Purpose: The purpose of this quality improvement project was to improve outpatient medication review and reconciliation through the introduction of nursing. It is understood that active health professional medication management assists patients in maintaining complete and correct medication lists. This in turn helps improve the patient’s medication awareness, sustains overall health, and promotes long-term wellness. Despite the benefit of medication review and reconciliation, fragmented outpatient visit processes result in medication lists not being reconciled between what is prescribed and what the patient is self-administering. Multi-factorial reasons have been outlined as to why the licensed prescriber may not resolve these discrepancies; however, the lack of action taken has resulted in compliance rates as low as 60% within the studied practice settings. Published evidence notes that many adults often partially or completely omit prescribed medications. Non-adherence has been estimated to contribute $290 billion annually to national health system spending. Shared effort towards improved medication management inclusive of nursing has demonstrated an increase in complete and correct improved problem anticipation and a potential reduction in adverse medication events.
Evaluation/outcome: Overall compliance and specifically nursing compliance contribution was measured. Reconciliation compliance data at baseline was 81.5% for the primary care and 74.7% for the otolaryngology setting. Overall reconciliation slightly improved to a high of 90.4% within the primary care and 86.2% within the specialty setting. The primary care overall nurse attributed compliance rate was 2.9% with a high of 4.4% at week 4. The otolaryngology practice recorded an overall rate of 22.8% with a high of 30.8% at week 6. Nursing exclusive encounters demonstrated a 30-40% reconciliation improvement. Medication review and reconciliation management during telephone encounters was minimal with a high of 2.5% during week 7 of the intervention. Patient satisfaction data was unchanged in the primary care practice setting and demonstrated a 13% positive change from baseline in the otolaryngology.