Knowledge Translation: Making the Evidence for Medication Reconciliation Meaningful

Monday, 30 July 2012

Kim McAuley, RN, BSN
Quality Management, Covenant Health System, Lubbock, TX

Learning Objective 1: Discuss how theoretical concepts from Knowledge Translation can be applied to medication reconciliation and discharge instruction to decrease readmissions.

Learning Objective 2: Discuss the use of an evidence-based practice approach to medication reconciliation and discharge instruction.

Purpose:  According to a 2007 Congressional report, hospital readmissions cost Medicare an estimated $15 billion annually.  Globally, a significant percentage of readmissions could be avoided with better medication reconciliation practices.  The purpose of this project is to evaluate the effectiveness of Knowledge Translation theory to guide nursing education on medication reconciliation and discharge instruction to increase understanding of “why” change is needed.

Methods:  A literature review was conducted to evaluate the evidence linking readmissions to medication reconciliation and discharge instruction.  An education awareness intervention was developed using Knowledge Translation concepts. This project uses a quasi-experimental, pre-test post-test design.  The research questions for this study are 1) What is the rate of inaccurate medication reconciliation/discharge instruction among heart failure patients prior to discharge? 2) Can the percentage of medication reconciliation inaccuracies at discharge in the cardiac service line be decreased by using the Knowledge Translation nursing education intervention? 3) What is the change in readmission rate for the cardiac service line pre and post Knowledge Translation nursing education awareness intervention?

Results:  The results of the research questions are 1) During a nine month period, 86.5% (n=199) of 230 heart failure patients were found to have inaccurate medication reconciliation/discharge instruction prior to discharge.  2)  Pre-test data collection, via chart review, is in progress using a random sample (n=67) of cardiac service line patients.  The Knowledge Translation nursing education intervention will immediately follow pre-test data collection.  3)  The pre intervention readmission rate for the cardiac service line is 13.8%.  Post test data will be collected and analyzed by t-test following the intervention. 

Conclusion:   Incorporating elements from Knowledge Translation theory to a nursing education intervention may improve medication reconciliation and decrease readmission rates, and merits further study.