The goal of the strategy is to immerse students in a quality improvement group project focused on medication reconciliation and patient safety. This exercise spans 2 weeks during which students practice medication reconciliation in the classroom and clinical practice settings.
Week 1: Extracting a Medication List (see PowerPoint presentation) Students work through the steps of medication reconciliation in class, role playing interactions and thinking together about potential risks and ways nurses can intervene in such encounters. Faculty guide students to consider:
How to obtain a complete/thorough medication list and history
How to identify possible medication interactions and the relationships among medications and abnormal physical findings
How to identify gaps in knowledge – specifically identifying how to ask focused questions and probe for additional information (i.e. exploring herbal and/or natural supplements in addition to prescribed medication) to assure care givers have a clear understanding of what medications patients are taking and how they are taking them.
How to identify real or potential systems failures – specifically identifying a) systems that are influencing (or have the potential to influence) medication adherence (or lack thereof), b) communication breakdowns that are influencing (or have the potential to influence) medication adherence, c) the extent to which the patient record contains an accurate picture of the patient’s medication history and adherence
The specific actions nurses can take to promote patient safety and quality care through medication reconciliation.
Week 2 : Moving into the clinical setting Students apply what they have learned in the clinical setting by completing medication reconciliation activities on an assigned patient. Faculty use post-clinical conference to explore identified safety issues and how these can be rectified. Concomitantly, students engage in a group project to extend their knowledge related to mediation reconciliation and to promote safety in the clinical area where they are completing their practicum. Specifically, students are asked to:
Complete literature review relating to medication reconciliation and safety
Draft/revise a policy/procedure for medication reconciliation specific to their assigned unit
Complete patient record audits to document healthcare team compliance
Provide education to staff/physicians/patients relating to the medication reconciliation policy and procedure.
Note: Many quality and safety topics can be woven into discussion. It is helpful for faculty to direct students’ attention to patient safety initiatives to contextualize the exercise. Also, by consistently using quality/safety terminology in discussions (e.g.: medication reconciliation, complex adaptive systems, transparency, collaboration and so forth) students become familiar with and adept at considering both individual and system perspectives.