Improving Completion Rates of Orthopaedic Surgery Discharge Medication Reconciliation: A Quality Improvement Initiative

Discharge Medication Reconciliation (DMR) is critical in the transition from inpatient to outpatient care. Incomplete or inaccurate DMR results in medication errors, polypharmacy, or missed medications. Our high-volume tertiary care orthopaedic division was identified as an underperformer in DMR. Therefore, this Quality Improvement initiative aimed to achieve >85% DMR completion at hospital discharge by June 30, 2023.

An interrupted time series study design, following the “Model for Improvement” of the Institute for Healthcare Improvement, was used with a committee formed with CTU representatives, a resident, and two facilitators. Diagnostic tools, including root cause analysis, stakeholder interviews, process mapping, and driver diagrams, were employed. Multiple Plan-Do-Study-Act cycles were executed, along with interventions, such as audit and feedback and involvement of medical residents and nurse practitioners. Electronic medical record functionality was enhanced to facilitate medication reconciliation, with 'Continue all Remaining Home Medications'. In addition, for monthly data tracking, statistical process control charts were employed.

Initial analysis showed a 38% DMR completion rate pre-implementation. Post-intervention, completion rates rose to 90%. The 'Continue all Remaining Home Medications' feature saw near-universal adoption among orthopaedic residents.

The initiative boosted the timely completion rates of DMR, achieving project-specific and institutional objectives. Key factors contributing to this success included active stakeholder engagement, representation from CTUs, timely analysis of performance data, and thorough root cause analysis. Resident involvement was pivotal in identifying and implementing workflow improvements. The audit and feedback system fostered a competitive environment, driving enhancements. Overall, this project improved DMR timeliness, enhancing the safety of patient transitions from hospital to outpatient care.