Date of Award
Summer 2023
Document Type
Final DNP Paper
Degree Name
Doctor of Nursing Practice (DNP) in Family Nurse Practitioner
Department
Nursing
Faculty Chair
Jessica Coe Lockhart, DNP, CRNP, FNP-BC, FNP-C
Preceptor
Frances Koe, MD
Abstract
Background: Medication safety by reducing the proportion of older adults who use inappropriate medications is a Healthy People 2030 goal (Office of Disease Prevention and Health Promotion, n.d.(a)). The research for this proposal supported an established medication reconciliation (MR) to reduce errors and adverse drug events (ADEs). Consistent MR is essential for patient safety and positive patient outcomes in rural outpatient primary care clinics, as these patients possess multiple comorbidities.
Purpose: This Doctor of Nursing Practice (DNP) quality improvement project (QIP) established a routine MR process within a rural primary care clinic with reduced unnecessary polypharmacy and decreased risk of medication errors and ADEs as the implementation goals.
Methods: The DNP QIP included stakeholder meetings to identify the goals and discuss the QIP development, an educational session for clinic staff before the QIP implementation, and printed resources for the clinic staff and patients to reinforce awareness of the evidence-based practice (EBP) QIP.
Results: The post-implementation report produced a total of 99 patient visit records within the March 18-31, 2023, evaluation period. Ages ranged from 65-97 years with an average of 74.9 and a median of 81. There were 53 female and 46 male patients. The primary goal was to establish a consistent, routine MR process to address unnecessary polypharmacy in patients 65 and older, which documented consistent review of medication lists for polypharmacy for at least 95% or greater of all appointments at the end of the QIP or a greater than 4.4% increase (≥95%) of patients having a “medication review” completed less than 90 days ago, based on a retrospective chart review, compared to the baseline data collected. This goal was met with all 99 patient visits (100%) having a documented MR within the last 90 days. Other measurable clinic-specific goals included a 10% or more significant reduction of patients with nine or more “unnecessary” medications listed (≤83.25%). This goal was also met with only 64 of the 99 patients (64.6%) having listed nine or more current medications. Of these patients, it was noted that female patients had the higher rate of nine or more medications at 53.1% (34/64), while 46.9% of male patients (30/64) had nine or more medications listed on their recent MRs.
Conclusion: This QIP addressed unnecessary polypharmacy in older adult patients in a rural primary care setting. The results of the QIP provided encouraging findings and supported the hypothesis that primary care providers can appraise patient medication lists in an effort to successfully deprescribe. The results also validated the evidence in the literature review advocating education and evidence-based QIPs as part of those efforts. This QIP was successfully implemented during the eight weeks, and the MD-PC reported that she and the NP providers could see other benefits of the QIP including simplifying patients’ medication lists, ensuring continuity of care, and preventing potential interactions or unnecessary side effects from medications. They also agreed that they saw re-freezing of the process begin as early as six weeks into the QIP. Preceptor evaluations were scored highly (5/5) and her comments were appreciative of the QIP being implemented at the clinic.
Recommended Citation
Kirkwood-Harp, Jessica, "Establishing a Routine Process of Medication Reconciliation in a Rural Primary Care Clinic to Address Unnecessary Polypharmacy in Patients 65 and Older" (2023). Doctor of Nursing Practice Projects. 102.
https://digitalcommons.jsu.edu/etds_nursing/102
Included in
Family Medicine Commons, Geriatrics Commons, Patient Safety Commons, Primary Care Commons, Public Health and Community Nursing Commons, Quality Improvement Commons