Effect of an educational intervention on surgical house staff’s medication reconciliation knowledge and practices

Pharmacy residents have the opportunity to complete a research project during their residency training, which provides them with skills on how to conduct and manage a research project. Projects often represent an area of interest and need that has been recognized by the host institution’s pharmacy department. Projects are presented as a poster at an annual CSHP Ontario Branch Residency Research Night, and many eventually go on to be published in a peer-reviewed journal.Background: Medication reconciliation is recognized as an important medication safety initiative. It is acknowledged that a comprehensive education program incorporating new staff training and ongoing instruction is a key success factor for medication reconciliation programs. Despite this, the impact of education on medication reconciliation practices is not well described. Currently, formal medication reconciliation training for physicians at Kingston General Hospital (KGH) is comprised of only a brief overview for new medical house staff during hospital orientation. Objectives: To develop and deliver a medication reconciliation educational intervention within the surgical services at KGH and to evaluate the effect on medication reconciliation compliance, quality, and knowledge. Methods: An educational intervention was developed and delivered to 24 general surgery, orthopaedic surgery, and urology residents. Medical records data were used to measure compliance. Patient charts with a documented Best Possible Medication History (BPMH) by both a pharmacist and a physician who attended the educational intervention were used to measure quality. A total of 20 charts pre-education and 20 charts post-education were randomly selected to evaluate the mean number of discrepancies/number of medications/patient, and their potential clinical significance. Pre-education and post-education tests were administered to measure knowledge. Results: Post-education medication reconciliation compliance significantly increased from 53.8% to 69.8% (P < 0.001). The mean number of BPMH discrepancies/number of medications/patient was significantly reduced (0.72 pre-education versus 0.52 post-education, P < 0.001). There was no difference in the relative distribution of discrepancy clinical significance classes (P = 0.191). No difference in test scores was noted among residents who completed the knowledge tests (57.8% pre-education versus 64.4% post-education, P = 0.317). Conclusion: A medication reconciliation educational intervention delivered to KGH surgical house staff significantly improved compliance with and quality of medication reconciliation documentation. This supports implementation of hospital-wide formal physician education due to the potential patient safety implications