Authors (including presenting author) :
Tsim SY(1), Chan OL(2), Chan YT(2), Shest PY(2), Li MC(2)
Affiliation :
(1) Nursing Services Division, United Christian Hospital, (2) Department of Medicine and Geriatrics, United Christian Hospital
Introduction :
Co-morbidities and poly-pharmacy are very common in geriatrics. Even more, the medications are often dispensed by different specialties in different healthcare settings. This makes medication management complicated and challenging to both healthcare workers and caregivers.
Objectives :
1. To promote medication safety and increase nurses’ awareness of the importance of valid and most updated medication prescription on top of “three checks five rights”.
2. To enhance medication education provided to caregivers of our geriatric patients as they are less capable of taking care of their own medications.
Methodology :
Align the workflow of checking the validity of medication prescription upon patient’s admission / discharge and make it as a compulsory practice before its commencement in February 2022 as follows:
Check in: case nurses are required to check drug profiles of all cases transferring in ward 11A. This is to ensure the medication prescription on IPMOE is from the latest episode and all medications are resumed unless stated with indications corresponding to the latest clinical conditions. Special attention is paid to medications from other specialties such as eye or psychiatric as they are easily overlooked.
Check out: case nurses are obligated to check the medication regime in discharge summary against 1. the IPMOE record 2. the drugs on hand of patient. This is to ensure any medication changes in this episode is updated and own stock is available / new drug is dispensed. Any unintended discrepancies must be clarified with physicians. Medication education is provided to caregivers concerning medication changes. Records are kept for 2 weeks before proper disposal to facilitate record tracing while balancing patient privacy.
Result & Outcome :
The records are spot checked randomly on a regular basis by designated nurses. A total number of 300 cases are inspected. All nurses are able to follow the workflow of nurse-led medication reconciliation. They all agree that medication safety awareness is enhanced. Prevention of medication incidents is largely achieved as a medication safety culture is cultivated. No medication incidents including drug omissions, dosing discrepancies upon admission and discharge are reported since the commencement of practice. A significant decrease in number of incoming calls from caregivers enquiring medication regime are noted as education is provided once changes are noted. This significantly reduces the workload of nurse and thus more time could be spent on other nursing care. Both patient safety and work efficiency are promoted.
