Improving Medication Reconciliation with Comprehensive Evaluation at a Veterans Affairs Skilled Nursing Facility

Area of Science:

• Patient Safety
• Healthcare Quality Improvement
• Geriatric Pharmacy

Background:

• Inadequate medication reconciliation in skilled nursing facilities (SNFs) leads to unintentional medication discrepancies, threatening patient safety.
• SNFs are high-risk environments for medication errors due to patient complexity and frequent care transitions.

Purpose of the Study:

• To describe a quality improvement (QI) approach to enhance medication reconciliation processes within a SNF setting.
• To address challenges identified in medication reconciliation as part of the Multi-Center Medication Reconciliation Quality Improvement Study 2 (MARQUIS2).

Main Methods:

• A quality improvement (QI) approach was implemented in a 112-bed US Department of Veterans Affairs SNF.
• Methods included data benchmarking, stakeholder surveys, process mapping, and Healthcare Failure Mode and Effect Analysis (HFMEA) for baseline assessments.

Main Results:

• Baseline assessments revealed error-prone medication reconciliation with high discrepancy rates.
• Processes were labor-intensive, complex, and lacked standardization, exacerbated by polypharmacy and EHR limitations.
• HFMEA identified key challenges, leading to the validation of the best possible medication history (BPMH) process, adapted for SNFs with additional medication lists.

Conclusions:

• SNFs are critical settings for medication reconciliation due to inherent reconciliation challenges and high risk of adverse drug events.
• Baseline assessments are crucial for identifying problems and guiding targeted interventions to improve medication safety in SNFs.