@article{18,
  author = {Tiranun Rungvivatjarus and Cynthia L. Kuelbs and Lisa Miller and Jeff Perham and Kendall Sanderson and Glenn Billman and Kyung E. Rhee and Erin S. Fisher},
  title = {Medication Reconciliation Improvement Utilizing Process Redesign and Clinical Decision Support.},
  abstract = {<p><b>BACKGROUND: </b>Despite years of attention, hospitals continue to struggle to implement successful medication reconciliation. This study aimed to increase the percentage of hospital admission medication reconciliation (AdmMedRec) completion to ≥ 95% in 12 months at a large academic children's hospital.</p><p><b>METHODS: </b>A quality improvement (QI) project was initiated in April 2017 by an interdisciplinary team of physicians, nurses, pharmacists, and analysts, co-led by a pediatric hospitalist and chief medical information officer. Interventions were implemented through sequential Plan-Do-Study-Act cycles. Process maps, fishbone diagrams, and failure mode and effects analysis were used to identify AdmMedRec failures. Baseline data from 12,481 admission encounters July 2016-April 2017 were analyzed. Interventions included electronic health record (EHR) workflow redesign, clarification of clinicians' responsibilities, targeted training, Best Practice Advisory alert, and weekly reporting of specialty- and physician-specific performance data. Data from 13,082 postintervention period admission encounters were examined. Reconciliation by therapeutic drug classes was calculated as a proxy for quality.</p><p><b>RESULTS: </b>AdmMedRec completion rate increased from a baseline of 73% to 95% within 7 months from the start of this project and was sustained at 94% during the postintervention period. Psychiatry and hospital medicine demonstrated the largest improvements, with rates increasing from 17% to 88% and 76% to 98%, respectively. Percentages of reconciled medications in all 13 therapeutic classes, including high-risk drugs, improved significantly (p < 0.05).</p><p><b>CONCLUSIONS: </b>Using an interdisciplinary team and interventions focused on process and culture changes, this QI initiative was successful at increasing AdmMedRec rates and reducing omission errors across all therapeutic drug classes.</p>},
  year = {2020},
  journal = {Jt Comm J Qual Patient Saf},
  volume = {46},
  pages = {27-36},
  month = {01/2020},
  issn = {1938-131X},
  doi = {10.1016/j.jcjq.2019.09.001},
  language = {eng},
}