Date of Award

5-2-2017

Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Theresa A. Kessler

Abstract

Pediatric patients are at an increased risk for medication errors and can benefit from processes that facilitate and promote medication safety (Stone et al., 2010). Medication reconciliation (Med Rec) is a valuable tool in improving patients’ medication safety and reducing adverse drug events (The Joint Commission, 2015). The purpose of this evidence-based practice (EBP) project was to improve the accuracy of the Med Rec process in a Midwestern pediatric hematology/oncology outpatient clinic by developing, promoting, and evaluating a standardized, collaborative Med Rec process. The Stetler EBP model guided the implementation of the intervention, with the goal of integrating current evidence into current practice. Kotter’s Model of Change laid the theoretical foundation for successful implementation of a current practice change. This EBP project intervention included a patient and team member component. The patient component consisted of a verbal call reminder to bring medications to the visit, a patient handout emphasizing the importance of medication safety and reconciliation, and patient education regarding Med Rec process. The team member component included education regarding the importance of the Med Rec process and updates regarding Med Rec accuracy. The outcomes measured included the number, type, and severity of medication discrepancies and the number of voluntarily reported medication errors. Data were collected during Phase 1 (pre-intervention) and Phase 2 (post-intervention) by the physicians and the project leader (PL). These data were analyzed using chi-square tests. The intervention lead to a significant increase in the number of accurate Med Recs reported by the physicians between Phase 1 (n = 50, 70%) and Phase 2 (n = 65, 90.8%) (X2 = 8.167, df = 1, p = .004). An insignificant decrease in the number of accurate Med Recs was reported by the PL between Phase 1 (73.1%) and 2 (72.5%) (X2 = .003, df = 1, p = 0.959). Physicians reported more incorrectness errors in Phase 1 (73.3%) and Phase 2 (83.3%) than incompleteness errors (X2 = .481, df = 1, p = .786). PL reported more incompleteness errors in Phase 1 (71.4%) and Phase 2 than incorrectness errors (81.8%) (X2 = 1.670, df = 2, p = .434). The majority of Med Rec inaccuracies were classified as minor during Phase 1 and 2 by the physicians (X2 = .827, df = 2, p = .363) and the PL (X2 = 1.039, df = 1, p = .308). No inaccurate Med Rec was classified as severe by physicians or the PL. Finally, there were no voluntary medication errors were reported during the duration of the EBP project. Revision and replication of this EBP project would be helpful in further improving Med Rec accuracy in this setting.

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