title: Quality improvement through implementation of discharge order reconciliation.
abstract: OBJECTIVE
  A coordinated multidisciplinary process to reduce medication errors related to patient discharges to skilled-nursing facilities (SNFs) is described.
  
  
  CONCLUSIONS
  After determining that medication errors were a frequent cause of readmission among patients discharged to SNFs, a medical center launched a two-phase quality-improvement project focused on cardiac and medical patients. Phase one of the project entailed a three-month failure modes and effects analysis of existing procedures discharge, followed by the development and pilot testing of a multidisciplinary, closed-loop workflow process involving staff and resident physicians, clinical nurse coordinators, and clinical pharmacists. During pilot testing of the new workflow process, the rate of discharge medication errors involving SNF patients was tracked, and data on medication-related readmissions in a designated intervention group (n = 87) and a control group of patients (n = 1893) discharged to SNFs via standard procedures during a nine-month period were collected, with the data stratified using severity of illness (SOI) classification. Analysis of the collected data indicated a cumulative 30-day medication-related readmission rate for study group patients in the minor, moderate, and major SOI categories of 5.4% (4 of 74 patients), compared with a rate of 9.5% (169 of 1780 patients) in the control group. In phase 2 of the project, the revised SNF discharge medication reconciliation procedure was implemented throughout the hospital; since hospitalwide implementation of the new workflow, the readmission rate for SNF patients has been maintained at about 6.7%.
  
  
  CONCLUSIONS
  Implementing a standardized discharge order reconciliation process that includes pharmacists led to decreased readmission rates and improved care for patients discharged to SNFs.
authors.affiliation: Hennepin County Medical Center (HCMC), Minneapolis, MN 55415, USA. yun.lu@hcmed.org
authors.forename: Yun
authors.initials: Y
authors.lastname: Lu
authors.forename: Pamela
authors.initials: P
authors.lastname: Clifford
authors.forename: Andreas
authors.initials: A
authors.lastname: Bjorneby
authors.forename: Bruce
authors.initials: B
authors.lastname: Thompson
authors.forename: Samuel
authors.initials: S
authors.lastname: VanNorman
authors.forename: Katie
authors.initials: K
authors.lastname: Won
authors.forename: Kevin
authors.initials: K
authors.lastname: Larsen
mesh_terms: D003266:Continuity of Patient Care / Q000592:standards* / Q000639:trends; D006801:Humans; D008508:Medication Errors / Q000517:prevention & control; D059065:Medication Reconciliation / Q000379:methods / Q000592:standards* / Q000639:trends; D009735:Nursing Homes / Q000592:standards* / Q000639:trends; D010351:Patient Discharge / Q000592:standards* / Q000639:trends; D010865:Pilot Projects; D058996:Quality Improvement / Q000592:standards* / Q000639:trends