research paper

Carmen Mustata

Chamberlain Collage of Nursing

NR – 449: Evidence Base Practice

January 2020

Clinical Question

Problem

Every year, several deaths have been connected to medication errors. This paper is going to address what is the effectiveness of an improved hospital discharge through medication reconciliation and education. It will also evaluate the effectiveness of an improved medication reconciliation and education and the risk for not improving it which decreases medication errors and promote patient safety.

Significance of problem

Kern, E., Dingae, M. B., Langmack, E. L., Juarez, C., Cott, G., & Meadows, S. K. (2017), states that across 18 months improved medication reconciliation increased from 9.8% to 91.3%. This improvement of medication reconciliation have led to medication that list missing dose/frequency to decrease form 18.1% to 15.8%. Also patient who have duplicate medication to decrease from 4.0% to 2.6%. The article identifies other aspect that contribute to improve medication reconciliation and education by requiring the organization to obtain the patient’s medication information at admission, and update when the patient’s medications change.

Kreckman J, Wasey W, Wise S, et al (2018), brought out that the healthcare team verifies with patient and their families and even contacting their pharmacies and providers to reconcile the patient’s hospital medication at admission and within 24 hours of discharge. This implementation prevented errors and early recovery if an error occurred. The percentage of improving medication conciliation decreased from 33.9% to 18.7% at the hospital admission and at discharge from 22.9% to 5.0%. With all these results, by improving the medication reconciliation and education prevented a lot of medication errors and also help patient to safer transition.

Purpose

The purpose of this assignment is to evaluate the effectiveness of improving medication reconciliation and education at hospital discharge.

Evidence Matrix Tool

In this paper matrix table was used and discussed two evidence based practice articles. The first evidence based article that was used is Kern, E., et al (2017), the purpose is to determine if medication reconciliation in a large subspecialty outpatient practice improved. The variables whereby the independent (I) is the improve medication reconciliation whiles the dependent (D) is the medication errors. The study design for this article is interview, and quantitative. The sample size and selection is N-75,000 adult outpatient in a National Jewish Health (NJH) hospital and data collection method is focus group in Denver. The major findings for this article is implementing measures to improve performance and quality of medication reconciliation from Electronic Health Records (EHR) over a periods of time. The article addresses potential safety concerns by ensuring when the medication is added, changed, or discontinued and needs to be evaluate. The health care team goal was to improve medication reconciliation by setting up a system that measures and validate electronic measures in daily work because NJH lacked measures of attestation that medication reconciliation is done. Concerning patient education, based on EHR documentation they were able to find out if patient had been offered a “Medication Safety Facts” handout to know if there have been any patient education regarding the medication prescribed.

The second evidence based article that was used is Kreckman J, Wasey W, Wise S, et al (2018), the purpose is to improve medication reconciliation at hospital admission, discharge and ambulatory care through a transition of care team. The variables where the independent (I) is improving medication reconciliation and dependent (D) is medication errors. The study design for this article quantitative, interview patients, and qualitative. The sample size and selection is N-70 patients in a tertiary-care facility in Illinois and the data collected method used is focus group. The major findings for this article is reduction in medication errors at admission, discharge, and follow-up by improving medication reconciliation. Furthermore, to improve medication reconciliation they formed a group called transition of care team which includes registered nurses to help improve medication errors. This group engaged with everyone involved with patient care. With this it allowed for additional investigation resources and preventing errors.

Conclusion

The major findings are the resources used establish reliability and validity. With both articles support the need to improve medication reconciliation whether at admission, discharge, or follow-up. The articles provide results that shows how using care team and electronic health records to improve medication reconciliation. Both articles set up strategies that are useful for healthcare workers regarding on how to improve medication reconciliation and education to reduce medication errors during transition of care.

References

Kern, E., Dingae, M. B., Langmack, E. L., Juarez, C., Cott, G., & Meadows, S. K. (2017). Measuring to Improve Medication Reconciliation in a Large Subspecialty Outpatient Practice. The Joint Commission Journal on Quality and Patient Safety, 43(5), 212–223. doi: 10.1016/j.jcjq.2017.02.005

Kreckman, J., Wasey, W., Wise, S., Stevens, T., Millburg, L., & Jaeger, C. (2018). Improving medication reconciliation at hospital admission, discharge and ambulatory care through a transition of care team. BMJ open quality, 7(2), e000281. doi:10.1136/bmjoq-2017-000281