• A Nurse Driven Process to Improve Ambulatory Medication Reconciliation

      Barshick, Bryan L.; Bullock, Lynn (2022-05)
      Problem: Medication non-adherence is a complex and difficult problem for patients and health care professionals. Despite the benefit of medication review and reconciliation, fragmented outpatient visit processes result in medication lists not being reconciled between what is prescribed and what the patient is self-administering. Purpose: The purpose of this quality improvement project, was to improve outpatient medication review and reconciliation through the introduction of nursing in the reconciler role. Methods: Two outpatient clinical areas were selected for intervention. One caring for primary care/infectious disease patients and the other a surgical otolaryngology practice. Workflow changes to achieve the project objectives included, staff nurse education; establishment and instruction on the preferred workflow; Electronic Health Record (EHR) workflow enhancement; and the introduction of nursing into the role of reconciler. Throughout 15 weeks, overall reconciliation compliance, nurse attribution to that compliance, and post encounter medication list provision were all measured. Additionally, patient satisfaction was measured using a Press Ganey, CG-CAHPs survey. Results: Reconciliation compliance data at baseline was 81.5% for the primary care. An improvement to 93.9% at week 11 was demonstrated. Nursing attribution to that compliance fluctuated but demonstrated a high of 4.4% at week 4. Baseline compliance for the otolaryngology setting was 74.7% with an achieved 87.2%. The otolaryngology nurse attribution hit a high of 30.8% at week 6. The greatest change was seen with nurse exclusive encounters. From a novel start, a demonstrated 30-40% improvement was recorded within the primary care practice. The otolaryngology practice witnessed a 71.4% improvement. Demonstrated changes in patient satisfaction included a positive change of 5% in the primary care and a 7% improvement in the otolaryngology setting. Conclusions: Shared effort towards improved medication management, inclusive of nursing, can increase medication reconciliation compliance.