Recently, medication reconciliation has been on the rise as a health intervention process for decreasing the errors committed while administering care. As postulated by the Centers for Medicare and Medicaid Services, this is a very important process in the Acute Care environment with potential implication in the wellbeing of patients. The overall method includes the identification of the entire treatment process, taking into consideration the patient’s prescription, name, and the type and frequency of medication among others. Some of the professionals that facilitate the efficiency of the medication reconciliation process are the nurses, pharmacists, and physicians. The role assumed by the nurses in the admission section of the process entails collecting and entering personal medical data into the electronic medical record. It is imperative for them to ascertain the accuracy of the information and enter that timely and correctly in the records. Moreover, the inclusion of the electronic medical record is yet to solve the documentation challenges associated with the medication reconciliation. However, the medication process has become more transparent than ever. This research proposal examines the level of knowledge of nurses as well as the knowledge retention potential regarding the admission medication procedure at three points in time in an educational intervention. The proposal will use a survey method to measure the ability of care providers to retain knowledge at the third point in time as well as collect additional data including demographics. The barriers perceived by nurses about the admission medication process have also been identified. The information obtained from this proposal gives the organization and administrators proper guidance to support the duties of nurses in the admission reconciliation process.
Admission Medication Reconciliation
Medication reconciliation is a procedure used to review and reconcile the current medications of patients with their admission, transfer, and discharge process. According to the Centers for Medicare and Medicaid Services, this is a very necessary step in the Acute Care environment as it influences welfare of patients. The system insists that the patients’ names and prescriptions must be collected to record the information about the types and frequency of medication. Nurses, pharmacists, and physicians are the professionals that facilitate the efficiency of the medication reconciliation process. The data is then entered in the electronic medical record. Before this step, the nurses must ensure the accuracy of the collected information. Though the electronic medical records have many advantages, documentation challenges are still haunting this technological tool. Yet, these records are easy to access and they offer a transparent medication process. The purpose of the process is to prevent the occurrence of errors due to drug interactions, medication errors, duplications or even omissions. A comprehensive completion of the reconciliation process is useful in ascertaining whether the patients receive correct prescriptions on admission, transfer and discharge process. However, in spite of the technology advancement and implementation of the electronic health records, there are still numerous factors that impact the medication reconciliation process, such as the use of technology and issues from the various disciplines.
This research proposal will allow the assessment of the knowledge retention capacity of nurses over a given period of the admission medication reconciliation and identify the barriers encountered by the nurses.
The scope of this research proposal focuses on the role of nurses in the medication reconciliation process on the admission of patients. A registered nurse (RN) is endowed with the duties of admitting patients, as well as collecting and recording the various medications used by patients at home. Hence, the care provider records the list of home medication in the electronic medical record, and this is the primary step that sets the pace of the medication reconciliation for the admission process. Therefore, the role played by the nurse is just one of the numerous elements involved in reducing the healthcare errors prompted by the admission medication reconciliation process. For instance, the home prescription list entered in the electronic record by the nurse is yet to go through a complete change from the moment of the implementation of the new EMR system. Meanwhile, it is essential for nurses to understand the importance of medication reconciliation and its relationship with patients’ well-being and quality outcomes.
The specific aim of this proposal is clarified in the following research question and objectives.
Research Question: What is the effect of medication reconciliation on highly vulnerable patients experiencing the transition of care in the ED?
Primary Objective: To determine the effect of medication reconciliation on highly vulnerable patients experiencing the transition of care in the ED.
Alternative Hypothesis: There is a difference between the outcome of the medication reconciliation process carried out by experienced and competent registered nurses compared to one that is undertaken by not so qualified professionals.
Null Hypothesis: There is no difference between the results of the medication reconciliation process carried out by competent and incompetent professionals.
The first assumption is that the patients will provide accurate data concerning their home prescriptions. The nurse will depend entirely on the patients to provide or rather share such critical information within the shortest time possible. The other assumption is that the nurses will collect the home medication data with the intention of entering correct data into the system.
This study is not without limitations. The first limitation is the inability to assess the knowledge of nurses pertaining to the medication reconciliation process. The other limitation is the frequency of medication error rates associated with the medication reconciliation process. The staff reports the errors as they occur and there is an assumption that healthcare errors linked with the admission medication reconciliation process are identified and reported.
Statement of the Problem
The medication reconciliation has been used at an increasing rate with aim of reducing the mistakes that often occur while administering care. The Centers for Medicare and Medicaid Services projects it as a very imperative process in the Acute Care environment that ensures the wellbeing of patients. The identification of the medical history including the patients’ prescription, their names, type of medication and frequency is essential for the procedure. Medication reconciliation is perceived as a significant part of the national safety goals established by the Joint Commission of nurses that maintains and conveys accurate data regarding patient medication information. Hence, the Joint Commission (2014) perceives the medication reconciliation as the best method in achieving its goals.
