(1286) Avoiding a "Med Wreck": Driving Change and Improvement Within the Medication Reconciliation Process

Introduction: Medication reconciliation (Med Rec), is the process in which a patient's outpatient medications are reviewed and then subsequently determined which, if any, will be continued and/or substituted during the inpatient admission. Currently there is no universal process for how this is completed across institutions. Adverse drug events (ADE’s) related to Med Rec contribute to significant patient harm annually across all healthcare systems. Roughly 1% of all admissions experience an ADE related to Med Rec with an estimated cost of $5,000 per event. In the Pediatric Intensive Care Unit (PICU) at Children’s Hospital Colorado, the baseline Med Rec completion rate was 35% and was the single leading cause (~50%) of ADE’s related to medication ordering. Prior studies have shown a reduction in Med Rec errors when pharmacy technicians complete medication histories upon admission. In the current healthcare environment with limited staffing resources, novel and efficient solutions must also be considered. Thus, the PICU implemented changes to its Med Rec process with goals of increasing compliance and reducing related ADE’s.

Methods: The PICU implemented a patient/family medication history form, in both English and Spanish, for patients and caregivers to review home medications in conjunction with a provider or nurse upon admission. Additionally, the electronic medical record (EMR) was updated to increase visibility with compliance across disciplines and Med Rec completion was discussed on PICU multidisciplinary rounds with additional pharmacist oversight. Education and training was provided to nurses, providers and pharmacists regarding the process improvements within the EMR and to share the impact Med Rec has on family-centered care and patient outcomes.

Results: Compliance in the PICU increased to 70% within a few months of implementation and has remained at this threshold. Consequently, the PICU also saw a 75% decrease in ADE’s related to Med Rec in the twelve months following initiation of this project.

Conclusions: Implementation of novel interventions to Med Rec in our PICU has led to improved Med Rec compliance and reduced associated ADE's. Non-compliance is a patient safety concern system-wide and the introduction of novel solutions as demonstrated in our PICU may aid in tackling the wider issue.