Reducing medication errors at admission: 3 cycles to implement, improve and sustain medication reconciliation
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Background In France, medication errors are the third leading cause of serious adverse events. Many studies have shown the positive impact of medication reconciliation (MR) on reducing medication errors at admission but this practice is still rarely implemented in French hospitals. Objective Implement and sustain a MR process at admission in two surgery units. The quality improvement approach used to meet this objective is described. Setting The gastrointestinal surgery and orthopedic surgery departments of a 407 inpatient bed French teaching hospital Methods A step by step collaborative approach based on plan–do–study–act (PDSA) cycles. Three cycles were successively performed with regular feedback during multidisciplinary meetings. Main outcome measure: mean unintended medication discrepancies (UMDs) per patients at admission. Results The three PDSA cycles and the monitoring phase allowed to implement, optimize and sustain a MR process in the two surgery units. Cycle 1, by showing a rate of 0.65 UMDs at admission (95 % CI 0.39–0.91), underlined the need for a MR process; cycle 2 showed how the close-collaboration between pharmacy and surgery units could help to reduce mean UMDs per patients at admission (0.18; 95 % CI 0.09–0.27) (p < 0.001); finally, cycle 3 allowed the optimization of the MR process by reducing the delays of the best possible medication history availability. Conclusions This work highlights how a collaborative quality-improvement approach based on PDSA cycles can meet the challenge of implementing MR to improve medication management at admission.
KeywordsFrance Medication reconciliation Multidisciplinary PDSA cycles Quality improvement Surgery
We would like to thank the fifth year pharmacy students for their help in collecting the BPMHs and we are very grateful for the cooperation and interest of the whole team of GS and OS. This work would not have been possible without their support. We also would like to thank Kevan Wind for reviewing our paper.
Conflicts of interest
The authors declare that they have no conflict of interest.
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