Change Implementation - Nursing

Criteria

Article 1

Article 2

Article 3

Article 4

APA Reference

All peer reviewed journal articles should be current (published within the last 5 years) and closely relate to the PICOT question developed earlier in this course. Include the GCU permalink or working link used to access the article.

Fatemi-Nejad, M., Mehrpooya, M., Ahmadimoghaddam, D., Shirmohammadi, K., Zamanirafe, M., Sharifikia, M., & Eshraghi, A. (2025). Improving medication safety with proactive reconciliation in acute coronary syndrome patients: A randomized trial. Exploratory Research in Clinical and Social Pharmacy, 18(1), 100577–100577. https://doi.org/10.1016/j.rcsop.2025.100577

Ahmed, A., Aziz, A., & Sethi, S. M. (2025). Improving medication reconciliation compliance in a tertiary care hospital of a developing country: a quality improvement initiative using the PDSA cycle. BMJ Open Quality, 14(4), e003487. https://doi.org/10.1136/bmjoq-2025-003487

Gunkelman, S. M., Jamerino-Thrush, J., Genet, K., Blackford, M., Jones, K., & Bigham, M. T. (2024). Improving Accuracy of Medication Reconciliation for Hospitalized Children: A Quality Project. Hospital Pediatrics, 14(4), 300–307. https://doi.org/10.1542/hpeds.2023-007396

Alghamdi, D. S., Alhrasen, M., Kassem, A., Alwagdani, A., Tourkmani, A. M., Alnowaiser, N., Barakah, Y. A., & Alotaibi, Y. K. (2023). Implementation of medication reconciliation at admission and discharge in Ministry of Defense Health Services hospitals: a multicentre study. BMJ Open Quality, 12(2), e002121. https://doi.org/10.1136/bmjoq-2022-002121

Purpose/Aim of Study

The purpose of this study was to determine the differences between the effectiveness and time efficiency of proactive and retroactive medication reconciliation models in preventing unintentional medication discrepancy among patients admitted in hospitals with acute coronary syndrome (ACS).

The purpose was to assess whether a structured, multidisciplinary quality improvement initiative using the PDSA cycle could improve medication reconciliation compliance within 24 hours of hospital admission.

The purpose was to examine whether targeted quality improvement interventions could improve the accuracy of medication reconciliation for hospitalized pediatric patients.

The purpose was to assess the impact of implementing a standardized medication reconciliation process on reducing unintentional medication discrepancies at hospital admission and discharge.

Research questions (Qualitative)/Hypothesis (Quantitative)

Hypothesis (Quantitative): Proactive medication reconciliation significantly reduces the occurrence of unintentional medication discrepancies and less time than retroactive medication reconciliation in hospitalized ACS patients.

Implementing multidisciplinary PDSA cycle interventions will significantly increase medication reconciliation compliance.

Implementation of PDSA-based interventions would increase the proportion of patients with at least one unnecessary home medication removed.

The study hypothesized that implementation of medication reconciliation would significantly reduce unintentional medication discrepancies and improve documentation compliance.

Design

Type of quantitative or type of qualitative study design

Quantitative Prospective, single-center randomized controlled clinical trial

Quantitative quality improvement study.

Quantitative quality improvement study.

Quantitative multicentre quality improvement study using a before-and-after design.

Setting

Where did the study take place? What type of setting – inpatient, outpatient, etc.?

The study took place in a 65-bed Coronary Care Unit (CCU) at a referral specialty and subspecialty cardiovascular teaching hospital in western Iran. The setting was an inpatient acute-care hospital environment.

Non-experimental quality improvement initiative using PDSA methodology.

Non-experimental, PDSA-based quality improvement design.

Conducted in 18 Ministry of Defense Health Services hospitals in Saudi Arabia; inpatient hospital settings.

Sample

Number and characteristics of participants

162 hospitalized ACS patients taking five or more medications; 81 assigned to each group.

Inpatient internal medicine ward at a 650-bed tertiary care teaching hospital in Karachi, Pakistan.

Inpatient acute-care units within a freestanding quaternary care children’s teaching hospital.

Hospitalized patients across participating hospitals; multidisciplinary audit teams including physicians, nurses, pharmacists, and quality staff reviewed patient records.

Methods

Interventions/Instruments

A clinical pharmacist-led medication reconciliation process was implemented using two models: proactive reconciliation (Best Possible Medication History obtained before admission orders were written) and retroactive reconciliation (BPMH obtained after admission orders).

Adult medical inpatients and healthcare professionals, including junior doctors, nurses, pharmacists, and IT staff.

Hospitalized pediatric patients on the pediatric hospital medicine service and care teams including residents, NPs, nurses, and physicians.

Implementation of WHO High 5s and AHRQ MATCH medication reconciliation toolkits, staff education, standardized policies, multidisciplinary audits, and feedback cycles.

Analysis

How were the data that were collected analyzed?

SPSS analysis using t-tests, Mann–Whitney U, and chi-square tests; p < .05.

