Change Implementation - Nursing

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Proposed Capstone Project

Student’s name

Institution

Course name

Prof.

Due date

Proposed Capstone Project Topic: Improving Medication Reconciliation Accuracy at Admission and Discharge

Problem Description and Topic Alignment

Improving medication reconciliation accuracy at admission and discharge is a significant clinical practice issue that will be the focus to this proposed capstone change project. Medication reconciliation refers to a methodical procedure of gathering, confirming, and cataloging a complete and exact list of the medicines that a person is taking and comparing it to current provider orders in interchangeable care units (Agency for Healthcare Research and Quality, 2024). The medication discrepancies are prevalent even with the existing guidelines during the hospital admission and discharge. Such errors result in adverse drug events, delays in treatment, and unnecessary hospital readmission. The proposed topic fits best into the leadership category since it is dedicated to the nurse led practice improvement, systems level coordination, and interprofessional collaboration that should promote the patient safety and quality outcomes. Nurses are at the forefront of leading in medication information and continuity of care across settings.

Setting and Population Affected

The problem of inaccurate medication reconciliation is most often observed in acute care hospital environments. It is especially evident in medical surgical and transitional care units where patients frequently move between care settings. Older adults, patients with several coexisting conditions, and individuals on complicated medication routines are the most vulnerable group of the population (Alghamdi et al., 2023). Such patients are more vulnerable to polypharmacy, impaired cognition, poor health literacy and intermittent interventions between the inpatient and outpatient providers. During admission and discharge, nurses play the leading role in the identification and prevention of medication discrepancy among this population

Nursing Practice Implications

The implications of this clinical practice problem on the nursing practice and patient safety are enormous. Nurses have moral duties to avoid harm and encourage safe drug use (Zhu et al., 2024). Medication reconciliation errors lead to more workload in nursing as they develop more clarification processes, correction, and adverse drug events management. It also leads to professional stress and moral distress and possible legal liability. Medication reconciliation accuracy improved enhances clinical decision making, and increases communication during care. A nurse led checklist or electronic workflow improvement supports nurses to lead quality improvement initiatives within their scope of practice.

Needs Assessment Priority

According to the needs assessment done in Topic 1, medication reconciliation accuracy is a priority in the clinical site and the targeted population because it is closely linked with avoidable patient-related injuries. The problem of medication errors in the care transition process has been identified as one of the top patient safety issues in the country. Discharged patients who had incomplete or wrong information about medication face high chances of occurrence of adverse drug events, low adherence and readmission into the hospital. The solution to this issue supports organizational quality goals, decrease the number of healthcare funds, and enhance a patient confidence level in the ability to cope with the medications after leaving the hospital. To the broader community, medication safety decrease emergency department visits and the continuity of care across the healthcare delivery process.

Organizational Structure and Care Coordination Processes

The practicum site is a midsize hospital with an acute care environment with a mission of providing high quality, safe, and patient centered care. The vision of the organization stresses on clinical excellence, patient experience, and community trust. The main core values are teamwork, integrity, accountability, and respect. The leadership is organized through executive leadership team, nursing administration and unit based shared governance councils. Electronic health record documentation, interdisciplinary rounds, and standardized discharge planning, are internal processes that influence coordination of care. Examples of external processes are communications with the primary care providers, community pharmacies, and post acute care facilities. These internal and external systems are direct factors that affect the efficiency of the medication reconciliation in the chosen population.

Organizational Effectiveness in Addressing the Problem

The company has adopted a medication reconciliation policy and has an electronic health record system that facilitates documentation. However, such attempts have not been successful in ensuring that the problem is addressed comprehensively. Inconsistent use of reconciliation tools, variable staff training, and time limits in the admission and discharge processes remain factors that can lead to the problem of the medication discrepancies. The organizational statistics show that there is still some concern regarding medication related readmissions and misunderstanding of discharge medications by the patient. This proposed capstone project aims to fill these gaps by proposing a structured nurse led checklist or electronic workflow improvement based on the existing evidence and collaboration across professions. This project proposal provides a realistic and leadership-oriented way of enhancing the outcomes of medication safety and nursing practice.

References

Agency for Healthcare Research and Quality. (2024, December 15). Medication Reconciliation | PSNet. Ahrq.gov. https://psnet.ahrq.gov/primer/medication-reconciliation

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

Zhu, L.-L., Wang, Y.-H., Lan, M.-J., & Zhou, Q. (2024). Exploring the roles of nurses in medication reconciliation for older adults at hospital discharge: A narrative approach. Clinical Interventions in Aging, Volume 19, 367–373. https://doi.org/10.2147/cia.s450319