Medication Reconciliation in a Rural Outpatient Setting

Abstract

Purpose: The purpose of this quality improvement project has two primary objectives. First, it aims to establish baseline data on the accuracy of medication lists within a small rural health practice by implementing the Brown Bag Method (BBM) medication reconciliation process. The second primary purpose of the project is to increase knowledge of, confidence in, and intent to perform medication reconciliation by combining education for both staff and patients with the BBM process. The overarching long-term goal is to reduce medication errors, thereby decreasing ADEs, morbidity, and mortality. Background: Each year, nearly 7 million individuals experience medication errors (MEs) and resulting adverse drug events (ADEs), often leading to injury, disability, and even death. Medication reconciliation systematically compares a patient’s current medications with their medication list to ensure accuracy. It has been shown to reduce MEs and ADEs. While primary care settings lack a standardized approach, the Agency for Healthcare Research and Quality (AHRQ) proposes the BBM as an effective and thorough method for completing this task. In this rural practice, the owner and sole medical provider identifies medication reconciliation as a persistent challenge, particularly as patients' medication regimens frequently change due to specialist visits, hospital admissions, and patient preferences. Methods: This project employs a quantitative descriptive design focusing on introducing a formal medication reconciliation process using the Brown Bag Method (BBM) to the practice. The primary investigator (PI) will conduct a BBM reconciliation with practice patients to establish baseline data about the accuracy of medication lists in the practice. The project will also include educational interventions for patients to explain the medication reconciliation process and its importance. By combining formal medication reconciliation with targeted education, the project aims to increase knowledge of medication reconciliation, confidence in the process, and intent to participate. Results : Of the 10 patients who participated, 9 (90%) had at least one discrepancy between their reported and documented medication list. The most common discrepancies included missing over-the-counter medications and duplicate prescriptions. On the post-intervention survey, 8 out of 10 participants agreed or strongly agreed that they learned about the importance of reviewing medications. Seven participants agreed or strongly agreed that they felt more confident keeping an accurate medication list, and six agreed or strongly agreed that they intended to participate in medication reconciliation at future visits. Conclusion: The BBM was feasible to implement in this rural clinic and was well received by participants. It revealed high rates of discrepancies in medication lists and highlighted the value of medication reconciliation in improving medication safety. Though the sample size was small, the intervention showed promise in enhancing patient understanding, confidence, and engagement. Site-specific recommendations were made to support ongoing implementation and sustainability.