2.50
Hdl Handle:
http://hdl.handle.net/10755/166378
Category:
Abstract
Type:
Presentation
Title:
Improving Inpatient Medication Reconciliation
Author(s):
Angiulo, Cindy
Author Details:
Cindy Angiulo MSN, RN-BC, Assistant Administrator, Patient Care Services at University of Washington Medical Center, email: cindya@u.washington.edu
Abstract:
HEALTHCARE ORGANIZATION DESCRIPTION: The University of Washington Medical Center is a 450-bed tertiary care academic medical center with a 5-state regional referral area and serves as a clinical teaching facility for local schools of nursing. BACKGROUND OF PRACTICE INNOVATION: Medication reconciliation is a National Patient Safety Goal and is a strategic process in the University of Washington Medical Center's (UWMC) goal of zero medication errors. As identified by The Joint Commission during a recent conference call on 1/31/08, this National Patient Safety Goal has proven difficult to implement across the United States. Historically at UWMC, data regarding patient medications were manually collected on three forms. In addition, nurses were duplicating information by entering their nursing admission history online in the clinical information system. The documentation process was complex, duplicative, and incomplete. The previous system involved multiple systems and forms for each patient which resulted in the lack of a single identified source of information. PRACTICE INNOVATION PURPOSE: To develop, implement, and evaluate an interdisciplinary performance improvement project to improve inpatient medication reconciliation. PRACTICE INNOVATION OBJECTIVES: (1) What electronic system for medication reconciliation could be developed to simplify the process and integrate information? (2) What percentage of patients have a completed medication reconciliation documented from time of admission at baseline and then monthly after process improvement implementation? (3) How effective will a "Stop the Line" approach be in an academic medical center? PRACTICE INNOVATION IMPLEMENTATION: This process improvement project included the following steps: (1) Simplifying the process: Integration of the information from the medication history, medication reconciliation, and admission orders into one document, which is available electronically to all care providers. All patients have a medication record form completed during outpatient visits. If the patient is admitted, these records are available electronically to the provider as part of admission orders or a new record can be completed. Medication information from the admission orders is electronically transferred to the inpatient and discharge forms. At each step the provider reviews and updates. (2) Education: A two-minute web-based education presentation was available to all providers with tailored, role-specific education for different specialties. (3) Compliance: Nurses are empowered to "Stop the Line" if medication reconciliation has not been accomplished within six hours of admission. (4) Feedback: Feedback on provider compliance individualized (by name) is sent to the nurse manager and medical service chief and chief resident weekly. PRACTICE INNOVATION OUTCOMES: The outcome measurements to evaluate effectiveness of the interventions were: (1) percentage of all admissions where medication reconciliation was completed, (2) medication errors, and (3) a subset analysis of the root cause of the medication error with specific focus on those aspects of the medication administration process that would be sensitive to this innovation. Medication reconciliation has increased from 24% (baseline) to 95% over a 10-month period. Seven services were deleted from weekly audits since they repeatedly demonstrated 100%. Analysis of medication errors and root cause analysis data is ongoing. The "Stop the Line" process had to be exercised on only two occasions during the 10-month process improvement implementation period. CONCLUSIONS: This interdisciplinary performance improvement initiative resulted in a 71% improvement in compliance with a National Patient Safety Goal and has the potential to decrease medication errors. In addition, this organizational innovation demonstrates the positive outcomes from a systemic interdisciplinary approach to improve performance across the continuum of care between inpatient, ambulatory care, and surgical settings.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2008
Conference Name:
ANCC Magnet Practice Innovations
Conference Host:
American Nurses Credentialing Center
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host for further details regarding this item.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleImproving Inpatient Medication Reconciliationen_GB
dc.contributor.authorAngiulo, Cindyen_US
dc.author.detailsCindy Angiulo MSN, RN-BC, Assistant Administrator, Patient Care Services at University of Washington Medical Center, email: cindya@u.washington.eduen_US
dc.identifier.urihttp://hdl.handle.net/10755/166378-
dc.description.abstractHEALTHCARE ORGANIZATION DESCRIPTION: The University of Washington Medical Center is a 450-bed tertiary care academic medical center with a 5-state regional referral area and serves as a clinical teaching facility for local schools of nursing. BACKGROUND OF PRACTICE INNOVATION: Medication reconciliation is a National Patient Safety Goal and is a strategic process in the University of Washington Medical Center's (UWMC) goal of zero medication errors. As identified by The Joint Commission during a recent conference call on 1/31/08, this National Patient Safety Goal has proven difficult to implement across the United States. Historically at UWMC, data regarding patient medications were manually collected on three forms. In addition, nurses were duplicating information by entering their nursing admission history online in the clinical information system. The documentation process was complex, duplicative, and incomplete. The previous system involved multiple systems and forms for each patient which resulted in the lack of a single identified source of information. PRACTICE INNOVATION PURPOSE: To develop, implement, and evaluate an interdisciplinary performance improvement project to improve inpatient medication reconciliation. PRACTICE INNOVATION OBJECTIVES: (1) What electronic system for medication reconciliation could be developed to simplify the process and integrate information? (2) What percentage of patients have a completed medication reconciliation documented from time of admission at baseline and then monthly after process improvement implementation? (3) How effective will a "Stop the Line" approach be in an academic medical center? PRACTICE INNOVATION IMPLEMENTATION: This process improvement project included the following steps: (1) Simplifying the process: Integration of the information from the medication history, medication reconciliation, and admission orders into one document, which is available electronically to all care providers. All patients have a medication record form completed during outpatient visits. If the patient is admitted, these records are available electronically to the provider as part of admission orders or a new record can be completed. Medication information from the admission orders is electronically transferred to the inpatient and discharge forms. At each step the provider reviews and updates. (2) Education: A two-minute web-based education presentation was available to all providers with tailored, role-specific education for different specialties. (3) Compliance: Nurses are empowered to "Stop the Line" if medication reconciliation has not been accomplished within six hours of admission. (4) Feedback: Feedback on provider compliance individualized (by name) is sent to the nurse manager and medical service chief and chief resident weekly. PRACTICE INNOVATION OUTCOMES: The outcome measurements to evaluate effectiveness of the interventions were: (1) percentage of all admissions where medication reconciliation was completed, (2) medication errors, and (3) a subset analysis of the root cause of the medication error with specific focus on those aspects of the medication administration process that would be sensitive to this innovation. Medication reconciliation has increased from 24% (baseline) to 95% over a 10-month period. Seven services were deleted from weekly audits since they repeatedly demonstrated 100%. Analysis of medication errors and root cause analysis data is ongoing. The "Stop the Line" process had to be exercised on only two occasions during the 10-month process improvement implementation period. CONCLUSIONS: This interdisciplinary performance improvement initiative resulted in a 71% improvement in compliance with a National Patient Safety Goal and has the potential to decrease medication errors. In addition, this organizational innovation demonstrates the positive outcomes from a systemic interdisciplinary approach to improve performance across the continuum of care between inpatient, ambulatory care, and surgical settings.en_US
dc.date.available2011-10-27T15:32:20Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T15:32:20Z-
dc.conference.date2008en_US
dc.conference.nameANCC Magnet Practice Innovationsen_US
dc.conference.hostAmerican Nurses Credentialing Centeren_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host for further details regarding this item.-
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