Practice Problem:There was a report of a high rate of medication errors from inaccurate medication reconciliation during admission to a local hospital in South Texas. The medication error rate was 14.88% on 20 reviewed charts, and 85% of all evaluated charts contained at least one medication discrepancy.
PICOT: This evidence-based, system-change project was guided by the following PICOT question: For nurses administering medication in a long-term acute care hospital, does the implementation of Medication Reconciliation Timeout Process (MRTP) decrease the medication errors, compared to the usual medication practice, in one month?
Evidence: Thirteen pertinent studies recommended the use of a combination of checklists and the timeout process to see a reduction in the number of medical errors and improvements in performance and safety.
Intervention: The evidence-based intervention utilized MRTP with a checklist while performing medication reconciliation during admission. Two nurses checked the medication reconciliation for accuracy and completeness by comparing the medication list against transferring facility to physician’s admission orders.
Outcome: The outcome of the project after the evidence-based intervention was a medication error rate of 3.77%, which was a significant reduction from 14.88%.
Conclusion: The implementation of MRTP resulted in an 11.11% decrease in medication errors within four weeks in a long-term acute care facility.