Discharge Time Out

Purpose:
To identify and resolve medication discrepancies at discharge through the implementation of an accurate reconciliation process, providing our patients a safe transition across the continuum of care.

Relevance/Significance:
Patients who are discharged with medication discrepancies are placed at risk for adverse drug events and re-admissions. The impact of these events on patient welfare, health care costs, and readmissions is significant to the patient and the health care system. A stronger focus on effective medication reconciliation is necessary to ensure safe transition of care and improved patient outcomes.

Strategy and Implementation:
In April 2012, the nurses on a 46-bed medical-surgical and cardiac unit identified discharge time as a crucial component in the medication reconciliation process and developed and implemented an innovative method for the process of discharge medication reconciliation. Utilizing the existing evidence-based practice approach of the surgical time out, they applied this evidence to the discharge medication reconciliation process and restructured it into the discharge time out. At discharge, patients undergo a time out process during which the nurse completes a nurse to nurse check list to identify discrepancies, such as a medication omission, duplication, change in frequency, and change in dose, adjustments, and new medications not accompanied by a prescription, all discrepancies initiate a reconciliation process. Through the implementation of a time out, nurses can ensure patients are discharged to home with an accurate medication list, thus improving the transition in care.

Evaluation:
A retrospective review of medical charts(n=86)over a 3-month period (January-March,2012)found 77.9%(n=67)of discharge documents contained discrepancies on the admission and discharge medication reconciliation forms. Over a 9 month period following initiation of the time out process 239 charts reviewed showed a discrepancy rate of 21.4% and has remained at or below 20% over the following 2 years.

Implications for Practice:
Nurses initially thought the project would increase their workload, when in actuality the project served to improve discharge practices by physicians,thereby saving nurses multiple phone calls and time. Nurses have described the time out process as a win-win for patient safety and time management.