1. Nursing Survey Results
Current Medication Reconciliation Process at a Community Family Health Clinic: Pilot Study
Brittany Bittner1, Ana Glavas1, Samantha Marquardt1, Karli Welter1
Preceptor: Dr. Emily Beckett2
1University of Iowa College of Pharmacy, PharmD Candidate 2020, 2University of Iowa College of Pharmacy, PharmD, BCPS
Background
Broadlawns Family Health Center, Des Moines IA
Provides comprehensive primary and preventative health care for the entire family to the underserved population
Staff includes 40 providers/residents, 9 nurses, and one 50% pharmacist
Results
8/9 nurses responded to the pre-pilot survey and 7/8 nurses responded to the post-pilot survey
35 (~20%) patient medication lists and data-collecting questionnaires were returned
4 medication lists included a change in dosage strength. 50% reported an unknown reason, while 25% reported a dose increase and decrease
4 medication lists included a change in dosage frequency, all of which were reported as unknown
70.6% reported an unknown reason for medication deletion, while the remaining 29.4% reported a specific reason for deletion (i.e. duplicate medications)
Nursing Survey Results
Question
Pre-Pilot
Post-Pilot
I feel that accurate medication lists are important to deliver good patient care.
1.50
1.00
Broadlawns current medication reconciliation process is efficient at accurately updating each patient medication list.
2.75
1.40
I feel comfortable with current medication reconciliation process.
2.13
1.20
I feel comfortable completing medication reconciliation with patients.
1.63
I always go through each medication on the medication list with every patient and accurately update the EMR.
1.88
The current EMR technology at Broadlawns allows me to accurately perform medication reconciliation and update medication lists 
2.25
1.60
Objective
Develop a framework for patient interviewing and medication reconciliation performance that can be implemented in a family health clinic to assess completion of accurate medication lists
The current EMR system, Meditech, requires nurses to check medications as “reviewed,” which eliminates the ability to know if the medication reconciliation occurred with quality and the ability to see past updates to patients’ medication lists
Limitations
Broadlawns previously did not have a formal procedure in completing medication reconciliations
Researchers had to rely on nursing staff and fourth-year pharmacy students for data collection
Unable to determine if nurses did not complete medication reconciliations based on a patient’s extensive medication list or if particular nurses were not compliant with the new policy
1 = fully agree, 2 = somewhat agree, 3 = neither agree nor disagree, 4 = somewhat disagree, 5 = fully disagree
Methods
Pre
Reminder phone calls to patients to bring in their medications/lists
Nursing survey
Created medication reconciliation procedure and medication pocket card template
Pilot
Nursing staff reviews and applies policy
Front staff prints patient’s medication list, which the patient update in the waiting room
Input all changes to patients’ medication lists into our online data collection questionnaire
Post
Identify and implement necessary changes to the new policy
199 patients seen in clinic during pilot study
178 patients eligible to participate in pilot study
35 responses from nursing staff
Average Prescription Per Patient
9.09
Conclusions
The overall understanding, comfortability, and confidence of the nursing staff performing medication reconciliations has improved
Medication reconciliations are essential for accurate medication lists, leading to improved outcomes in patient safety and quality of care
The Broadlawns medication reconciliation process remains a work in progress
Average OTC Per Patient
2.49
Average Number of Changes to Each Medication List = 1.8 Updates