38 Excellence in medication reconciliation during COVID-19 pandemic

Background Effective medication reconciliation (MedRec) promotes patients‘ safety, while poor compliance with MedRec may result in adverse events and medication errors.¹ MedRec was identified as a patient safety measure and Joint Commission standard for hospital accreditation.² In Communicable Disease Center (CDC), majority of COVID-19 admissions were high-risk patients, taking multiple chronic medications, at risk of drug interactions and medication errors from concomitant COVID-19 medications. Therefore, it was crucial to conduct proper MedRec to prevent these harmful events in this vulnerable population. Low compliance with MedRec was observed in CDC during COVID-19 pandemic (mean 86%). This project aimed to increase the proportion of inpatients who had their medications reconciled within 24-hours of admission from 86% in December 2020 to 95% by the end of December 2022.

Methods The current practice of MedRec was reviewed and analysed to identify areas for improvement. Process map for inpatient was prepared and the Institute for Healthcare Improvement (IHI) model for improvement was utilised. Multiple measures were developed to monitor the project effectiveness (figure 1a). A physician satisfaction survey was distributed as a balance measure. The multidisciplinary taskforce tested multiple Plan-Do-Study-Act (PDSA) cycles with various change concepts (figure 1b).

Results Average compliance increased from 86% to 92% by December 2021 and further increased to 97% by the end of December 2022. During the pandemic, there was only one reported medication error that is due to missed or improperly conducted MedRec (figure 2), one patient missed his insulin dose. Peer review was done for this case and found that the medication reconciliation was incomplete for this patient. For the balance measure, the majority of physicians (n=27/33, 82%) agreed that MedRec process does not have a negative impact on their tasks.

Conclusion CDC has successfully ensured patient safety and consistently delivered high-quality care during and beyond the COVID-19 pandemic by enhancing MedRec practices.

References

1. The High 5s Project-Standard Operating Protocol for Medication Reconciliation Standard Operating Protocol Assuring Medication Accuracy at Transitions in Care. 2014. Version 3. [accessed on 30 November 2023]. Available from: https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/psf/high5s/h5s-sop

2. Gardella J, Cardwell T, Nnadi M . Improving medication safety with accurate preadmission medication lists and post discharge education. Jt Comm J Qual Patient Saf 2012;38:452–8. doi: 10.1016/s1553-7250(12)38060-4. PMID: 23130391.

Ethical Approval/IRB Statement This quality improvement project was approved by the Assistant Head of Infectious Disease Division and the CEO and Medical Director of Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar).

Disclosures and Acknowledgments The authors have no disclosures.