Impact of a Medication Reconciliation Improvement Package on Adherence to Medication Reconciliation Among Internal Medicine Physicians: A Quality Improvement Project in a Lower-Middle Income Country

Abstract

Background: Medication reconciliation is one of the best measures to prevent medication-related errors at the time of admission and discharge of patients. We conducted a quasi-experimental study to evaluate the impact of a Medication reconciliation improvement package (intervention) on adherence to medication reconciliation at the time of admission in Department of Internal Medicine. The study included all adult patients admitted to internal medicine from August 2019 to December 2020. Pre-intervention data on adherence to medication reconciliation was less than 50%. The study involved creation of a quality improvement team to conduct a root-cause analysis which identified the need to target physician related issues and hence drafted a medication reconciliation improvement package which included meetings with physicians on the internal medicine floor, dedicated WhatsApp groups for repeated reminders, and appreciation messages for timely adherence. We used the Chi Square test to check the association between adherence to medication reconciliation and physicians and acuity level. Findings: We included 7914 records of patients, in which 4471 participants (56.4%) were from pre-intervention phase and 3443 (43.5%) were from intervention groups. The overall adherence to medication reconciliation was 54.3% (4297/7914). Adherence of medication reconciliation increased from 44.4% (1983/4471) in the pre-intervention phase to 67.2% (2314/3443) in the intervention phase ( P < .001). Improvement was observed in adherence of medication reconciliation done by residents and in low acuity areas ( P < .005). Conclusion: The Medical reconciliation improvement package is a simple low-cost intervention that resulted in improvement in adherence to medication reconciliation but needs further studies to assess its sustainability. However, it awaits to be seen if the same improvement can also be replicated to qualitative medication errors and clinical outcomes respectively.