Medication Reconciliation at a Rural Primary Care Clinic

Abstract

Background Medication Reconciliation (MR) is the process by which healthcare providers collaborate with patients, caregivers, and families to ensure that an accurate and comprehensive patient medication information is communicated throughout the transitions of care. Local Problem A primary care physician clinic on the East Coast provided approximately 5700 patient visits annually. It was standard practice at the clinic to assess and treat patients without a formal medication reconciliation process. Interventions The MR quality improvement (QI) project was implemented in a 14 week period. The first four weeks were educational. The Plan, Do, Study, Act (PDSA) cycle was implemented in weeks 5 through 7, and the QI was fully implemented in weeks 8 through 14. The Medications at Transition and Clinical Handoff (MATCH) medication reconciliation (MR form) was used to document the patients’ current medications that were omitted from their Electronic Medical Record (EMR). The secretary printed a MR form along with the patient medication list, and placed them on a clipboard. The MR form was accessed through the MR folder added to the computer system. The patients reviewed their patient medication list, and added any medication that were omitted, or discontinued on the MR form. The MA’s reviewed the patient’s current medications and reconciled them with the clinics EMR. They highlighted the changes made on the EMR, and on the patients MR form for the provider’s approval. The MR form and patient medication list were placed in a clearly marked folder in a locked cabinet in the secretary’s office. The secretary printed an accurate medication list at checkout from the updated EMR, and encouraged the patients to carry the list to all appointments. They scanned the MR form and patient medication list into the clinics EMR, under the MR folder. The forms were shredded once completed. Results The QI project was implemented on a total sample (N= 343). Sixty-six percent of the sample population completed the MR form. The percentage of reconciled EMRs from the MR forms was 66 percent; an increase of 48.5 percent from baseline. An average of 1.3 medication discrepancies per participant was identified (N= 239), with 64.4 percent of participants experiencing at least one discrepancy. Sixteen-point-three percent were discrepancies of omission. A total of 49 (n= 49) sample observations were made to determine the percentage of the sample who received a copy of their updated medication list at check-out. Forty-seven percent of the observed sample received an updated medication list at check-out; an increase of 47 percent from baseline. Conclusions MR leads to an increased patient safety, and a higher quality of care. The results from this quality improvement project provides support for the implementation in other settings. However, patients with multiple over the counter medications increased interview time and had the potential for error. The DNP practitioner has an integral role in the partnership with the community in synthesizing and translating the evidence, and promoting education in compliance with their training.