Medical Reports & Case Studies

A Quality Improvement Study's Findings on Medication Reconciliation Error Prevention

^*Correspondence: Rebeca Stones, Editorial Office, Medical Reports and Case Studies, France, Email:

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Introduction

Medication disclosure: Healthcare systems work to deliver competent care without causing additional harm. The numbers on pharmaceutical mishaps nowadays are startling. One method for addressing prescription errors and averting potentially fatal results is medication reconciliation. Dialysis patients see a variety of specialists and have several serious concomitant illnesses. Dialysis patients take an average of 19 tablets per day from an average of 4.7 prescribers. The best way to ensure that we don't cause any harm is to create an intervention that gives all medical teams access to a current health summary and medications. Our duty as healthcare professionals are to instil a culture of safety among our patients. Patients receiving home dialysis may have an average of 2-3 providers, some of whom may be located far apart from one another. The patients use several different drugs for various issues. Our patient segment is one that frequently travels and is also quite frail, putting them at risk for infections, falls, and the need for ER visits.

Available option

Electronic Medical Records (EMR) have made it possible for institutions and providers to better follow up with one another (collaborating systems). Sometimes it takes a long time for noncollaborating healthcare settings to obtain consent to share medical information. Apps for smartphones can help with some of these problems, but older, more frail people may find it difficult to use them because they require charging and some level of computer intelligence. The QI intervention addressing these issues is the Medication Wallet.

Measurement

We used a questionnaire-based survey to track the effects of the intervention; the results are reported below. Every six months, we also intend to review the patient records for follow-up.

Strategy

The QI measure was divided into three stages.

Phase 1: Finding peritoneal dialysis patients who will take part in this QI measure. (12/15) opted in.

Phase 2: Review of the chart to determine the severity of the issue Analyze the medications listed in the patient's EMR or dialysis record and compare them to any admission or discharge records or any hospital prescription lists that may be available. It was established whether medicine source was more accurate. Verification of medications with patients. There are mistakes in 95% of patents. In other words, during two physician visits, at least one medicine was either not listed or omitted.

Phase 3: Implementation of the intervention (Medication Wallet) and evaluation of its performance in facilitating medication reconciliation.

To determine the effectiveness of this intervention, a questionnairebased survey was conducted at the beginning of each clinic appointment.

Wallet

We designed the wallet as a tool that the patient may carry with them at no extra cost or discomfort. The wallets cost about $10 each, and they were bought from online retailers. The dialysis facility contributed the money. In order to manually record the information, we intended to convey, blank visiting cards and index paper were employed. Due to the fact that we did not have many patients at this point, it did not take long. We intend to print out pharmaceutical labels as a future step in our expansion. Every team member has the ability to easily update the wallet once it has been built. If the patient was able, we also encouraged him or her to update the wallet, along with our nurses and the patient's healthcare companion.

Medication wallet's content

• Details on the patient and care buddy (with phone number). Allergies, current code (if DNR).
• Information about a Dialysis Center (name, address, phone number and fax number).
• Dietician, Social Worker (with phone number and/or email), Nurse Practitioner, Registered Nurse, and Nephrologist.
• Primary care physician and pharmacy (with phone numbers).
• Patient prescription for dialysis (type of dialysis, PD catheter placement date and surgeon, dialysis start date, type of cycler if cycler is used).

Medical history

1-4 medications per page, including dosage and frequency information

Immunization history

ID cards, credit cards, cash, and insurance cards all have spaces.

Results

Limitations and Lessons

We intended to add a pocket diary, a wallet, or an app for the patient to carry on their person at the beginning of the project as a quality improvement measure and as a patient safety tool. Simple information on his or her medications, a prescription for dialysis, and the phone number for his or her primary care physician were to be included in the journal or app. The patient, nurse, pharmacist, or doctor could review and update this diary/app. It could be used as a tool to reduce drug omissions, hasten care transitions, and facilitate communication among different caregivers. It could act as a reminder for the patient and provide him/her greater control over how to take care of their medical requirements. The wallet, however, won the patient's selection and the journal was set aside. Since we needed to act quickly, we introduced the wallet because we were unable to finish the app in time. The software is still under development and could be useful for people who are more tech adept.

The intervention was viewed favourably by all patients and their medical professionals, who recognised the value of the wallets. Both patients and doctors have expressed their support for this project in a variety of positive ways. The wallet wasn't always carried by patients (typically when a caregiver was present), and even after evaluating its contents and making medication modifications, other doctors didn't update their records. The patients sometimes forgot to tell their other medical professionals about this information. As there were only so many cases, our sample size was tiny.

The starting dialysis prescription was one of the many details in our initial design that we later decided was simply too much information to carry. We made an effort to make this useful by just including current prescription. Both the wallet's wear and tear and the possibility of losing the wallet raise concerns. No one in this group has misplaced a wallet thus far, and we intend to purchase additional wallets to replace worn-out ones as necessary. The most recent batch has a shelf life of around a year. One patient removed the central piece of the wallet and attached it to his own preferred wallet because he did not like the wallet's cover. Overall, since he still has all the necessary information on him, nothing has altered regarding the outcome of his wallet. Every time a patient comes in, we try to explain to them the value of updating their wallet. We are informing healthcare professionals about our drug reconciliation initiatives through grand-round presentations, articles, and poster presentations. We intend to make it available to all of our patients and promote its use at other facilities.

Conclusion

The likelihood of medication errors and the related negative effects can be significantly reduced by accurate reconciliation. Patients with end-stage renal illness use the healthcare system heavily, necessitating communication across various clinicians and healthcare systems. Patients on dialysis run a higher risk of becoming polypharmacy (average of 12 medications per patient in our home dialysis clinic). Our findings demonstrate the value of the Medication Wallet as a tool for medication reconciliation. We now estimate a considerable drop to 100% right drugs at hospital admits when the patient made available their wallets to admitting providers, and 70% correct list at discharge, from prior estimated medication reconciliati on mistakes at 95%. We are still working to educate healthcare professionals and people on how to use this intervention effectively. For our patients, this has proven to be a cheap and useful solution. We believe this to be sustainable, and the dialysis centre is encouraging us to expand the programme to include all dialysis patients. This was more of a pilot research, and we are hoping that its extension will allow us to monitor its durability.