Comparison of Audit Techniques
An easy, efficient method to assess adherence to process ("quantity" assessment).
- Tracks percent adherence for documenting medications patient takes prior to admission (e.g., quantity of medication history documentation).
- Tracks percent of nursing and/or pharmacist adherence, by unit, for completing medication reconciliation documentation form (e.g., quantity of reconciliation).
- May be able to sample up to 100% of patients.
Manual Retrospective Evaluation
Although time consuming, a manual chart review can be used to obtain percent adherence to process ("quantity" assessment) in addition to assessing the "quality" or effectiveness and patient safety benefits.
- Tracks quality of the collection of medications the patient was taking prior to admission (e.g., quality of medication history verification and documentation).
- Tracks the type of discrepancies, number of interventions, drug/drug class involved, harm averted, etc. ("quality" of history verification and reconciliation).
- Sample size is determined by the time and resources available for manual auditing.
Manual Prospective Evaluation
In addition to the quantity and quality data collected in the audits above, this audit also captures the following:
- Independent reviewer obtains medication history (approximately 24 hours after admission), which is reconciled with physician's medication history and current orders.
- Independent reviewer evaluation is in addition to current medication reconciliation process.
- Evaluation of data tracks who made intervention (MD, RN, RPh, reviewer) and also shows missed opportunities (medication reconciliation failures) with the current medication reconciliation process.
- Ability for reviewer to intervene on any missed opportunities and provide real-time feedback to staff for continued process improvement.
- High-risk areas can be targeted for this evaluation to avoid potential harm (e.g., intensive care units, oncology).
Note: Independent reviewer could be any discipline involved in medication reconciliation (e.g., physician, nurse, or pharmacist), a quality improvement leader, patient safety representative, or researcher. The reviewer must feel empowered to intervene if errors are identified.