Medication reconciliation completed by pharmacy on admission from the ED
View File(s)
- Author(s)
- Details
-
Lauren Humiston, BSN, RN, CEN; Rachael Duncan, PhramD, BCPS, BCCP; Nancy Fry, BSN, RN
- Sigma Affiliation
- Non-member
Visitor Statistics
Visits vs Downloads
Visitors - World Map
Top Visiting Countries
Country | Visits |
---|
Top Visiting Cities
City | Visits |
---|
Visits (last 6 months)
Downloads (last 6 months)
Popular Works for Humiston, Lauren by View
Title | Page Views |
---|
Popular Works for Humiston, Lauren by Download
Title | Downloads |
---|
View Citations
Citations
Purpose: Medication reconciliation should be performed at all transitions of care according to the Institute for Healthcare Improvement and AHRQ Patient Safety Network. A recent systematic review on errors in medication history at admission estimated that 54-67% of all admitted patients have at least one discrepancy between the medication history obtained by the admitting clinicians and the actual preadmission regimen and that, in 27-59% of those cases, such discrepancies have the potential to cause harm. This project aimed to assess the accuracy of a newly implemented pharmacy-driven admission medication reconciliation service based in the ED.
Design: This was a quality assurance project done to assess the accuracy of medication histories enterered into the EHR on patients being admitted from the ED. Prior to implementation of the pharmacy pilot, nursing staff completed medication histories. The pilot put certified pharmacy technicians in the ED, working to capture medication histories on patients being admitted. Technicians were overseen by the ED Pharmacist, who checked all medication lists for accuracy and follow-up.
Setting: This quality assurance study was completed in the emergency department at an urban level 1 trauma center.
Participants/Subjects: All ED staff participated in this project. Pharmacy technicians and ED pharmacists were assessed for the quality assurance project.
Methods: A randomly selected group of 50 patients being admitted from the ED was assessed over a one week period prior to implementation of the pharmacy pilot. Medication histories were collected and recorded in the EHR by nursing staff. Upon completion a pharmacist conducted an independent medication history on each patient and then compared the results for accuracy. During the pilot, medication histories were collected and recorded in the EHR by pharmacy technicians and pharmacists. An identical assessment of accuracy was performed with technicians completing the medication list and a pharmacist checking.
The number of total inaccuracies on the medication list were totaled for each patient studied. Inaccuracies were further defined as an omitted, incomplete, and incorrect medication. High-alert medications (defined via the ISMP definition) were identified and assessed for accuracy.
Results/Outcomes: Results of the assessment showed that 19% of the medication histories completed by ED nursing staff pre-pilot were accurate. 33 of the 50 patients studied were taking at least one high-alert medication (opioids, anticoagulants, insulin and oral hypoglycemics, antineoplastics) identified as inaccurate. When the same assessment was completed on another 50 patients completed by the pharmacy staff overall accuracy increased by over 80%. There were no inaccuracies in this group associated with high-alert medications. Physician and nursing satisfaction were measured both pre- and post-pilot, finding a significant increase in both following the implementation of the pilot.
Implications: Medication reconciliation completed upon admission from the ED is most accurately completed by pharmacy rather than nursing staff. This is likely due to the many high-level tasks and charting that nurses must complete and an inability to focus dedicated time and energy to the medication list. Pharmacy technicians and pharmacists located in the ED are in a prime position to see that an accurate admission medication reconciliation is completed in a timely manner.
ENA 2017: Education, Networking, Advocacy. Held at America's Center Convention Center, St. Louis, Missouri
Items submitted to a conference/event were evaluated/peer-reviewed at the time of abstract submission to the event. No other peer-review was provided prior to submission to the Henderson Repository, unless otherwise noted.
Type | Poster |
Acquisition | Proxy-submission |
Review Type | Abstract Review Only: Reviewed by Event Host |
Format | Text-based Document |
Evidence Level | N/A |
Research Approach | N/A |
Keywords | Medication Reconciliation; Quality Assurance; Emergency Department |
Name | Emergency Nursing 2017 |
Host | Emergency Nurses Association |
Location | St. Louis, Missouri, USA |
Date | 2017 |
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
All permission requests should be directed accordingly and not to the Sigma Repository.
All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Related items
Showing items related by title, author, creator and subjects.
-
Implementation of an opioid reduction protocol utilizing alternatives for the treatment of pain in the emergency department of a level 1 trauma center
Duncan, Rachael; Fry, Nancy J.; Maguire, Michelle (2017-12-04)Purpose: Pain is the number one reason for emergency department visits in the United States. Many ED physicians find it quick and effective to prescribe opioids for patients that present complaining of pain. In many cases, ... -
Improving ScannED medications
Cothran, Amanda; Harmon, Nicholas; Smith, Kevin Jr. (2017-12-04)Purpose: Barcode medication verification has been proven to be an effective safety measure to help prevent errors during medication administration. It is necessary to provide safe medication administration to ensure quality ... -
Sepsis standoff
Fry, Nancy J.; Miller, DanaPurpose: With an increasing number of patients being diagnosed with sepsis there was a need for increased awareness, improved education strategies, and updated initiatives at this level 1 trauma center to decrease mortality ... -
Impact of protocol driven provider order sets on patient mortality and bundle compliance
Fry, Nancy J.; Cotter, SamanthaPoster presentationSession D presented Monday, September 30, 2:30-3:30 pmPurpose: With an increasing number of patients being diagnosed with sepsis, there was a need for increased awareness, improved educational strategies, ... -
Using the EBP sepsis bundle to decrease ED mortality
Skaggs, Mary Kate Dilts; Hodge, Angela J. (2017-12-04)Purpose: Sepsis is the leading cause of death in non-coronary intensive care units and the tenth leading cause of death in the United States overall. One in one-hundred eighty five Americans were expected to be ...