PRACTICUM SUMMARY REPORT
Name: Ellie Salter
Team Members: Ellie Salter, Eilidh Gunn, Jennifer Gray
Project Title: Improving Medicines Reconciliation on Acute Surgical Receiving Unit
University/Organization Name: The University of Dundee, Scotland
Health System Sponsor Name: NHS Tayside
Aim of project
That more than 50% of all medicines reconciliation documents will be fully completed and 100% accurate on
admission to ASRU (Acute Surgical Receiving Unit), Ninewells Hospital, Dundee, Scotland by April 2013.
This aim is built upon the foundations of an ongoing quality improvement project surrounding medicines
reconciliation initiated in August 2012; this project has a working target of 95% of all medicines reconciliations
performed being 100% accurate.
Planned changes tested (2-3 sentences)
Completion and accuracy data (11 data items) was collected for 13 patients on the Acute Surgical Receiving Unit,
following two changes to the medicines reconciliation form (v1). Data analysis occurred following which further
changes to the form were made (v2). This was tested on a sample of 37 patients, collecting 10 data items. To
gauge patient experience of medicines reconciliations a questionnaire was distributed to 19 patients who had been
admitted to ASRU.
Predictions (2-3 sentences)
It is predicted that the form will result in more accurate completion of medicines reconciliation with >50% fully
completed and 100% accuracy. This will improve the quality of med rec completion in a unit where reliance on the
pharmacy team to complete medicines reconciliation has developed.
Individual ability to complete the documentation may cause variation.
Results
Present your results with a graph(s).
Graph Displaying Number of Medicines Reconciliations: 100% Complete 100% Accurate
Run Chart
The graph below clearly describes that there was a very poor level of full completion and 100% accuracy of medicines
reconciliation in the forms collected on the unit. Only 2 forms from the 50 collected were both fully completed and
100% accurate. Both of these medicines reconciliations were collected in the early cycles of the project. This level of
completeness and accuracy fell far below the target established at the onset of this quality improvement project. The
plausible reasons for this are described further in the remainder of this practicum report.
Graph Displaying Number of Medicines
Reconciliations: 100% Complete 100% Accurate
Run Chart
100
% Medicines Reconciliation %100 Complete and
100% Accurate
90
80
%: 100%
Complete 100%
Accurate
70
60
Target: 50%
50
40
Early Cycles:
n= 2/13
Later Cycles:
n= 0/37
Total n=50
30
20
10
0
Early Cycles
Later Cycles
Stage of Project
Graph Displaying Number of Medicines Reconciliations: 100% Complete 100% Accurate
Run Chart
The graph below displays the findings of the patient questionnaire that was distributed to 19 patients to explore their
experience of medicines reconciliation on the unit. It shows that 100% of patients were asked for an allergy check and
that they are a reliable source of information regarding their medications. 100% of patients believed that they were
taking all necessary and required medications.
Graph Displaying Patient Experience of Medicines
Reconciliation
100
80
Yes
60
40
No
YesN/A
20
No
0
N/A
Summary of results (3-4 sentences):
The early cycles showed that there was better completion and accuracy than the later cycles.
In later cycles with the implementation of v2 forms no complete and accurately filled mec rec forms were
retrieved.
An improvement in the accuracy and completion was not observed during the four week project.
Learning (4-5 sentences)
Comparison of questions, predictions, and analysis of data:
From the results, it can be seen that there was better completion and accuracy than during the early cycles
compared to the later cycles. Following the early cycles (using form v1), the data collection technique and time
management was improved by the team members with data being collected on 37 patients.
Individual variation can impact a great deal on results; in this project there was a junior doctor who failed to
perform any medicines reconciliation due to lack of education surrounding its importance.
Communicating with the unit staff and explaining the improvement project that was occurring over the 4 week
period was vital in ensuring that the project ran smoothly and that data collection was successful.
Changing the prerequisite minimum number of sources required to complete medicines reconciliation from 2 to 3,
resulted in decreased compliance in completion of forms.
Basing the outcome measure on both full completeness and 100% accuracy proved too ambitious. This resulted in
the outcome measure not being met. When performing any future quality improvement projects a greater level on
consideration will be taken when determining outcome measures.
Patients are a reliable source of information when performing medicines reconciliation.
Impact on systems (3-4 sentences)
Discuss the project’s significance on the local system and any findings that may be generalizable to other systems:
It is clear that there is an unreliable system for medical staff completing medicines reconciliation in the unit which
results in poor completion and accuracy.
Changing the requirement from 2 to 3 sources consulted during medicines reconciliation was too much without
implementing staff education and was therefore poorly performed by medical staff (see PDSA cycle 2 document).
Foundation doctors may be difficult to engage. They are often on the unit for only a short amount of time, don’t
have clinical support for the improvement and may not have essential undergraduate training and understanding
of their responsibility as part of medicines reconciliation.
Changing med rec forms will have an impact on all who use them, so ensuring that they are aware of the changes
implemented and rationale behind them is vital in ensuring improvement prior to expanding such changes to other
units.
Conclusions (3-5 sentences)
Summarize the outcome of the project. Is this project sustainable? What are the requirements for sustainability?
Disappointingly, no improvement was seen during the project.
The project is sustainable, however if continued, the measures should be modified. Potential outcome measures
include an improvement of 50% from the baseline level of 100% accuracy with the level of completeness becoming
a process measure.
Using patients as a source of information is a sustainable part of the system.
Overall the project has highlighted the requirement for adequate staff training and education to enable them to
perform adequate med rec when working in such a unit. Such education would be required for sustainability,
reminding medical staff of their roles and responsibility regarding med rec. Some of the education surrounding
medicines reconciliation could form part of the undergraduate medicine curriculum.
Reflections/Discussions (5-7 sentences)
Discuss the factors that promoted the success of the project and that were barriers to success. What did you learn from
doing this project? What are your reflections on the role of the team?
Despite being the responsibility of the medical team there has become a reliance on the pharmacy team to
complete med rec. The whole culture of the unit combined with the perceived lack of time proved to barrier to
success. With regards to leadership there is no consultant (attending) driving the improvement work resulting in a
lack of motivation within the medical team to engage with the pharmacy staff in this area of quality improvement.
Through undertaking this quality improvement project, the team members have gained an insight into the
organisation and the considerations and skills required to implement future projects. In particular, ensuring that
measures are easy to define and outcome measures are achievable.
Education of staff and team members is essential for further improvement.
By signing this document (electronic signature is acceptable), I attest that the information provided by the learners in
this project is accurate.
LEARNER(S):
Signature:
Signature:
Printed Name: Eilidh Gunn
Printed Name: Ellie Salter
Area of Study: ARSU, Ninewells, Dundee
Area of Study: ASRU, Ninewells, Dundee
FACULTY SPONSOR:
HEALTH SYSTEM SPONSOR (if different from faculty sponsor):
Signature:
Signature:
Printed Name: Vicki Tully
Printed Name: Jennifer Gray
Institution:
Institution:
University of Dundee
NHS Tayside
AUTHORIZATION
Do the learners, faculty sponsor, and health system sponsor authorize this project for publication at www.ihi.org?
☒ Yes
☐ No