Iterative Interventions to Improve Admission Medication Reconciliation Completion Rates and Reduce Medication Errors at Post-Acute Care Facilities

Background Medication errors are common, especially during care transitions, and associated with adverse patient outcomes. Effective medication reconciliation is essential to prevent errors. Multiple medication discrepancies were documented on admission to the post-acute care facilities within a large academic medical center. These patients missed at least one dose of an important medication that was on their medication list from the discharging hospital. It was discovered that providers were inconsistently using the admission medication reconciliation (AdmMedRec) tool within the electronic health record. Methods Using failure mode and effects analysis, key contributing failures were identified in the existing AdmMedRec process. An interdisciplinary team was assembled to design and implement interventions using iterative Plan-Do-Study-Act cycles to improve AdmMedRec completion rates and reduce medication errors. We developed a standardized workflow, an educational curriculum, and a feedback mechanism to achieve these goals. Results AdmMedRec completion rate significantly improved from 13% to 87% in the inpatient rehabilitation facility and from 51% to 82% in the long-term acute care hospital in the four months after project implementation. Conclusions Our interventions significantly improved AdmMedRec compliance and reduced medication errors upon admission. Plain Language Summary When a patient is transferred from one hospital or facility to another, one important step in the hand-off process is admission medication reconciliation (AdmMedRec), during which the patient’s current medications are recorded and a healthcare provider reviews the list to determine whether to continue, hold, substitute, or discontinue each medication. Medication errors may occur during AdmMedRec, resulting in patients not receiving one or more doses of an important medication. There are many challenges to AdmMedRec, including low compliance rates and a lack of a defined process or formal training. When a large academic medical center noted multiple errors related to AdmMedRec, an interdisciplinary team investigated the causes and designed and implemented interventions, which were refined in rapid, iterative “Plan-Do-Study-Act” cycles. Through this improvement initiative, they introduced a standardized AdmMedRec workflow, developed education (including one-on-one training and a tip sheet), introduced an AdmMedRec dashboard in their electronic health record, monitored medication reconciliation status and proactively reached out to providers, and collected feedback. These comprehensive and collaborative efforts resulted in significant increases in AdmMedRec completion rates in the facilities in which these interventions were rolled out—as well as an anticipated decrease in the number of medication errors.