PC1234: Improvement of Pediatric Medication Reconciliation in the Outpatient Setting

Purpose/Objectives:

Background: Medication reconciliation (MedRec) is particularly important for the pediatric population due to their increased risk compared to adults for adverse drug events because of weight based dosing. This risk is even higher for children with medical complexity. The parent or patient have been found to be a more reliable source of information for a pediatric patient’s medication regimen compared to their pediatrician or electronic medical record. Unfortunately, the parent may not always be available upon admission to the hospital or there may be barriers including language or medical literacy that may prevent good communication of the medication regimen.

Objective: By May 2022, outpatient medications will be reviewed for pediatric patients in resident, attending, and pediatric subspecialty clinics over 50% of the time by closing of a patient encounter.

Design/Methods: Methods: Baseline data for completion of MedRec by chart closure in the outpatient setting was obtained for all pediatric patients in pediatric sub-specialists, pediatric and medicine-pediatric (MP) residents, and pediatric and MP attending clinics. MedRec was considered complete if the provider had marked the medications as reviewed in EPIC for the encounter. Several Plan-Do-Study-Act (PDSA) cycles were implemented: 1. Grand Rounds Education 2. E-mail graphics of MedRec done correctly 3. Labels on Computers 4. Circulating individual practitioner data April 2022. Data were then collected on a monthly basis comparing rates through the PDSA cycles mentioned above.

Results:

Results: A total of 11,020 pediatric encounters with a monthly average of 1378 were reviewed each month. The baseline rate was that 10% of encounters had medications reviewed upon chart closure. Rates gradually increased with the varying PDSA cycles. By February 2022, the goal of over 50% review rate was obtained and maintained over two months with respective rates of 51% and 52%.

Conclusion/Discussion:

Discussion: After 4 PDSA cycles we were able to obtain our goal of 50% MedRec rate. It is too early to tell at this point if that rate will be maintained particularly with a new resident class coming in July of 2022. We plan to continue to monitor the data and implement further interventions with the goal of further improving our rates and sustaining the goal. We chose to implement this quality improvement project in the outpatient setting because we wanted to have our electronic medical record have the most up to date medication list in case a clinic patient was admitted and thus help prevent adverse drug events.