Education, workflow redesign, electronic system access, reminders, and shared accountability implemented through iterative PDSA cycles.

EHR workflow simplification, resident and provider education, chart audits, and real-time feedback through multiple PDSA cycles.

Data were analyzed using control charts, t-tests, and correlation analysis with statistical significance set at p < 0.05.

Outcomes/key findings of the study and implications for nursing practice (Summary of study results)

Proactive reconciliation significantly reduced discrepancies, potential harm, and completion time, improving patient safety and nursing collaboration.

Descriptive tracking of reconciliation compliance rates over time using electronic hospital data.

Statistical process control charts (P charts and U charts) were used to monitor performance over time.

Medication discrepancies significantly decreased at admission and discharge, and compliance with reconciliation documentation improved, demonstrating enhanced patient safety and nursing accountability.

Recommendations of the Researcher

Implement proactive reconciliation for high-risk patients and involve trained pharmacy staff.

Compliance increased from 4% to 96%, improving patient safety and reinforcing interdisciplinary nursing collaboration.

Patients with at least one medication removed increased from 35% to 48%, with sustained improvement for 12 months, enhancing medication safety.

Researchers recommended sustaining standardized medication reconciliation, clarifying team roles, and ongoing education and monitoring.

Explain how this article supports your proposed PICO(T) question and Capstone Change Project

The study provides strong evidence supporting proactive medication reconciliation as an effective intervention for improving medication safety in hospitalized patients.

Scale the intervention hospital-wide and sustain improvements through ongoing education and system integration.

Continue education, optimize EHR usability, and apply similar interventions in pediatric inpatient settings.

Criteria

Article 5

Article 6

Article 7

Article 8

APA Reference

(include the GCU permalink or working link used to access the article)

Nguyen, A., Gibson, S., & Wembridge, P. (2022). Improving medicine information on discharge summaries through implementation of a reconciliation‐based intervention. Journal of Pharmacy Practice and Research. https://doi.org/10.1002/jppr.1828

Xu, K., Renzi, N., & Ragusa, L. (2025). Iterative Interventions to Improve Admission Medication Reconciliation Completion Rates and Reduce Medication Errors at Post-Acute Care Facilities. Patient Safety, 7(2). https://doi.org/10.33940/001c.134045

Jošt, M., Kos, M. K., Kos, M., & Knez, L. (2024). Effectiveness of pharmacist-led medication reconciliation on medication errors at hospital discharge and healthcare utilization in the next 30 days: a pragmatic clinical trial. Frontiers in Pharmacology, 15. https://doi.org/10.3389/fphar.2024.1377781

Stanley, W., Falconer, K., & Hume, M. (2025). Improving 24-Hour Medication Reconciliation Through Audit and Feedback: A Multicycle Quality Improvement Study at a Scottish District General Hospital. Cureus. https://doi.org/10.7759/cureus.84445

Purpose/Aim of Study

The study aimed to determine whether a reconciliation-based intervention, involving an intern pharmacist reviewing discharge summaries (DSs) and identifying discrepancies with discharge prescriptions, could reduce medication errors on DSs.

To evaluate whether iterative Plan-Do-Study-Act (PDSA) interventions could improve admission medication reconciliation (AdmMedRec) completion rates and reduce medication errors in post-acute care facilities.

To evaluate the impact of routine pharmacist-led medication reconciliation on the occurrence of clinically important medication errors at hospital discharge and unplanned healthcare utilization within 30 days.

This study aimed to assess local compliance with the national benchmarks and evaluate whether a structured audit-feedback intervention could improve MR documentation and the recording of reasons for withholding medications.

Research questions (Qualitative)/Hypothesis (Quantitative)

Quantitative hypothesis: Patients receiving the reconciliation intervention would have fewer medication errors on DSs compared to patients receiving standard care.

Quantitative hypothesis: Implementation of iterative interventions will significantly increase AdmMedRec completion rates and reduce admission medication errors.

Quantitative hypothesis: Pharmacist-led medication reconciliation reduces clinically important medication errors at discharge and may reduce unplanned healthcare utilization.

Quantitative hypothesis: Pharmacist-led medication reconciliation decreases clinically important medication errors at discharge and may reduce unplanned healthcare utilization.

Design

Type of quantitative or type of qualitative study design

Quantitative, retrospective comparative study. Intervention group compared to a control group over different two-week periods.

Quantitative, quality improvement study using iterative PDSA cycles with pre- and post-intervention comparisons.

Pragmatic, prospective, controlled clinical trial comparing intervention and control groups in routine hospital practice.

Pragmatic, prospective, controlled clinical trial with intervention and control groups.

Setting

Where did the study take place? What type of setting – inpatient, outpatient, etc.?

Conducted on a 32-bed general medicine ward in a metropolitan hospital. Inpatient setting.

Conducted at a 58-bed inpatient rehabilitation facility (IRF) and an 18-bed long-term acute care hospital (LTACH) within a large academic medical system. Inpatient post-acute care setting.

