A Pharmacist-Led Quality Improvement Project to Optimize Medication Evaluation and Reconciliation in Home Healthcare

Medication reconciliation was adopted as a National Patient Safety Goal by the Joint Commission in 2005 and is now standard practice across care settings. More recently, the concept of medication optimization has gained attention, recognizing that safe medication use requires more than reconciliation alone. Home healthcare (HHC) is one setting with a critical need for medication optimization. This work describes a pharmacist-led interdisciplinary team (IDT) effort to reduce hospitalization rates at Providence VNA Home Health by improving medication reconciliation, evaluation, and prescriber communication. The IDT developed a tool and a 1-hour training with operational definitions and scenarios for reconciliation and documentation, along with a separate training focused on medication evaluation. To assess training effectiveness, the primary outcome was to reduce 30-day hospitalizations among high-risk heart failure patients to below 12%. This outcome was met and sustained for 8 weeks post-implementation. A secondary goal-reducing 30-day rehospitalizations per Strategic Healthcare Programs (SHP)-was also met and sustained from April to December 2020. This quality improvement project demonstrated that enhancing medication reconciliation and evaluation in high-risk patients reduces hospitalizations. Reconciliation may be especially important in patients with two or more self-reported unreconciled medications in the EHR, which may signal suboptimal medication evaluation. Addressing the challenges HHC clinicians face in optimizing medications and reinforcing best practices can improve outcomes. Pharmacists play a key role in interdisciplinary teams in HHC, given the complexity of medications and their impact on quality measures.