An Impact of Evidence-Based Practice of Medication Reconciliation on Professional Nursing Practice - Research Paper Example

Medication reconciliation Student’s name Institution Royal Children’s Hospital Melbourne, Paediatrics, primary clinical focus in primary, tertiary care, and prevention programs The focus of the Med-SLA project is to establish weaknesses of medication reconciliation procedures and how these may be made better The intervention proposed is the making of medication reconciliation a clearly set out process which all professionals are required to adhere to Vulnerabilities in safety procedures due to issues such as patient lack of knowledge and lack of integration of records in the continuum of care make it necessary to have well set out procedures of medical reconciliation This intervention will prevent adverse drug events; reduce errors of omission, drug disease interactions, and drug –drug interactions Approval to conduct the Med-SLA was obtained from the Graduate transition coordinator who also approved the topic of study. Medication Reconciliation Guide for Nurses and Physicians Leadership Responsibility Accountability Accurate medication history Medication review and reconciliation Medication action plan Medicines information to consumers Ongoing access to medicines (discharge reconciliation) Communication medicines information Evaluation Royal Children’s Hospital Melbourne I have been practicing nursing for the past two years at the Royal Children’s Hospital in Melbourne. I work in the paediatrics department and I am involved in the provision of health care under different aspects of care. However for much of my time at the hospital I have been involved in tertiary care and prevention programs. The hospital is one of the largest paediatric hospitals in the state and hence serves a very large number of patients. It has been established that the potential for error increases by up to 3% points for every increase of a 1000 patients in the hospital (Bates et al, 2007, P. 307-311). Working in both primary and tertiary care I have from time to time come to deal with errors in medications which were as a result of ineffective reconciliation. Prevention programs are also influenced to a great deal by errors in medication reconciliation. In my time at the hospital I have established that errors of medication reconciliation and filling of charts and administration have in some instances resulted in adverse events. Tertiary care is also a focus of my practice which calls for effective medication reconciliation if it is to be effective. Rizach et al, (2004, P. 5-14) established that the effectiveness of tertiary care is influenced by up to 27 % by the effectiveness of medication processes undertaken in primary care. The Royal Children’s Hospital Melbourne while a hospital renowned for the quality of its paediatric care, still needs to fine tune it medication reconciliation practices in order to be more effective. Purposes and Aims of the Medication Reconciliation The Australian Commission of Quality and Safety in Health Care guidelines and safe nursing practice asserts that patients, carers, clinicians and non clinical staff all have a role to play in ensuring effective medication practice (ASQS, 2013). This paper seeks to establish the role of the clinicians towards ensuring that medication reconciliation which is a critical part in reducing adverse medication events is enhanced. Safety vulnerabilities in medication call for medication reconciliation at all stages of health care (Mayo & Duncan, 2004, p. 209-217). This paper will aim at an analysis of the importance of integration across the health setting continuum, patients’ lack of knowledge regarding medications and nurse and physician workflows. A study conducted by Kohn et al (2010) established that 25% of medications that are used at home did not appear in hospital records. This lack of inventory may be attributed to the physician and nurse workflows and also incomplete records offered by the patient or their pharmacists. Reconciliation is in some instances disregarded in emergency situations. For instance patients requiring immediate surgery or hospitalization may have their regular medications stopped or disregarded. In the ambulatory setting it has been established that there were discrepancies in 26.3% of patient charts that needed renewal of prescriptions (Gleason et al, 2004, p. 1689-95). Most ambulatory settings did not conduct a reconciliation process with the patient. Bayley et al (2005) found that altered doses, omission of orders and incomplete allergy histories were discrepancies present in up to 38% of the hospitalized patients in the study. According to Hughes et al (2008) nurses found the process of clarifying medication orders on transfer, determining medications which were being taken at home, and ensuring accurate discharge of medication orders to be tedious and time consuming. The lack of centralization of records is a factor which may result in the process of medication reconciliation being tedious and time consuming. Admissions between hospitals and skilled nursing facilities resulted in over 65% discontinuity in medications Greenwald & Halasyamani, (2010, p. 477-485). Medication histories may be enhanced through electronic health records. Computer generated records are found to be effective by up to 43% if data is inputted correctly (Lau et al, 2010, p. 597-603). A centralized record with information from all members of the team will ensure better outcomes. Impact on my Nursing Practice Evidence based practice as aforementioned will have a great impact on my professional nursing practice. The instance of the effectiveness of medication reconciliation means that it has to be made