Semester

Spring

Date of Graduation

2011

Document Type

Dissertation

Degree Type

DNP

College

School of Nursing

Department

Not Listed

Committee Chair

Kari Sand-Jecklin.

Abstract

Statement of the Problem and Significance: Inaccuracies in patients' medication lists in primary care are safety concerns. Extensive research has been conducted on medication practices and patient safety within the hospital; however, the research for primary care is sparse.;Study Design: Lippitt's Change Theory was utilized as the theoretical framework. The project design was based on evidence derived from the 2008 The Joint Commission National Patient Safety Goals. The study was performed over a period of three months. Pre-intervention data was gathered and analyzed for the use of current electronic medication records. The healthcare team was educated on the electronic medication record system, and the importance of medication accuracy, listing of all pharmaceutical agents utilized by the patient, including over-the-counter agents, vitamins, herbals and home remedies. Post-implementation data was collected and analyzed two weeks post education to determine acceptance of the process change. Final post-implementation data was collected and analyzed at six weeks post implementation to evaluate adoption of the process change. Results were present to the team.;Sampling Methods: One hundred retrospective patient records were reviewed for each audit. Records were randomly selected from participating providers' encounters using the Research Randomizer tool. Mondays, Tuesdays and Thursdays, were used as audit days based on high patient volumes. Inclusion criteria included: English language, patients 18 years of age and older, one or more chronic disease diagnoses, and presence of one or more long-term maintenance medications. Fifteen patients were randomly selected from the pre and final post-implementation audits for a phone survey to establish baseline data and the healthcare teams' compliance with the process change. The healthcare team was surveyed for effectiveness of the educational intervention.;Results: There was significant evidence to support meeting medication reconciliation objectives. Patient reports of the telephone survey indicated 100% compliance with all criteria post practice change. There was a significant decrease in the number of medications listed and in the total number of active acute medications listed post practice change. Record audits indicated a significant increase in the number of over-the-counter, vitamins, herbals and home remedies and new over-the counter, vitamins, herbals and home remedies listed. A significant increase in compliance with checking the "Reviewed" box was also demonstrated.;Recommendations: Continue staff medication reconciliation behaviors. Re-audit the process at six months then annually, and develop a formal policy for the reconciliation practice at this facility.

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