Measuring to Improve Medication Reconciliation in a Large Subspecialty Outpatient Practice

Area of Science:

• Healthcare Quality Improvement
• Clinical Informatics
• Patient Safety

Background:

• Medication reconciliation (med rec) is crucial for patient safety at clinical transitions.
• Sustainable and valid performance measures are needed to assess and improve med rec in outpatient settings.

Purpose of the Study:

• To develop and validate measures for assessing medication reconciliation performance in an ambulatory care setting.
• To demonstrate improvement in medication reconciliation processes through targeted interventions.

Main Methods:

• An interdisciplinary team implemented practice and electronic health record (EHR) documentation changes for physicians, nurses, and medical assistants.
• New performance measures were derived from EHR data to assess med rec quality and validity.

Main Results:

• Electronic attestation of med rec completion increased from 9.8% to 91.3% (p<0.0001).
• Medication list errors, including missing dose/frequency and duplicate inhalers, significantly decreased.
• Printing and patient receipt of medication lists at visits substantially increased, though patient education documentation remained poor.

Conclusions:

• Deriving performance and quality measures from EHR data is a feasible and sustainable method for assessing changes in medication reconciliation.
• Concurrent, complementary measures derived from EHR data can validate summary performance indicators.