001 - Avoiding a "Med Wreck": A QI Project Optimizing the Medication Reconciliation Process to Reduce ADEs on the Pediatric Hospital Medicine Service

Publication Number: 1.3655

ADAM YAZBECK, Children's Hospital Colorado, Centennial, CO, United States; Kathleen G. Brimsek, University of Colorado School of Medicine, Centennial, CO, United States; Mollie Kempa, Children's Hospital Colorado, Aurora, CO, United States

Background: Medication Reconciliation (Med Rec) is the process of reviewing a patient’s home medications and deciding which to continue during a hospital admission. On the Pediatric Hospital Medicine (PHM) service at our three freestanding children’s hospitals, compliance with this process was 43%, and leading cause (46%) of all adverse drug events (ADEs) prior to this project. As part of this quality improvement (QI) project, manual audits found 36% of patients had an unreported error or omission, with one-third of these errors related to high-risk medications. Additionally, ADEs related to Med Rec are costly, estimated around $5,000 per incident, costing the PHM service roughly $275,000 annually.

Objective: To increase Med Rec compliance from 43% to 70% on the PHM service and reduce ADEs related to Med Rec by 50% by the end of third quarter 2024.

Design/Methods: Using Lean methodology and 6-Sigma principles, we engaged in a one-year QI project with two PDSA cycles. Our initial interventions included targeted education to PHM providers/residents, and increased communication between pharmacists and providers supported by change management principles. Our second cycle involved the creation of a best practice advisory (BPA) within the electronic medical record (EMR) to notify providers of an incomplete Med Rec prior to placing new orders. We evaluated compliance with the creation of an automated data collection dashboard within the EMR, and assessed ADE data alongside our Patient Safety team.

Results: Compliance on the PHM service increased from baseline to 64% following our initial interventions, then decreased to around 55%. Following the implementation of the EMR BPA during the second cycle, compliance increased to greater than 85% within the study period (Chart 1). Although not initially within the scope of this project, compliance across the entire system for all admitting departments increased from 40% pre-intervention to 65% following the BPA. Occurrence of ADEs related to Med Rec on the PHM service reduced from 46% to 15%, a decrease of 67% post-intervention.

Conclusion(s): Although literature often highlights best practices for Med Rec as involving pharmacy technicians or primary ownership by pharmacists, this is costly, time-intensive and may be limited by staffing restrictions. Implementation of an EMR BPA, paired with pharmacy partnership and education, have the potential to greatly improve Med Rec compliance without requiring additional resources. Future directions include continued work to improve the EMR Med Rec interface to make it more user-friendly and partnerships with admitting departments beyond PHM.

Run Chart: Inpatient Hospital Medicine Service
Inpatient run-chart.pdfPercent compliance on PHM service pre-intervention and post PDSA cycles.

Run Chart: Inpatient Hospital Medicine Service
Inpatient run-chart.pdfPercent compliance on PHM service pre-intervention and post PDSA cycles.