Economically supporting direct care providers in medication reconciliation to ensure safe transition to and from hospital and community

Communication deficits across the care continuum place patients at serious risk for harm. Medication reconciliation examines medication use at transition points. A reconciliation failure is an unintentional prescribing error uncovered during the reconciliation process. This project addresses the impact of nursing care processes, nursing workforce and environment, and nurse-led innovation on patient care quality in acute care settings. It seeks to answer the question of how to economically support direct care providers in medication reconciliation to ensure safe transition to and from hospital and community. Goals are to evaluate effectiveness of a nurse-pharmacist clinical information coordination team in improving drug information management on admission and discharge, quantify potential harm due to reconciliation failures, and determine cost-benefit related to averted harm. A quasi-experimental design will be used to evaluate team efficacy in preventing potential adverse events. The nine-month study has two arms. Patients receive standard of care in the control arm. In the intervention arm, study nurses obtain home medication lists from consenting patients and use triage criteria to involve the pharmacist in list completion; linkages are created with primary providers and local pharmacies; and team-facilitated medication reconciliation occurs within 48 hours of admission and at discharge. Key outcomes include reconciliation failures, estimates of potential harm associated with these errors, profile of patients at risk for harm, and net economic benefit of the intervention. Ninety-five percent exact binomial confidence intervals will be used to estimate error rate uncertainty, regression analysis to identify patient traits associated with error, and a probabilistic sensitivity analysis to describe certainty of a positive net economic benefit.

Grant Details

Amount Awarded $299,028.00

Awarded on: 8/13/2007

Time frame: 9/1/2007 - 8/31/2009

Grant Number: 62596


Johns Hopkins Hospital and Health System

600 North Wolfe Street
Baltimore, 21287-0005


Linda L. Costa
Project Director