Authors (including presenting author) :
Shek MK (1), Lui WK (1), Ng YB (1)
Affiliation :
(1) Medical and Geriatric, United Christian Hospital
Introduction :
Adverse drug effect of erroneously use of medications remain a factor lead to unplanned readmission to Emergency Department and prolonged hospitalization of patients. Nurses should Perform an accurate medication reconciliation as gatekeeper between patients and physicians. Standardized Medication Reconciliation has been carried out in Acute Medicine Ward 9B since 2016. A standardized procedures and checklist designed and integrated into existing workflow. No related significant medication error noted after the implementation. It is ready to move onto the next and advanced step. Besides mechanical procedure checklist, promoting critical thinking of staffs is crucial for any medication safety enhancement measures and its sustainability. A safety culture would be cultivated in the long run.
Objectives :
1. Enhance critical thinking of nurses in Medication Reconciliation
2. Increase commitment of nurses in medication safety
3. Linking medication reconciliation with other initiatives
4. Cultivate medication safety culture
Methodology :
Eliminate erroneous discrepancies is utmost important purpose of Medication Reconciliation. A clear and easy to understand algorithm of critical thinking process was established and demonstrated for identification of discrepancies of prescriptions and determining whether a clarification is needed. Discrepancies were classified into 3 categories: Category 1, medications prescribed during in-patient are exactly the same of prior prescription and no amendment upon discharge. For examples, long used Metoprolol dosage is continued during stay and upon discharge. Thus, NO clarification required. Category 2 (Purposeful Discrepancy), Discrepancies exist but are appropriate based on documented treatment plan. For examples, Increased Amlodipine dosage for achieving better hypertension control. Thus, NO clarification required. Category 3 (Unintended Discrepancy). Discrepancies without support from clinical condition or care plan. For examples, Aspirin for atrial fibrillation was omitted upon discharge without clear reasons. Physician must be clarified with to prevent error. Case scenario published on KEC Quality & Safety Bulletin about medication reconciliation was kept highlighted and presented to staffs.
Result & Outcome :
Enhanced competency in handling complex medication lists of patients are expressed by preceptees when follow the algorithm. Staffs all agreed Unintended Discrepancy could be easily discovered by applying systematic process of medication reconciliation. Majority of patients / relatives with complex medication regime encountered agree that nurse-led medication reconciliation aided them in handling amended complex prescription and feel more safe and confident. Professional image of nurses is affirmed. Gratefully, the program was shortlisted in the KEC Employee Suggestions Award Program. Prospectively, the program would be further advanced and promoted for greater success of patients.
Co-location with:
