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Improving Medication Reconciliation compliance at admission: A single department's experience
Eyad Almidani1, Emad Khadawardi1, Turki Alshareef1
1Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Saudi Arabia.
Insights
Implementing an evidence-based approach significantly improved medication reconciliation compliance in pediatrics. Intensive education and monitoring led to higher documentation rates, enhancing patient safety.
Area of Science:
- Medical Quality Improvement
- Patient Safety
- Pediatric Healthcare
Background:
- Medication reconciliation is crucial for patient safety during hospital admissions.
- Previous attempts to improve reconciliation compliance at KFSH&RC were unsuccessful.
- Low baseline compliance (0-15%) highlighted a critical need for intervention.
Purpose of the Study:
- To enhance medication reconciliation compliance at patient admission in the Pediatrics Department.
- To implement an innovative, evidence-based strategy to address compliance issues.
- To establish a sustainable process for accurate medication documentation.
Main Methods:
- A two-month intensive educational and monitoring program was conducted (June-July 2015).
- Daily interactive training sessions for residents and a "Super-User" system were established.
- Consultant supervision, daily follow-up, and independent audit reports were utilized.
Main Results:
- Compliance in the general Pediatrics Ward increased from 57% to 92% within weeks.
- Significant improvements were observed in other pediatric admission areas, including NICU (reaching 100%).
- The initiative demonstrated a rapid and substantial rise in medication reconciliation rates.
Conclusions:
- Intensive educational and monitoring programs markedly improved pediatric admission medication reconciliation compliance.
- The department-based success suggests potential for broader hospital-wide applicability.
- This approach offers a model for enhancing medication safety in pediatric populations.
Background And Objectives:
The objective of this research is to improve compliance of the medication reconciliation process at the time of patient admission in the Department of Pediatrics at King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia using an innovative evidence-based approach.
Materials And Methods:
Most of the recent efforts at our institution to revamp the medication reconciliation process have failed. Thus, we implemented an innovative evidence-based approach to improve the compliance of the reconciliation process at admission. This approach focused on the Department of Pediatrics at King Faisal Specialist Hospital and Research Centre (KFSH&RC). We established specific educational and monitoring programs that were run over a two-month period, from June to July 2015. The educational program consisted of focused hands-on daily interactive training sessions presented to a small group of residents, i.e., 5-6 residents per session, for a period of one week. One resident was identified as a "Super-User" to provide ongoing support for the other residents involved in the process. A close monitoring process was also implemented, which included daily follow up and encouragement from three assigned consultants. In addition, periodic independent audit report results prepared by Healthcare Information Technology Affairs (HITA) were communicated to the Department of Pediatrics regarding physician compliance in the medication reconciliation process.
Results:
Physician compliance for admission medication reconciliation documentation in ICIS ranged from (0-15%) between the first quarter of 2012 and the first quarter 2015, we designated the official hospital audit for the first quarter of 2015 as a baseline audit report. Between the first quarter of 2012 and 2015, the physician compliance for admission medication reconciliation was ranged between 0 to 15% according to the official hospital audit. We implemented our initiative during the months of June and July 2015. During that time, there was a gradual improvement in the number of admission medication reconciliations reported by the independent audits of our general Pediatrics Ward (B1), which represents the majority of pediatric admissions. The 57% of 26 patients had medication reconciliation completed by the first report dated 16 June 2015. This percentage improved to 92% out of a total of 13 patients at the last report on 12 July 2015. This consistent improvement also occurred in other areas where pediatric patients were admitted including the B3-1 (from 88% to 90%), the NICU 1 (from 83% to 100%) and the NICU 2 (from 90% to 100%).
Conclusions:
By structuring and implementing intensive educational and monitoring programs, a marked improvement in the compliance of medication reconciliation at the time of admission for the pediatric patient population was achieved. We believe that our department-based results would be generalizable if a similar hospital-wide programme was to be rigorously implemented.