Patient safety is a key element during transitions in care. Medication omissions and dosing errors during changes in care settings can be sources of avoidable patient harm. The occurrence of errors can be substantially reduced through medication reconciliation, which can be described as “the task of bridging discrepancies in a patient’s medical history after a care setting changes” (Ferdandes & Shojania, 2012, p. 43). The aim of this paper is to outline a research project proposal on the improvement of medication reconciliation practices.
The quality of health care delivery during both within-hospital and external transfers hinges on the elimination of medication discrepancies that can lead to the occurrence of adverse drug events, discontinuity of treatment, and dosing errors. According to Mueller, Sponsler, Kripalani, and Schnipper (2012), the frequency of the occurrence of adverse drug events fall in the range from 5 percent to 40 percent for hospitalized patients and 12 percent to 17 percent for post-discharge patients. These are extremely high rates that indicate a serious underlying issue troubling national health care facilities—the inadequacy of medication reconciliation practices. At present, medication discrepancies affect almost 70 percent of patients at some point in transitional care (Mueller et al., 2012).
Given the scope of the problem, it is necessary to join the efforts of the Joint Commission, which has identified the enhancement of medication reconciliation quality as a national goal (Ferdandes & Shojania, 2012). The extant literature on the topic indicates that medication reconciliation the process that can be divided into three important steps (Hassali et al., 2012). The first step is the verification process that involves the collection of accurate medication history records. The next step is the comparison of medication lists thorough medication history. The final step is the reconciliation of records, followed by documentation of all changes.
This process helps to reassure that preventable errors associated with medications and doses are eliminated. Currently, not all health care organizations have effective procedures for medication reconciliation at each point of transitional care that involves the collaboration between such parties as physicians, nurses, patients and their families, and pharmacists, among others (Hassali et al., 2012).
Significance of the Problem to Nursing
The significance of the problem to nursing is evident in the fact that the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey has been expanded by the addition of the Care Transition Measures (DelBoccio et al., 2015). Furthermore, the Joint Commission and other similar organizations have developed recommendations for safe transition practices that include medication reconciliation.
The heightened awareness of the problem of inadequate medication reconciliation procedures suggests that there is a pressing need for action. Given that the medication history is formed by contributions from multiple sources that include, but are not limited to, “the patient, primary care physician, medical specialists, outpatient medical records, hospital discharge summaries, and community pharmacies” (Hassali et al., 2012, p. 78), it is necessary to ensure that errors eliminated at all data nodes.
The significance of the issue for nursing is also underscored by the fact that medication errors occur not only during the transitions from emergency departments, which are characterized by substantial time-pressures but across all points of transitional care. A study on the perceptions among health care practitioners towards the implementation of a comprehensive medication reconciliation program shows the willingness of nurses to participate in the improvement of patient safety (Hassali et al., 2012).
Purpose of the Research
The aim of the research is to determine the most effective practices that can be used for improving medication safety across all points of transitional care. The research will help to better understand the complexity of the current medication management process as well as typical organizational failures leading to the occurrence of errors. The research will be instrumental in the development of a program for the integration of proper medication reconciliation protocols into all pertinent clinical processes and addressing the major implementation challenges, thereby ensuring safety and positive patient outcomes.
The review of the extant literature on the topic has helped to formulate the following research questions:
- Q1: What are the most effective strategies for the reduction of medication errors during the medication reconciliation process?
- Q2: Which health care professionals contribute the most to the homogeneity of medication history records?
These questions will help to understand all critical elements in transitional care that might facilitate the occurrence of discrepancies between prescriptions and other medication errors.
The following Essentials of Master Education in Nursing are aligned with the project: organizational and systems leadership, quality improvement and safety, translating and integrating scholarship into practice, interprofessional collaboration for improving patient and population health outcomes, and clinical prevention and population health for improving health (AACN, 2011).
The research project will help to address the issue of the extremely high rates of medication error occurrence across all points of transitional care. The project is aligned with five out of nine Essentials of Master Education in Nursing that are extremely important in graduate education.
AACN. (2011). The essentials of Master’ Education in Nursing. Web.
DelBoccio, S., Smith, D., Hicks, M., Lowe, P., Graves-Rust, J., Volland, J.,…Fryda, S. (2015). Successes and challenges in patient care transition programming: One hospital’s journey. OJIN, 20(1), 19-34.
Ferdandes, O., & Shojania, K. (2012). Medication reconciliation in the hospital: what, why, where, when, who and how? Healthcare Quarterly, 15(1), 42-49.
Hassali, M., Al-Hadda, M., Shafie, A., Tangiissuran, B., Saleem, F., Atif, A.,…Al-Qazaz, H. (2012). Perceptions among general medical practitioners toward implementation of medication reconciliation program for patients discharged from hospitals in Penang, Malaysia. Journal of Patient Safety, 8(1), 76-80.
Mueller, S., Sponsler, K., Kripalani, S., & Schnipper, J. (2012). Hospital-based medication reconciliation practices. Archives of Internal Medicine, 172(14), 1057-1069.