Quality and Workflow: How Novel Medication Reconciliation Software Transformed Communication & Enhanced Patient Safety

Purpose:
To increase the accuracy of home medications collected on admission to acute care facilities through enhanced communication among interdisciplinary providers in order to reduce Adverse Drug Reactions (ADRs) during hospitalization utilizing an electronic medication reconciliation software solution.

Significance:
Communication breakdown and medication errors have both been established in the literature as significant factors negatively impacting patient safety and outcomes. The Joint Commission, Institute of Medicine, and Institute for Safe Medication Practices support enhancing communication.

Strategy and Implementation:
An interdisciplinary team was formed to create a novel electronic medication reconciliation software tool. The desired outcome was to enhance communication and eliminate unnecessary redundancy in written home medication data collected. The electronic process was designed to enhance patient safety through the reduction or elimination of medication discrepancies inherent in the written method by establishing an electronic cross-check (independent double check), thereby reducing ADRs. The implementation process began in March 2011 with a pilot on a heart failure telemetry unit seeking nurse and physician feedback on system usability. After needed software changes were made, an iterative approach of implementation began Summer, 2011, and culminated in December 2011. Leveraging the Magnet model and shared governance, a nurse-led team was formed and included a physician liaison, lead pharmacist, and 6 staff nurses. Just-in-time education was used, supplemented with computer-based learning.

Evaluation:
The primary metric measured was reduction of ADRs in the post-implementation period. In Q1 2011, there were 25 non-dye related ADRs. In Q1 2012, there were 18, a 28% reduction. Analysis of accuracy of written documentation of home medications compared to electronically collected data is underway.

Implications for Practice:
Multidisciplinary collection of a home medication list using an integrated electronic medication reconciliation software tool to modify workflow can create an environment of patient safety through collaboration and communication and reduce adverse drug reactions in the acute care setting.