Improving medication reconciliation during care transitions at a tertiary care cancer center.

427 Background: Accurate medication reconciliation at admission is crucial for patient safety, especially in oncology populations with complex regimens. We launched a quality improvement project to standardize the medication reconciliation (Med Rec) process and reduce delays in restarting home medications. The intervention was guided by the WHO’s High 5s project and the MARQUIS Toolkit. Methods: Process mapping and Root Cause Analysis (RCA) identified key gaps, leading to Standard Operating Procedures (SOPs) ensuring timely, high-quality Med Rec. Emphasis was placed on Best Possible Medication History (BPMH) protocol, role clarity, and a chain-of-contact system among all teams. Education sessions were done, and hospitalist shift cards introduced for accountability. Pre- and post-intervention data were analyzed with two-sample t-tests assuming unequal variances. Process measures: 1. time from admission to medication history confirmation, 2. time from confirmation to medication restart, 3.nursing role clarity, 4. contact protocol awareness, and 5. hospitalist awareness of EMR indicators. Outcome measures assessed satisfaction of hospitalists and nurses. Pre-intervention data covered 3,577 patients over 29 weeks and surveys from 129 nurses and 29 hospitalists. Implementation began in March 2025; post-surveys and Phase 2 education are ongoing. Post intervention data set included 1320 patients. Results: Post-intervention, medication restart time significantly decreased from 31.6 ± 13.1 to 16.9 ± 4.8 hours (46.5% reduction; p < 0.001). SPC charts showed special cause variation. Medication verification time slightly increased (12.1 ± 3.0 to 14.2 ± 4.4 hours) but this was not statistically significant (p = 0.19). Initial post-implementation trends show sustained improvement and positive staff feedback. Conclusions: A focused, SOP-based intervention markedly reduced medication restart delays without compromising verification quality. Early results indicate better interdisciplinary coordination. Ongoing evaluation will assess sustainability and workforce impact. Comparison of medication verification and restart times before and after SOP-based intervention. Measure Pre-Intervention Mean ± SD (hours) Post-Intervention Mean ± SD (hours) Sample Size (Weekly Data Points) Patients Represented (Pre / Post) p-Value 95% Confidence Interval (Difference) Home Medication Verification 12.1 ± 3.0 14.2 ± 4.4 29 / 10 3,577 / 1,320 0.19 -5.4 to 1.2 Medication Restart Time 31.6 ± 13.1 16.9 ± 4.8 29 / 10 3,577 / 1,320 <0.001 8.9 to 20.5 Home Medication Verification Time: Time (in hours) from patient arrival on the floor to completion of home medication history. Medication Restart Time: Time (in hours) from medication history completion to the restart of home medications by the hospitalist. Statistical comparisons: Two-sample t-tests assuming unequal variances.