Improving Medication Reconciliation Through an Older Adult Education Initiative

It is estimated that nearly 40% of all hospital admissions in the United States are adults age 65 and older, with approximately 30% of these being a result of medication adverse reactions. Inadequate medication reconciliation across care continuums contributes greatly to this problem and may cost nearly half of every healthcare dollar spent (Mattison, 2015). The increasing complexity of medication regimens leaves older adults vulnerable to the hazards of polypharmacy and adverse drug reactions and puts them at high risk for medication errors during care transitions such as admissions, discharges and transfers. This evidence-based project involved a comprehensive medication educational initiative utilizing a teach-back methodology, which improved older adult involvement in medication reconciliation during care transitions. Customized 1:1 education sessions focusing on the safe use of high-risk medications were developed and conducted based on the responses to a pre-education medication knowledge questionnaire. The effectiveness was then evaluated by a post-education questionnaire. An overall improvement in participant medication knowledge was realized from a group mean of 3.8 (Pre) to 4.42 (Post), which met the defined 4.0 benchmark. Medication errors as a result of incomplete or inaccurate medication reconciliation must be addressed as a global issue. Advanced Practice Nurses (APRNs) must work collaboratively with other members of the healthcare team including physicians and pharmacists to address this monumental healthcare dilemma. Working together as a cohesive team will help address this problem. The APRN should act as the change agent, strategically placed as a pivotal member of the inter-professional team who is responsible not only for the older adults under their care, but the public at large.

As patient advocates, APRNs can assume the transformational leadership style that is often associated with positive patient-safety outcomes, integrating research into daily practice. As an CNS whose focus is gerontology, there is the added important leadership role in bringing attention to medication safety issues that arise in the care of older adults and to give intelligent, compassionate guidance to all stakeholders involved, including inter-professional team members. CNSs have tremendous opportunities through assessment, monitoring, teaching and evaluation to intervene so that maximum benefit (beneficence) and minimal harm (non-maleficence) come to America’s older adult population receiving complex drug therapies (Guido, 2014). A framework for transforming patient educational processes will be provided to ensure a seamless transition into CNS practice. This framework can easily be translated into any patient/family interaction, throughout the lifespan, not just the older adult.