Improving Outpatient Medication Reconciliation and Reducing Adverse Drug Events: Development of a New Process

Abstract

Importance: Prescribed medications can pose risks to patient safety. In the United States, persons aged over 65 account for nearly 450,000 annual emergency department (ED) visits, and they are seven times more likely to require hospital admission than younger persons (Centers for Disease Control and Prevention, 2022). Medication reconciliation (MR) errors are more likely to affect those older than 65, but can be prevented by using standardized MR criteria that identify medications with higher risks for adverse drug events (ADEs) (O’Mahoney, 2020).

Objective: The DNP project goal was to create and implement a risk stratified medication reconciliation (RSMR) intervention process using a tool that identified medication(s) and patient risk factors for ADEs prior to diagnosing and prescribing.

Methods: RSMR was used in triage and identified the patients’ total number and type of high-risk prescriptions, drug-to-drug interactions with ADE potential, and high-risk comorbidities. RSMR accuracy was compared to the established MR within an outpatient primary care clinic and identified prescription and/or monitoring changes due to tool usage.

Results: 50 pre-implementation patient charts were analyzed and compared to 50 post RSMR implementation patient charts. In 56% of patients, the RSMR differed from the pre-implementation MR. RSMR was more accurate than current MR and had greater ADE risk acknowledgement. RSMR resulted in changes to treatment/prescription in 60% of patients and monitoring changes in 70% of patients. RSMR post-implementation data demonstrated an 81% decrease in total DDIs.

Conclusion and Relevance: This QI project identified that RSMR can increase MR accuracy, reduce documented DDIs, and support changes to prescribing and patient monitoring.