Reducing medication errors at admission: 3 cycles to implement, improve and sustain medication reconciliation.

BACKGROUND: In France, medication errors are the third leading cause of serious adverse events. Many studies have shown the positive impact of medication reconciliation (MR) on reducing medication errors at admission but this practice is still rarely implemented in French hospitals.
OBJECTIVE: Implement and sustain a MR process at admission in two surgery units. The quality improvement approach used to meet this objective is described.
SETTING: The gastrointestinal surgery and orthopedic surgery departments of a 407 inpatient bed French teaching hospital.
METHODS: A step by step collaborative approach based on plan-do-study-act (PDSA) cycles. Three cycles were successively performed with regular feedback during multidisciplinary meetings. MAIN OUTCOME MEASURE: mean unintended medication discrepancies (UMDs) per patients at admission.
RESULTS: The three PDSA cycles and the monitoring phase allowed to implement, optimize and sustain a MR process in the two surgery units. Cycle 1, by showing a rate of 0.65 UMDs at admission (95 % CI 0.39-0.91), underlined the need for a MR process; cycle 2 showed how the close-collaboration between pharmacy and surgery units could help to reduce mean UMDs per patients at admission (0.18; 95 % CI 0.09-0.27) (p < 0.001); finally, cycle 3 allowed the optimization of the MR process by reducing the delays of the best possible medication history availability.
CONCLUSIONS: This work highlights how a collaborative quality-improvement approach based on PDSA cycles can meet the challenge of implementing MR to improve medication management at admission.