Improving 24-Hour Medication Reconciliation Through Audit and Feedback: A Multicycle Quality Improvement Study at a Scottish District General Hospital

Introduction Medication reconciliation (MR) is a key patient safety process during hospital admission. MR ensures an accurate list of a patient's medications is compiled on hospital admission, enabling safe downstream prescribing and reducing adverse events. This responsibility falls primarily to the admitting clinician in paper-based systems with limited pharmacy input at the point of admission. This study aimed to assess local compliance with the national benchmarks and evaluate whether a structured audit-feedback intervention could improve MR documentation and the recording of reasons for withholding medications. Methods This quality improvement project was conducted over four 1-week periods: an initial audit, a pre-intervention baseline, a post-intervention follow-up, and a reaudit 10 days later. The medical records and prescription charts of 305 acute admissions were reviewed within 24 hours of presentation. The primary process measures were (i) the proportion of patients with a documented MR and (ii) the proportion of withheld medications with a documented reason, recorded in the clinical notes, drug chart, or MR sheet. The intervention included personalized compliance feedback to admitting doctors and consultants, public recognition of high performers, and educational posters placed in clinical areas. Two-proportion Z-tests were used to assess significance. Results The proportion of patients with a documented MR increased from 55 of 73 (75.3%) pre-intervention to 50 of 65 (89.3%) post-intervention (p = 0.044), and further to 64 of 69 (92.8%) at reaudit (p = 0.0049). The proportion of withheld medications with a documented reason rose from 23 of 39 (59.0%) to 30 of 37 (81.1%) post-intervention (p = 0.036) and remained elevated at 35 of 44 (79.6%) during the reaudit (p = 0.041). The most commonly withheld medication classes were diuretics (n = 27, 14.5%), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (n = 24, 12.9%), and statins (n = 16, 8.6%). The most frequent reasons for withholding were acute kidney injury or dehydration (n = 39, 27.8%), hypotension (n = 15, 11.5%), and medications deemed not indicated (n = 15, 11.5%). Conclusion A targeted, low-cost audit-feedback intervention directed at admitting clinicians significantly improved compliance with MR standards and the documentation of withheld medications. These findings suggest that, even in resource-limited, paper-based settings, behavioral strategies can deliver meaningful improvements in prescribing safety and move practice closer to national standards.