored as in the patient’s records (Wilson, Murphy & Newhouse, 2013). This process includes collection of medication history, ensuring the medication’s dose and instructions are appropriate, and making changes to the medication list (Wilson et al., 2013, p. 311). Precise medication reconciliation is important in all setting especially in outpatient oncology because many of these patients have multiple health issues requiring multiple treatment. The process of medication reconciliation is done by a designated healthcare provider and without standard of practice, complete and accurate medication reconciliation would not be obtain. Therefore, implementing a standardize process that clearly defines nursing and physician’s role would allocate accountability which would help reduce medication errors and improve safety measures.

Standardizing the Process of Electronic Medication Reconciliation
Medication reconciliation is an essential part of improving medication safety. However, it requires the participation of and intervention from both healthcare providers and the patient (Leonhardt, Pagel, Bonin, Moberg, Dvorak, and Hatlie, 2007). According to Gurwitz, Field, Harrold, Rothschild, Debellis, Seger, Cadoret, Fish, Garber, Kelleher, & Bates (2003, p. 1115), it is reported that medication errors and adverse drug events (ADEs) varies widely depending on the setting of the practice and methods used to measure them, nonetheless, evidence show that errors and ADEs are common in ambulatory setting. In 2005, Joint Commission identified medication reconciliation as a National Patient Safety goal (NPSG), therefore requiring institutions to develop and implement medication reconciliation effective July 2011 (Porcelli, Waitman & Brown, 2010). Porcelli et al. (2010) suggest a ‘gold standard’ of practice is needed for the process of medication reconciliation; this paper will discuss an improvement plan to an already in placed electronic medication reconciliation process in an outpatient oncology setting.

Mosaiq, a computerized electronic oncology medical records database is being used in an outpatient oncology setting. A process of medication reconciliation is already in place, however, there is no standardize practice to obtain the medications history. Currently, medication reconciliation is done by a license healthcare provider, mainly by the nurse. When a patient comes for an office visit, a list of their medication is printed out and given to the patient. The patient reviews the list and makes noted changes to the paper list. Once the patient is sent back to the clinic room, the nurse reviews the list with the patient, making necessary changes in the computer as appropriate. If the patient is a new patient to the practice, they are asked to bring in either their home list or the physical bottle of medication itself to review. The nurse with review and enter the medications into the computer system as a permanent medical record.

Currently, there is not policy on how the nurse reviews and complete the medication reconciliation. Each nurse has their own style in reviewing their patient’s list. For example, when a patient is seen in the office very frequently, the nurses will ask “do you have any medications changes,” and if the patient denies any changes, then the nurse would consider the medication list reconciled. Medication reconciliation according to the Institute for Healthcare Improvement (IHI) is defined as “creating the most accurate list possible of all medications a patient is taking—including drug name, dosage, frequency, and route—and comparing the list” (IHI, 2012). In the example above, verifying the...

References: Agency for Healthcare Research and Quality (2000). Translating research into practice: Reducing Errors in Health Care.
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Horack, C.L., & Taylor, R.M. (2006). Critical care nurses are integral to the precess of decreasing medication errors and adverse drug events. Nursing 2006 Critical Care, 1(2), 26-33.
Institute for Healthcare Improvement (2011). Science of improvement: How to improve. Retrieved from:
Ketchum, K., Grass, C.A., & Padwojski, A., (2005)
Wilson, M.L, Murphy, L.S., & Newhouse, R.P. (2013). Medication reconciliation across the continuum of care: A meaningful use mandate. Journal of Nursing Administration, 43(6), 311-314.
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