Conducted in five general medical wards at the University Clinic of Respiratory and Allergic Diseases Golnik, Slovenia. Inpatient setting.

Conducted in five general medical wards at the University Clinic of Respiratory and Allergic Diseases Golnik, Slovenia. Inpatient hospital setting.

Sample

Number and characteristics of participants

22 patients in the intervention group; 31 patients in the control group. All patients discharged during study periods and reviewed by clinical pharmacists.

Patients admitted to the IRF and LTACH; all admissions during the intervention period were included. Provider participants included resident physicians, hospitalists, and advanced practice providers involved in admission medication reconciliation.

414 adult patients (225 intervention, 189 control), median age 71, with comorbidities and polypharmacy. Inclusion excluded non-Slovenian speakers, diagnostic-only admissions, transfers, or repeated participants.

414 adult patients (225 intervention, 189 control), median age 71, with comorbidities and polypharmacy. Excluded non-Slovenian speakers, diagnostic-only admissions, transfers, or repeated participants.

Methods

Interventions/Instruments

Intern pharmacist compared DSs with discharge prescriptions, summarized discrepancies, communicated them to medical staff, and performed a second review. Time to complete reviews was recorded.

Interdisciplinary team used FMEA to identify workflow failures, developed standardized AdmMedRec process, educational curriculum, and feedback mechanisms in the EHR. Interventions implemented iteratively via PDSA cycles.

Intervention: pharmacist-led medication reconciliation at admission and discharge, patient counseling, BPMH verification, and collaboration with treating physicians. Control: standard discharge instructions. Standard operating procedures guided all steps.

Intervention: pharmacist-led medication reconciliation at admission and discharge, patient counseling, best possible medication history (BPMH), and collaboration with physicians. Control: standard written discharge instructions. Standard operating procedures guided all steps.

Analysis

How were the data that were collected analyzed?

Errors classified by modified APINCH system. Data analyzed using chi-square tests with R software; Excel used for data management.

AdmMedRec completion rates and medication errors were tracked and compared before and after interventions. Data analysis included descriptive statistics and trend comparisons.

Descriptive statistics, chi-square/Fisher’s exact test, Mann–Whitney U test, and multiple logistic regression. Model fit evaluated via Hosmer–Lemeshow test, odds ratios with 95% CIs reported.

Descriptive statistics, chi-square/Fisher’s exact tests, Mann–Whitney U test, and multiple logistic regression. Model fit assessed with Hosmer–Lemeshow test; odds ratios with 95% confidence intervals reported.

Outcomes/key findings of the study and implications for nursing practice (Summary of study results)

Intervention reduced any medication errors (4% vs 84%) and high-risk errors (0% vs 29%). 77 recommendations were made; most errors occurred in the control group.

Completion rates improved from 13% to 87% (IRF) and 51% to 82% (LTACH). Medication errors decreased; near-miss reporting increased due to heightened awareness. Interventions enhanced provider engagement and workflow adherence.

Intervention significantly reduced clinically important medication errors (9.3% vs 61.9%), 20-fold risk reduction. No significant difference in unplanned healthcare utilization (33.9% vs 27.8%). Higher age, acute admission, and polypharmacy increased risk.

Clinically important medication errors significantly reduced in intervention group (9.3% vs 61.9%), representing a 20-fold reduction. No significant difference in unplanned healthcare utilization (33.9% vs 27.8%). Older age, polypharmacy, and acute admission increased risk.

Recommendations of the Researcher

Authors recommend integrating reconciliation interventions at discharge to improve DS accuracy, potentially using pharmacy technicians or adding tasks to clinical pharmacists’ roles.

Recommend ongoing education, standardized workflows, real-time EHR visibility, and provider champions to sustain AdmMedRec compliance and minimize errors.

Implement pharmacist-led medication reconciliation as a routine practice to reduce discharge medication errors, emphasizing patient safety. Healthcare utilization may require additional strategies.

Implement pharmacist-led medication reconciliation as routine practice to enhance patient safety. While errors decreased, additional interventions may be needed to reduce healthcare utilization.

Explain how this article supports your proposed PICO(T) question and Capstone Change Project

Supports improving medication safety at discharge by demonstrating that structured pharmacy interventions significantly reduce DS errors, aligning with a PICO(T) question focused on enhancing patient safety and nursing practice outcomes.

Supports improving patient safety during care transitions by demonstrating structured interventions reduce medication errors, aligning with a PICO(T) focus on enhanced medication safety and nursing practice outcomes.

Supports PICO(T) focus on improving patient safety through structured medication reconciliation, demonstrating that pharmacist-led interventions significantly reduce discharge errors, aligning with nursing practice and patient care improvement goals.

Demonstrates that structured medication reconciliation led by pharmacists effectively reduces discharge medication errors, supporting a PICO(T) project aimed at improving patient safety and nursing-led quality initiatives.