Standardizing Medication Reconciliation in a Pediatric Emergency Department

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.