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Quality improvement through implementation of discharge order reconciliation
Yun Lu1, Pamela Clifford, Andreas Bjorneby
1Hennepin County Medical Center (HCMC), Minneapolis, MN 55415, USA. yun.lu@hcmed.org
Summary
A new process reduced medication errors for patients discharged to skilled-nursing facilities (SNFs). This quality improvement project led to fewer medication-related readmissions, improving patient care.
Area of Science:
- Healthcare Quality Improvement
- Patient Safety
- Medication Management
Background:
- Medication errors are a significant cause of hospital readmissions for patients discharged to skilled-nursing facilities (SNFs).
- Existing discharge procedures require enhancement to ensure patient safety and reduce adverse events.
Purpose of the Study:
- To describe a multidisciplinary process designed to reduce medication errors in patients discharged to SNFs.
- To evaluate the effectiveness of a new workflow in decreasing medication-related readmissions.
Main Methods:
- A two-phase quality improvement project was implemented, starting with a failure modes and effects analysis.
- A multidisciplinary, closed-loop workflow involving physicians, nurses, and pharmacists was developed and pilot-tested.
- Medication-related readmission rates were compared between an intervention group and a control group stratified by severity of illness (SOI).
Main Results:
- The intervention group (n=87) had a 30-day medication-related readmission rate of 5.4% across all SOI categories.
- The control group (n=1893) had a significantly higher readmission rate of 9.5%.
- Hospital-wide implementation resulted in a sustained readmission rate of approximately 6.7% for SNF patients.
Conclusions:
- Implementing a standardized discharge order reconciliation process involving pharmacists significantly decreased readmission rates.
- The multidisciplinary approach improved the safety and quality of care for patients transitioning to SNFs.
- This initiative demonstrates a successful strategy for reducing medication errors and readmissions in a vulnerable patient population.
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