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  1. Article ; Online: Improving Accuracy of Medication Reconciliation for Hospitalized Children: A Quality Project.

    Gunkelman, Samantha M / Jamerino-Thrush, Jennifer / Genet, Katherine / Blackford, Martha / Jones, Kerwyn / Bigham, Michael T

    Hospital pediatrics

    2024  Volume 14, Issue 4, Page(s) 300–307

    Abstract: Background and objectives: Medication reconciliation is a complex, but necessary, process to prevent patient harm from medication discrepancies. Locally, the steps of medication reconciliation are completed consistently; however, medication errors still ...

    Abstract Background and objectives: Medication reconciliation is a complex, but necessary, process to prevent patient harm from medication discrepancies. Locally, the steps of medication reconciliation are completed consistently; however, medication errors still occur, which suggest process inaccuracies. We focused on removal of unnecessary medications as a proxy for accuracy. The primary aim was to increase the percentage of patients admitted to the pediatric hospital medicine service with at least 1 medication removed from the home medication list by 10% during the hospital stay by June of 2022.
    Methods: Using the Model for Improvement, a multidisciplinary team was formed at a children's hospital, a survey was completed, and multiple Plan-Do-Study-Act cycles were done focusing on: 1. simplifying electronic health record processes by making it easier to remove medications; 2. continuous resident education about the electronic health record processes to improve efficiency and address knowledge gaps; and 3. auditing charts and real-time feedback. Data were monitored with statistical process control charts.
    Results: The project exceeded the goal, improving from 35% to 48% of patients having at least 1 medication removed from their home medication list. Improvement has sustained for 12 months.
    Conclusions: The combination of interventions including simplifying workflow, improving education, and enhancing accountability resulted in more patients with medications removed from their home medication list.
    MeSH term(s) Child ; Humans ; Medication Reconciliation ; Child, Hospitalized ; Medication Errors/prevention & control ; Patient Admission ; Hospitalization
    Language English
    Publishing date 2024-03-01
    Publishing country United States
    Document type Journal Article
    ISSN 2154-1671
    ISSN (online) 2154-1671
    DOI 10.1542/hpeds.2023-007396
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Redirecting Nonurgent Patients From the Pediatric Emergency Department to Their Pediatrician Office for a Same-Day Visit-A Quality Improvement Initiative.

    Wolski, Thomas P / Jamerino-Thrush, Jennifer / Bigham, Michael T / Kline-Krammes, Sarah / Patel, Nirali / Lee, Timothy J / Pollauf, Laura A / Joyce, Crystal N / Kunka, Sarah / McNinch, Neil L / Jacobs, Michelle / White, P Cooper

    Pediatric emergency care

    2022  Volume 38, Issue 12, Page(s) 692–696

    Abstract: Objectives: Providing high-quality care in the appropriate setting to optimize value is a worthy goal of an efficient health system. Consequences of managing nonurgent complaints in the emergency department (ED) have been described including ... ...

    Abstract Objectives: Providing high-quality care in the appropriate setting to optimize value is a worthy goal of an efficient health system. Consequences of managing nonurgent complaints in the emergency department (ED) have been described including inefficiency, loss of the primary care-patient relationship, and delayed care for other ED patients. The purpose of this initiative was to redirect nonurgent patients arriving in the ED to their primary care office for a same-day visit, and the SMART AIM was to increase redirected patients from 0% of those eligible to 30% in a 12-month period.
    Methods: The setting was a pediatric ED (PED) and primary care office of a tertiary care pediatric medical system. The initiative utilized the electronic health record to identify and mediate the redirection of patients to the patient's primary care office after ED triage. The primary measurement was the percentage of eligible patients redirected. Additional measures included health benefits during the primary care visit (vaccines, well-visits) and a balancing measure of patients returned to the PED.
    Results: The SMART AIM of >30% redirection was achieved and sustained with a final redirection rate of 46%. In total, 216 of 518 eligible patients were redirected, with zero untoward outcomes. The encounter time for redirected patients was similar for those who remained in the PED, and additional health benefits were appreciated for redirected patients.
    Conclusions: This initiative redirected nonurgent patients efficiently from a PED setting to their primary care office. The process is beneficial to patients and families and supports the patient-centered medical home. The balancing measure of no harm done to patients who accepted redirect reinforced the reliability of PED triage. The benefits achieved through the project highlight the value of the primary care-patient relationship and the continued need to improve access for patients and families.
    MeSH term(s) Humans ; Child ; Quality Improvement ; Reproducibility of Results ; Primary Health Care ; Emergency Service, Hospital ; Pediatricians
    Language English
    Publishing date 2022-11-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632588-9
    ISSN 1535-1815 ; 0749-5161
    ISSN (online) 1535-1815
    ISSN 0749-5161
    DOI 10.1097/PEC.0000000000002879
    Database MEDical Literature Analysis and Retrieval System OnLINE

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