into a process. Ernst et al (2011, p. 2072-2075) reported that the implementation of reconciliation standards improved medication by up to 75%. As such the process will be defined through a three step process; verification of a list of medications; clarification of the appropriateness of dosages and medications and reconciliation of any changes. Team roles and responsibilities need to be clearly set out. I do believe that I would have to ensure that I have knowledge of my roles and responsibilities in the medication reconciliation process. Standardization of the process of medication reconciliation would mean that the occurrence of medication errors is greatly reduced (Cohen & Smetzer, 2007). Standardization of processes and procedures would make it easier for my practice since I would have knowledge on what has been administered and what needs to be administered. Time frames for completionn of tasks would come in handy since the tediousness and time consuming nature that nurses report would be minimized. A trade off would have to be found between taking too much time on reconciliation and the need to enhance effectiveness (Vira et al, 2006, p. 122-6). My professional practice would be enhanced through the implementation of a monitoring process such as computerized data input that would ensure I have all necessary information before medication administration. Lastly this intervention would call for my practice to involve patients and carers as advocates in the provision of accurate histories and medical records on medications. Process of the Med-SLA Medication reconciliation is a term referring to the comparison of a patient’s medication orders to what they are or have been taking. The process of carrying out this was done through a literature review of the terms related to medication reconciliation. Terms such as medication errors, medication reconciliation, medication systems, medication verification and medication safety were used to search medical databases such as PUBMED and CINAHL. Health care literature starting from 2000 to 2007 was reviewed in addition to clinical websites on safety standards such as Australian Commission of Quality and Safety in Health Care guidelines and safe nursing practice, Institute for Health Care Improvement and Institute for Safe Medication Practices. Articles on medication reconciliation were a valuable source in the identification of relevant journal articles. Articles based on studies conducted were also consulted in seeking a methodology of the Med-SLA at Royal Children’s Hospital Melbourne. Studies identifying the different aspects of the health continuum such as transfer between facilities, home care, and discharge were consulted. These offered a base and a theoretical foundation on which medication reconciliation analysis was conducted. Consent was obtained from the authorities of the hospital in order to conduct a research to find out the extent to which evidence based practice was consistent with theory. Research was conducted through questionnaires and observation of records of nursing practice. This was then correlated to the evidence based theories that had been collected before. Potential Outcomes of Medication Reconciliation Medication errors are the most common of errors related to patient safety occurring at least once a day. Approximately 45% of reported errors are due to ineffective medication reconciliation in the process of admission, transfer and discharge of the patient (Manley et al, 2013, p. 231-239). Of the errors reported approximately 25% could have been avoided if proper medication reconciliation processes had been put in place. If medication reconciliation were to be undertaken at Royal Children’s Hospital Melbourne it would be of great help in revaluating, accessing and improvement of medication outcomes. The intervention will reduce adverse drug events; reduce errors of omission, drug disease interactions and drug-drug interactions. The hospital which offers paediatric care would be ain a better position to offer more effective care through a continuum of care that includes a process of medication reconciliation. Medication reconciliation may be easier accessed reviewed and evaluated in future if it were to incorporate a process system as proposed (Miller et al, 2012, p. 421-9). Such a system which ought to be centralized would ensure ease of access to information. This would ensure that adverse effects brought about by lack of information due to inaccurate patient histories are minimized (Bedell et al, 2010, p. 2129). Appropriate drugs would thus be administered to the patients that need them. This would make nursing practice more effective while also making the hospital more effective in achieving its purposes of health care provision. Bibliography Australian Commission on Safety and Quality in Health Care. National Recommendations for User-applied Labelling of Injectable Medicines, Fluids and Lines. www.safetyandquality.gov.au/our-work/medication-safety/user-applied-labelling/ Bates DW, Spell N, Cullen DJ, et al. The costs of adverse drug events in hospitalized patients. JAMA. 2007;277:307–11. Bayley KB, Savitz LA, Rodiquez G, et al. in patient safety: from research to implementation. 3 . Rockville, MD: Agency for Healthcare Research and Quality; 2005. Barriers associated with medication information handoffs. AHRQ Publication No 050021–3. Bedell SE, Jabbour S, Goldberg R, et al. Discrepancies in the use of medications. Arch Intern Med. 2010;160:2129. Cohen, M & Smetzer, L. (2007). Medication Error Reporting Systems. 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Reconcilable differences: correcting medication errors at hospital admission and discharge. Qual Saf Health Care. 2006;15:122–6. Read More