Medication reconciliation in an emergency department: a process of continuous improvement

Abstract Objectives: to structure an improvement plan for medication reconciliation in a Portuguese emergency department. Method: The improvement project was developed using the Plan, Do, Act, Plan (PDSA) methodology in an observational, descriptive, quantitative study. In the Plan stage, 282 patients admitted to the emergency department participated, whose family member had received a nursing teleconsultation; and 447 participated in the Study stage. The teleconsultation was structured using the Identify, Situation, Background, Assessment, and Recommendation (ISBAR) technique; the team was trained. Results: in nurses’ usual practice, 4.6% (n=13) unintentional discrepancies were identified between the prescription and the medication in use at home. The number of discrepancies increased to 9.4% (n=42) after the teleconsultation was structured to include questions about usual medication. The most frequent discrepancy, which was later corrected, was the interruption, especially of drugs that act on the central nervous system, of the wrong dose/frequency. Conclusion: the study helped to identify/correct failures in medication reconciliation, highlighting the importance of nursing and family participation.