A Quality Improvement Project: Resident Engagement with the Medication Reconciliation Process [8O]

Abstract

INTRODUCTION: Adverse drug events are injuries resulting from medication use and are associated with increased morbidity and mortality and higher costs. More than 40% of medication errors are believed to result from inadequate medication reconciliation (MR) during admissions and discharges. Historically, MR completion on patient admission to L&D at our institution is estimated to be 50%. Our aim was to evaluate Ob/Gyn resident understanding and compliance with the MR process prior to and following a resident didactics session. METHODS: During a didactics session, residents took a multiple choice quiz to evaluate their understanding of MR and then listened to a presentation detailing the process and its significance. MR completion rates for all resident admissions to L&D during the 14 days prior to and the 40 days following the session were calculated. Residents were then emailed individualized report cards detailing their progress. Finally, completion rates for the 26 days following the personalized feedback were calculated. RESULTS: Prior to the session, only 41% of residents could correctly identify an adverse drug event and their frequency of occurrence (85% response rate). Prior to the session, 64% of MRs were completed while 99% were completed in the following 40 days (p=0.02). Following personalized feedback, 100% of MRs were completed (p=0.01). CONCLUSION: Significant improvements in resident participation in quality measures can be achieved with focused peer interventions. Given that the Institute of Medicine estimates that the average hospitalized patient is subject to one medication error a day, such improvements in MR are likely to substantially improve patient care.