O0005 Oct.4: 3:45pm - Pediatric Inpatient Discharge Medication Reconciliation: Improving Compliance

Background: Medication errors are a leading cause of patient harm and frequently occur at transitions of care. Though the Joint Commission set medication reconciliation (MedRec) as a National Patient Safety Goal years ago, hospitals continue to struggle with discharge MedRec (DisMedRec) in the pediatric population.

Aim: To increase the entire institution’s percentage of overall inpatient discharge medication reconciliation (DisMedRec) completed to greater than 90% in 12 months.

Design/methods: Plan-Do-Study-Act (PDSA) Cycles were initiated in July 2019 with a pediatric hospitalist (PHM)/Chief Quality Officer co-led interdisciplinary team of MDs, RNs, pharmacists, and IT specialists across acute and subacute hospital sites in our large academic children’s hospital. (P): Process map and Ishikawa diagrams were used to identify DisMedRec failures. Baseline data from Sep 2019 – Nov 2019 were analyzed. (D) PHM-led resident/attending level trainings on DisMedRec expectations (S) Biweekly unit and service-specific data reviewed with the MedRec taskforce. (A) Cycle 2-4 interventions chosen by team: C2: Nursing training on DisMedRec via email. C3: Weekly department-specific data emailed out to each department chief. C4: Best Practice Advisory (BPA) alert fires when discharge order placed while DisMedRec is incomplete. The BPA was built to fire only for providers who have signed a discharge order and fire when the providers are attempting to exit the patient’s chart. C5: DisMedRec dashboard with patient-level data was created and made available to all departments.

Results: DisMedRec Compliance (Fig 1) shows overall hospital-wide DisMedRec completion rate increased from baseline average of 82% to 95% with most significant improvement after the implementation of DisMedRec BPA. Trends are noted on the graph. We were able to successfully achieve our SMART AIM in only 3 months. Factors that lead to success included buy-in from senior leadership and members of multidisciplinary team to support a culture of safety, effective integration of EMR into the DisMedRec work flow, and institution of EMR tools that promote high reliability medication reconciliation prescriber practices.

Conclusions: Using an interdisciplinary team across all sites, this QI initiative was successful at increasing DisMedRec compliance for the entire institution. Clinical decision support tools, designed to follow the 5 Rights, were integral to its success. Next cycle includes sustaining performance rates and assess rate of duplication pre- versus post-intervention as a proxy for DisMedRec quality.