Additionally, the commission states that an effective medication reconciliation process wants the nurses and other medical practitioners to understand the patients’ prescriptions. The process should be completed during the admission and discharge stages, but most importantly during the admission time since most of the healthcare errors occur and accumulate in the hospital before discharging the patient. Several studies have supported the concept of medication reconciliation as an integral step in preventing medication errors during the discharge period. Indeed, this is significant during the discharge process too, considering that throughout the admission and discharge procedures several mistakes are likely to surface. Actually the absence of the medication reconciliation process accounts for approximately forty-six percent of all the healthcare errors and nearly twenty percent of adverse drug incidents in the hospital environments.
Review of the Literature
The scope of this study focuses on the role of nurses in the medication reconciliation process on the admission of patients. The registered nurses (RNs) are in-charge of admitting patients and collecting and recording the list of medicines used by patients at home in the electronic medical record. This is the primary step in the medication reconciliation for the admission process.
In a study conducted by Van den Bemt et al (2013) a review of the records of one hundred and fifty-one patients created by pharmacists on admission is taken up and this revealed that about 54% illustrated a single discrepancy in the medication reconciliation process. Another study conducted by the same authors revealed that among 3755 patients, 67% had experienced some medication errors. Definitely, many different studies explore the subject of medication reconciliation, healthcare errors, and electronic medical records. For instance, the study conducted by The Joint Commission (2014) states that patients whose medical information had been obtained during the admission process showed a statistically substantial reduction in errors. Furthermore, the findings by the California Department of Public Health (2014) unveiled that electronic healthcare records are valuable in ensuring the completion and accuracy of the documentation by the care providers. The literature affirms the need for the nurses to understand the importance of the medication reconciliation and its relationship with patients’ well-being and quality outcomes.
The Quality-Caring Model shall be used as a guide in this project. One of the purposes of developing this model is to integrate the role and duties of nurses into an objective form that could be practically tested. The model assists care providers to achieve quality and positive results for the patients based on the manner they administer their professional practices. Furthermore, the model contains various components which generate several implications for the nurses practicing at the bedside, nurse educators and administrators. This method assists those who work at bedside in bringing back the focus of the patients and nurturing a relationship that integrates caring as a cord throughout all the medical intervention procedures and assessments. It is imperative for the nurse educators to incorporate the need for a caring attitude into the competency and skill evaluations. The model also influences the nursing administrators since they are endowed with the responsibility of developing a culture for nurses to conduct their practice in a particular manner.
This study will use retrospective data collection and data collection using survey. The retrospective data collected on medication errors will be associated with admission medication reconciliation process. Together with that, retrospective pre and post test data related to the admission medication reconciliation will be collected. The survey will include several questions regarding; demographic data, knowledge pertaining to the admission medication reconciliation knowledge and interrogations concerning the barriers to the admission medication reconciliation process. The pre-test, post-test, and survey will be examined by an expert before their use. Participation in the survey will be controlled and confidential.
The study will be conducted in a medium sized acute care facility in the State of California. The facility has an authorized bed capacity of 269 beds, with about 120 patients seeking services every day.
Population and Sample
The participants of this proposal will be selected using a sampling technique. Approximately 600 nursing staff at an acute care facility will be surveyed. The inclusion criterion for the participants is the frequency of attendance during the course on the admission medication reconciliation process. The list of nurses attending the education program will be collected from the tracking software installed in the education departments. Staffs that will not complete a pretest and posttest will be excluded from the sample. The target population will approximately contain 420 staff nurses.
The study will be approved and certified by the Institutional Review Board at the Campus. Also, the project will be reviewed by the Research Department situated in the study hospital. Data collected and stored electronically will be password-encrypted, while paper data sources will be kept in locked cabinets and destroyed after the data analysis process.
Data Collection Procedure
A survey questionnaire will be distributed to the nursing staff in every department. The participation is voluntary and confidential. The responses collected from the survey shall be entered into an SPSS data set.
Proposed Data Analysis
SPPS is the proposed software for performing data analysis. The analysis will comprise descriptive statistics.
Applicability to Nursing Practice
This research proposal is essential in allowing the assessment of the knowledge retention of nurses over a given period pertaining to the admission medication reconciliation. The study also helps in identifying the barriers encountered by them in ensuring the effectiveness of the process. The findings collated by the various research studies affirm the significance of the admission medication reconciliation process in minimizing medication errors. Hence, more studies in the field will certainly improve the provision of healthcare services.
California Department of Public Health. (2014). Medication error reduction plan (MERP) program. Retrieved from: http://www.cdph.ca.gov/programs/LnC/Pages/MERP.aspx
The Joint Commission. (2014). 2014 Hospital National Patient Safety Goals. Retrieved from http://www.jointcommission.org/assets/1/6/2014_HAP_NPSG_E.pdf
Van den Bemt, P.M.L.A., Van den Scherieck-de Loos, E.M., Van der Linden, C., Theeuwes, A.M.L.J., Pol, A.G. (2013). Effect of medication reconciliation on unintentional medication discrepancies in acute hospital admissions of elderly patients: A multicenter study. Journal American Geriatrics Society 61(8), 1262- 1268