Introduction
Medical reconciliation is an issue that often arises in medical practice. Therefore, the goal of this assignment is to develop an initiative for improving medication reconciliation processes. In particular, “The Road to Evidence-Based Practice” process will be applied to gather scientific and reliable evidence. The final results will be used to inform the medical reconciliation initiative aimed at decreasing medication errors and increasing patient safety.
Overview of the Problem
As it stands, medication reconciliation is a recurring issue in medical practice. Medication reconciliation is the process of comparing a patient’s pharmaceutical orders to their actual medications to make sure there are no errors (Killin et al., 2021). Medication discrepancies can have detrimental effects on patients, including adverse drug reactions, worsening of their medical condition, and in severe cases, death (Killin et al., 2021). As for the setting of the problem, medication errors can occur at various points in the healthcare system, particularly during prescribing, transcribing, dispensing, or administering medications (Killin et al., 2021). The ubiquity of medication prescriptions in medical practice signals that improving medication reconciliation processes is a significant quality improvement opportunity.
Explanation and Expected Outcome
Ultimately, improving medication reconciliation processes in medical practice is needed to reduce the number of medication errors. However, medication reconciliation can be a challenging process due to factors such as a lack of access to complete and accurate medication lists, poor communication between healthcare providers, and a high workload for staff (Killin et al., 2021). As a result, medication errors related to reconciliation are common and can have serious consequences for patients. By implementing a quality improvement initiative to improve medication reconciliation processes, it is expected that the number of medication errors will be reduced, resulting in improved patient safety and potentially better patient outcomes.
Previous Research
“The Road to Evidence-Based Practice” process can be applied to the issues regarding medication reconciliation. As per this approach, the first step is to ask a question (Helbig, 2018). In this case, the appropriate question would be “Is there a way to improve medication reconciliation processes in medical practice to reduce the number of medication errors?” To answer this, there will be a search for evidence, which would then be appraised (Helbig, 2018). A search of scientific databases will be conducted to find relevant studies, following which three articles will be selected. The study design of the articles will be critically appraised in order to determine their validity, reliability, and applicability to medical practice. Following the established steps, the implementation of possible discovered solutions, as well as their potential evaluation, will be discussed (Helbig, 2018). This will potentially provide a solution for improving medication reconciliation processes.
The first article is titled Effect of an Electronic Medication Reconciliation Intervention on Adverse Drug Events. The main finding of the article is that electronic medication reconciliation was somewhat effective, reducing medication discrepancies but had no effect on adverse drug events, emergency department visits, or readmission (Tamblyn et al., 2019). The study design is a cluster randomized trial, which is appropriate for evaluating the effectiveness of an intervention such as electronic medication reconciliation (Tamblyn et al., 2019). It allows for the comparison of outcomes between the intervention and control groups while taking into account any potential confounding factors. Likewise, the sample size of 3491 patients is adequate for a cluster randomized trial of this type, as it provides sufficient power to detect differences between the groups (Tamblyn et al., 2019, p. 1). The study appears to be well-conducted, and the conclusion about electronic medication reconciliation is likely to be reliable.
The next article is Evaluation of an Educational Strategy to Improve Medication Reconciliation in Ambulatory Care. The main finding of the study is that the educational program on medication reconciliation was found to be acceptable and appropriate by pharmacists and clinic personnel, but it was often adapted to fit site-specific needs (Jones et al., 2022). This study employed a partially mixed sequential dominant status evaluation, which is a type of mixed-methods evaluation that combines both quantitative and qualitative data collection and analysis (Jones et al., 2022). The use of both quantitative and qualitative data collection methods is likely to increase the validity of the findings, as it allows for the examination of multiple aspects of the implementation and impact of the educational program.
Finally, the last article to be discussed is Impact of a Medication Reconciliation Care Bundle at Hospital Discharge on Continuity of Care: A Randomised Controlled Trial. Overall, the study suggests that implementing a care bundle including medication reconciliation is an effective strategy for improving patient outcomes (Bouchand et al., 2021). This has important implications for improving medication reconciliation processes in medical practice, as it shows that certain procedures can be established to ensure the quality of care. The study described in this article is a randomized controlled trial (RCT) (Bouchand et al., 2021). Random assignment of participants to either the intervention group or the control group aids in preventing the possibility of confounders and biases. Overall, the RCT design of this study is strong, and the results suggest that a care bundle including medication reconciliation by a pharmacist may be effective.
