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Departments: QSEN & NURSING EDUCATION

Medication Reconciliation

Altmiller, Gerry EdD, APRN, ACNS-BC

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doi: 10.1097/NNE.0000000000000512

Recent studies1,2 indicate that faculty need resources and continuing education to integrate the Quality and Safety Education for Nurses (QSEN) competencies into nursing curricula. This is accomplished using innovative approaches to meet this accreditation requirement in preparing nursing students for the expectations of current practice. Most important to this work is understanding that integration is not teaching the 6 competencies; it is implementing purposeful activities designed to facilitate students developing the knowledge, skills, and attitudes needed to meet the competencies and to translate that learning into actions. Current practice concerns can serve as the stimulus for developing focused learning activities for students.

One of The Joint Commission’s high-priority patient safety goals is to provide medication reconciliation for all patients.3 For students to view medication reconciliation as a significant safety practice that improves the quality of care, they must first recognize its value in identifying potential drug interactions, unsafe prescriptive redundancy, and patient knowledge deficits related to safe medication use. Faculty need to create opportunities for students to experience the process of a medication reconciliation in a safe learning environment where there is less emphasis on completing the form in a timely manner and more emphasis on developing skills for obtaining information and recognizing safety threats related to the patient’s prescribed medication regimen.

Many quality and safety teaching strategies to support student learning are available on the QSEN Web site (www.QSEN.org). These free resources contain instructions for implementation, the actual learning materials, and suggested methods for evaluation of learning. One that fits well for the first class of an adult medical-surgical course is an 8-slide unfolding case study addressing medication reconciliation for a patient presenting to the emergency department with symptoms of congestive heart failure.4 As students move through the exercise, they uncover information from the patient that allows them to identify dangerous drug interactions and unsafe health practices, signaling needs for patient education and adjustments to the medication regimen. This interactive learning experience challenges students to gather information from a reluctant patient, react with the next questions, and appreciate their knowledge and ability to protect patients from harm related to medications.

To connect the knowledge and attitude development of this classroom experience to clinical learning and skill development, changes can be made to the patient medication list that students complete each week. In addition to listing the standard information of classification, mechanism of action, dose, and nursing implications, students can be required to include, at the bottom of the page, the date and time they spoke to either the patient or a family member about the medications (without including names or identifying information) (Supplemental Digital Content, http://links.lww.com/NE/A459, Figure). This additional requirement ensures a discussion between care provider and patient or designee, which is the essential component of effective medication reconciliation.

Integrating educational activities for medication reconciliation into classroom and clinical learning can support students in achieving competency in patient-centered care, safety, and informatics. By developing knowledge, skills, and attitudes that support these competencies, students not only learn to value the systems in place to improve quality and safety but also recognize their own role in improving health care through actions rooted in the QSEN competencies.

References

1. Altmiller G, Armstrong G. 2017 National Quality and Safety Education for Nurses faculty survey results. Nurse Educ. 2017;42(5S suppl 1):S3-S7.
2. Cooper E. Quality and Safety Education for Nurses implementation: is it sustainable? Nurse Educ. 2017;42(5S suppl 1):S8-S11.
3. The Joint Commission. National patient safety goals. 2017. Available at https://www.jointcommission.org/hap_2017_npsgs/.
4. Young J. Medication reconciliation. 2008. Available at http://qsen.org/medication-reconciliation-2/.

Supplemental Digital Content

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