Nurse-Led Medication Reconciliation Protocol in the Adult Outpatient Mental Health Setting

This scholarly project implemented a medication reconciliation protocol within the adult outpatient mental health clinic setting. The protocol aimed to increase the medication reconciliation rate from 55% to 60% within three months by May 2025, as well as improve the perception of medication reconciliation among nursing staff. The project was implemented within an outpatient mental health clinic, part of a local community mental health center in Austin, Texas. Patients often see multiple healthcare providers, leading to risks of polypharmacy. This can lead to adverse reactions, medication interactions, and hospitalizations. A flowsheet protocol was created to help guide nursing staff on the process of medication reconciliation. Changes to the protocol during the implementation period were guided by the Plan Do Study Act method. Likert scale questionnaires were distributed before, during, and after the implementation to assess nursing staff’s perception of the medication reconciliation process and effectiveness of the protocol tool. Three nursing staff participated; however, staff turnover limited the ability to have an adequate sample size. A 10% increase in medication reconciliation rate was seen compared to baseline rate of 55% and the post-implementation rate of 65%. Post-implementation questionnaires showed that nursing staff believed the protocol to be easy to interpret, improved the reconciliation process, and fits into their workflow. Barriers to medication reconciliation included workflow compatibility and implementation climate factors, such as staff turnover. It is recommended to extend the use of the protocol to other outpatient mental health clinics and integrate it into the electronic health record system.