Teaching Project: Discharge Medication Reconciliation

1. Teaching Project: Discharge Medication Reconciliation Andrea Martinez University of Texas Health Science Center at San Antonio

2. Introduction • Institute of Medicine report • Institute for Healthcare Improvement definition • When do errors occur?

3. Goals • Patients discharged with a correct list of medications • Verified and signed by two nurses, and a Core Measures auditor • St. Luke’s Baptist Hospital Stroke Program

4. Learning Theory • Andragogy by Malcolm Knowles • Self-concept • Problem-centered • Motivation

5. Learning Objectives • Discharge nurse will compose a comprehensive list of newly prescribed, current, over-the-counter, and herbal medications • Discharge nurse will apply the process for assuring accurate transcription of physician discharge medication orders to the patient discharge medication list

6. Process • Physician fills out discharge medication reconciliation form • A list is composed from form • Two nurses compare form to list • Core Measures auditor compares form to list • Medications that are new or changed are indicated on list • Patient is discharged with updated list

7. Evaluation • Exam administered before and after presentation, and any time during audit • Appropriate for current and incoming nurses • Simple and direct questions assess nurses’ understanding of discharge medication reconciliation process • Survey allows for feedback of process

8. References • Climente-Marti, M., Garcia-Mañon, E.R., Artero-Mora, A., & Jimenez-Torres, N.V. (2010). Potential risk of medication discrepancies and reconciliation errors at admission and discharge from an inpatient medical service. The Annals of Pharmacotherapy, 44, p. 1747-1754. doi: 10.1345/aph.1P184 • Crawford, S.R. (n.d.). Andragogy: Malcolm Knowles. Retrieved from http://academic.regis.edu/ed205/Knowles.pdf • Hakim, H. (2014). Not just for cars: Lean methodology. Nursing Management, 45(3), p. 39-43. doi: 10.1097/01.NUMA.0000443942.06621.6e • Weber, R.J. & Moffatt-Bruce, S. (2014). Patient Safety. New York, NY: Springer Science+Business Media, LLC.