Authors (including presenting author) :
Ip HT(2), Fung PK(1), Lam HY(1), Shek MK (1)
Affiliation :
[1] Department of Medicine and Geriatrics, United Christian Hospital [2] Nursing Services Division, United Christian Hospital
Introduction :
Medication errors are a significant concern in medical institutions, occurring frequently during the patient journey from admission to discharge. Up to 46% of these errors are linked to failures in medication reconciliation. This issue is particularly pronounced in Acute Stroke Unit, where stroke patients often require frequent adjustments to cardiovascular agents or anticoagulants. Such changes increase the likelihood of errors if reconciliation processes fail. Furthermore, acute stroke patients treated with intravascular thrombolysis (IV rtPA) face heightened risks of severe hemorrhagic complications if concurrent anticoagulant use is not adequately screened. Given that nurses are actively involved in patient care from IV rtPA administration to discharge, implementing a standardized, nurse-led medication reconciliation process is essential to ensure safety and improve outcomes.
Objectives :
The primary objectives of this initiative were to prevent medication errors such as omissions, duplications, incorrect dosages, or improper timing during a patient’s hospital stay and to avoid erroneous IV thrombolysis administration in patients using contraindicated anticoagulants. These goals aimed to enhance medication accuracy, improve patient safety, and ensure adherence to best practices.
Methodology :
A specialized team of Advanced Practice Nurses and Registered Nurses in the ASU was formed to address medication safety. The initiative adopted the World Health Organization’s (WHO) seven principles for medication reconciliation to create a standardized process. This process utilized the Inpatient Medication Order Entry (IPMOE) system, the Electronic Patient Record (ePR) system, and the Hong Kong territory-wide eHealth (eHRSS) system. Training sessions focused on Best Possible Medication History (BPMH) collection, incorporating demonstrations of the ePR/eHRSS systems and scenario-based exercises to tackle complex stroke cases. Patients, along with their caregivers, were actively involved in the reconciliation process to enhance medication adherence and understanding.
Result & Outcome :
The program successfully increased formal medication reconciliation training among ASU nurses from 25% to 100%, with all participants reporting improved prescription management skills. No thrombolytic or anticoagulant-related incidents were reported, and the process aligned with WHO recommendations. Nurses reported increased awareness of the importance of medication reconciliation, leading to enhanced professionalism and patient safety. Active participation of patients and caregivers proved critical for reliable outcomes. Despite challenges, such as the lack of standardized tools, the initiative highlighted the potential of advanced technologies, like artificial intelligence, to further streamline reconciliation processes and improve safety in stroke care.