Necessary Steps
Based on the evidence, a quality improvement initiative could be employed to improve medication reconciliation processes. This initiative will include implementing electronic medication reconciliation systems, providing education and training to staff on proper reconciliation processes, and establishing medication reconciliation procedures. As this quality improvement initiative to improve medication reconciliation processes consists of multiple parts, implementing it would involve several steps. Thus, it is necessary to discuss them to determine what actions could be taken.
The first step would be to conduct a baseline assessment. This step involves gathering data on the current state of the medication reconciliation process, including any existing systems, procedures, and staff training. The rationale for this is that studying rates of medication errors related to medication reconciliation in the facility can be used to identify areas for improvement and set goals for the initiative. Certain areas of the medication reconciliation process, such as reconciling medication lists at admission, discharge, and transfer of care, could be associated with a higher risk of medication errors (Killin et al., 2021). Additionally, feedback from staff members, patients, and family members about the pain points in the current process could be used. These areas should be prioritized based on their potential impact and feasibility of improvement.
The next potential step is the development of a detailed plan for implementing the electronic medication reconciliation system, providing staff education and training, and establishing new procedures. This plan should include specific goals, timelines, and resources needed to implement the initiative, which may vary based on the baseline assessment results. This ties into the final step of the process, which would be the implementation of the said plan.
Evaluation, Variables, Hypothesis Test, and Statistical Test
After completing the outlined steps, the effectiveness of the quality improvement initiative will be evaluated. The goal would be to determine whether it is meeting its goals and to identify any areas for further improvement. This could involve collecting data on medication errors before and after the intervention, surveying staff and patients about their experiences with the new processes, and reviewing any relevant metrics, such as hospital readmission rates.
To evaluate whether the quality improvement initiative has led to an improvement in medication reconciliation processes, several variables, hypothesis tests, and statistical tests can be used. The primary variable of interest would be the rate of medication errors or adverse drug events related to medication reconciliation. The null hypothesis would be that there is no significant difference in the rate of medication errors or adverse drug events before and after the implementation of the quality improvement initiative. The alternative hypothesis would be that there is a significant reduction in the rate of medication errors or adverse drug events after the implementation of the quality improvement initiative. To test these hypotheses, a statistical test such as a chi-squared test or a t-test can be used to compare the rate of medication errors or adverse drug events before and after the implementation of the initiative. These tests can be used to determine whether the difference in the rate of medication errors or adverse drug events before and after the initiative is statistically significant.
Conclusion
In conclusion, strengthening medication reconciliation procedures is crucial to lowering pharmaceutical errors and raising patient safety. The large body of research on the topic has highlighted the importance of effective medication reconciliation and has provided various strategies to improve the process. A quality improvement initiative to improve the medication reconciliation process can be implemented. By critically appraising the available evidence, it is possible to determine the validity, reliability, and applicability of the selected articles to medical practice and find the best solution for the medication reconciliation process. With a successful implementation of the initiative, it is expected that the number of medication errors will be reduced, resulting in better patient outcomes.
References
Bouchand, F., Leplay, C., Guimaraes, R., Fontenay, S., Fellous, L., Dinh, A., Deconinck, L., Sénard, O., Matt, M., Michelon, H., Perronne, C., Salomon, J., Villart, M., Izedaren, F., Pottier, S., Barbot, F., Orlikowski, D., Vaugier, I., & Davido, B. (2021). Impact of a medication reconciliation care bundle at hospital discharge on continuity of care: A randomised controlled trial. International Journal of Clinical Practice, 75(8). Web.
Jones, L. K., Hayduk, V., Romagnoli, K. M., Flango, A., Marks, J., Graham, J., & Gionfriddo, M. R. (2022). Evaluation of an educational strategy to improve medication reconciliation in ambulatory care. Journal of the American Pharmacists Association, 62(4), 1179-1188. Web.
Helbig, June. (2018). Applied statistics for health care. Grand Canyon University. Web.
Killin, L., Hezam, A., Anderson, K. K., & Welk, B. (2021). Advanced medication reconciliation: a systematic review of the impact on medication errors and adverse drug events associated with transitions of care. The Joint Commission Journal on Quality and Patient Safety, 47(7), 438–451. Web.
Tamblyn, R., Abrahamowicz, M., Buckeridge, D. L., Bustillo, M., Forster, A. J., Girard, N., Habib, B., Hanley, J., Huang, A., Kurteva, S., Lee, T. C., Meguerditchian, A. N., Moraga, T., Motulsky, A., Petrella, L., Weir, D. L., & Winslade, N. (2019). Effect of an electronic medication reconciliation intervention on adverse drug events. JAMA Network Open, 2(9), e1910756. Web.