Date of Final Presentation
Cara Gallegos, PhD, RN
Deena Rauch, DNP, RN, NEA-BC, CENP, EBP-C, FACHE
Coordinator/ Chair of DNP Program
Pamela Gehrke, EdD, RN
Abstract/ Executive Summary
Poor medication reconciliation processes in acute care hospitals, combined with poor communication across the healthcare team, and a failure to bring specialized pharmacy resources to the team can be attributed to adverse drug events that in turn result in hospital readmissions within 30 days of discharge (Sutherland, David-Kasdan, Beloff, Mueller, Whang, Bleday, & Urman, 2016).
The aims of project included: 1. Utilize an interprofessional team that included, nursing, pharmacy, RN care management, and physicians to develop hospital policy and procedures for medication reconciliation, 2. Develop a risk stratification method to identify patients at highest risk for medication related complications post discharge, 3. Improve patient medication management at discharge, and 4. Improve patient and staff satisfaction and confidence surrounding medication reconciliation.
The interprofessional team members and staff were more satisfied and engaged in their jobs after collaborating in this DNP project as evidenced by the Collaboration and Satisfaction About Care Decisions (CSACD) survey conducted pre improvement and post improvement (Baggs, 1994). An early warning system was created, based upon the 2012 Beers Criteria and developed into a screening tool for the nursing staff. This was implemented in the electronic medical record to automate a referral for the interprofessional team for patients at high risk for an adverse drug event. During implementation, 35 of the 163 admissions were categorized as high risk and were evaluated by the interprofessional team. Also, 20% of the patients during the two-month implementation phase had medication errors identified and corrected by this team. Chronic prescriptions at discharge were reduced by 1.25 prescriptions per patient through the process, potentially lowering patient risk.
Due to the small sample size and short duration of the project implementation phase, it is recommended that further study and additional process improvement projects be implemented to validate the data.
This project demonstrated that nursing staff and interprofessional team members may be more satisfied and feel more engaged as a result of collaborating in a quality improvement project with other healthcare professions. An early warning system may be developed to identify patients at risk for adverse drug events, making it possible for organizations to assign the appropriate resources to these patients. An interprofessional team process to improve medication reconciliation could result in the identification and correction of medication errors, reduce the quantity of chronic prescriptions at discharge, and possibly enhance patient satisfaction regarding the medication management process.
Robertson, Misty, "Interprofessional Approach to Medication Reconciliation in the Hospitalized Medicare Patient." (2021). Doctor of Nursing Practice. 35.