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A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
Published on: November 9, 2016
Standardizing Medication Reconciliation in a Pediatric Emergency Department
Sarika Sheth1,2, Mario Bialostozky1,2, Kathy Hollenbach1,2
1Rady Children's Hospital San Diego, San Diego, California.
Insights
Medication reconciliation at discharge improved significantly in pediatric emergency (ED) and urgent care (UC) settings. This initiative enhanced patient safety during care transitions.
Area of Science:
- Healthcare Quality Improvement
- Patient Safety
- Medication Management
Background:
- Medication errors frequently occur during care transitions like emergency department (ED) and urgent care (UC) discharge.
- The Joint Commission emphasizes medication reconciliation as a critical patient safety practice.
- The study aimed to improve medication reconciliation rates at pediatric ED and UC discharge.
Purpose of the Study:
- To increase the percentage of patients with completed medication reconciliation at discharge from a pediatric ED and four UCs.
- The target was to raise the completion rate from 25% to 75% within a 12-month period.
Main Methods:
- Stakeholder engagement included ED/UC physicians, nurses, informatics, and quality management.
- Process mapping, Ishikawa diagrams, and electronic health record adaptations (inpatient workflow, clinical decision support) were employed.
- Educational interventions comprised just-in-time training, presentations, video tutorials, and physician feedback using funnel plots.
Main Results:
- In UCs, home medication nursing review rose from 91% to 98%, and medication reconciliation increased from 35% to 82% in 4 months.
- In the ED, home medication nursing review improved from 2% to 83% in 8 months, with medication reconciliation reaching 64% in 18 months.
- Statistical process control analyzed changes in these key performance measures over time.
Conclusions:
- The implemented interventions successfully increased the proportion of patients with completed medication reconciliation at discharge from both UC and ED settings.
- This study demonstrates an effective strategy for enhancing medication safety during critical care transitions.
Background:
Medication errors are common during transitions of care, such as discharge from the emergency department (ED) or urgent care (UC). The Joint Commission has identified medication reconciliation as a key safety practice. Our aim was to increase the percentage of patients with completed medication reconciliation at discharge from our pediatric ED and 4 UCs from 25% to 75% in 12 months.
Methods:
Key stakeholders included ED and UC physicians and nurses, informatics, and quality management. The baseline process for medication reconciliation was mapped and modified to create a standard process for nurses and physicians. An Ishikawa diagram was created to assess potential failures. Electronic health record interventions included adapting an inpatient workflow and using a clinical decision support tool. Educational interventions included just-in-time training, physician education via division meeting presentations, video tutorials, and physician-specific and group feedback using funnel plots. The secondary process measure was the proportion of patients discharged from the ED and UCs with completed home medication nursing review. We used statistical process control to analyze changes in measures over time.
Results:
In the UCs, home medication nursing review increased from 91% to 98% and medication reconciliation increased from 35% to 82% within 4 months. In the ED, home medication nursing review increased from 2% to 83% within 8 months and medication reconciliation increased from 26% to 64% within 18 months.
Conclusions:
We successfully increased the proportion of UC and ED discharged patients with completed medication reconciliation.
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