How does standardized medication reconciliation process utilizing electronic methods (I) compared to standard questionnaire (C) reduce adverse drug reactions (O) within the operative phases of care (T)?

Synthesis Project Presentation.

 2.PICOT

PICOT question: For ambulatory surgical patients(P)of age <75, how does standardized medication reconciliation process utilizing electronic methods (I) compared to standard questionnaire (C) reduce adverse drug reactions (O) within the operative phases of care (T)?

3.Systematic Search

Facchiano, L., & Snyder, C. H. (2012). Evidence-based practice for the busy nurse practitioner: Part two: Searching for the best evidence to clinical inquiries . Journal of the American Association of Nurse Practitioners, 24(11), 640–648.

Eder, M. (2012, November 19). Developing and Selecting Topic Nominations for Systematic Reviews. Retrieved October 2, 2019, from https://www.ncbi.nlm.nih.gov/books/NBK115731/.

• Key words I have used in my searches include medication discrepancies and surgery, medication reconciliation, medication errors associated with surgery, interaction of medications in surgical phases, readmission after surgery, medication history questionnaire, standardized medical history questionnaire, drug reaction in surgery, overuse of opioids in surgery.
• Inclusion criteria for patient population will be only patients having surgeries in ambulatory centers or same day surgery centers
• Exclusion criteria for patient population will be patients are classified as ASA3, cognitive impairments and age above 75
• My baseline search was to find research articles from year 2010 to 2019.For study, I have used the USA online library databases such as CINAHL, PubMed, Google Scholar, and Google search engine. I also looked for full text, peer reviewed articles, prospective studies, meta-analysis and systematic reviews.

                                    

4. Evidence slide and synthesis of main ideas plus citations

Table 1

Synthesis Matrix

Main ideas	Russ, A. L., Jahn, M. A., Patel, H., Porter, B. W., Nguyen, K. A., Zillich, A. J., … Simon, S. (2018). Usability evaluation of a medication reconciliation tool: Embedding safety probes to assess users’ detection of medication discrepancies. Journal of Biomedical Informatics, 82, 178–186	Friedman, S. (2018). Can Standardizing CABG care with clinical pathways reduce length of stay and hospital acquired infections? Seton Hall University DNP Final Projects. 25.	Vetter, T. R., Barman, J., Hunter, J. M., Jones, K. A., &Pittet, J. F. (2017). The effect of the implementation of preoperative and postoperative care elements of a perioperative surgical home model on outcomes in patients undergoing hip arthroplasty or knee arthroplasty. Anesthesia & Analgesia, 124(5), 1450-1458.	Taylor, S. Andrzejowski, J. Wiles, M. Bland, S. Jones, G. & Radley, S. (2018). A prospective observational study of the impact of an electronic questionnaire (ePAQ-PO) on the duration of nurse-led pre-operative assessment and patient satisfaction. PLoS One. 13(10)	Mekonnen, A. B., McLachlan, A. J., & Brien, J. A. E. (2016). Pharmacy‐led medication reconciliation programs at hospital transitions: a systematic review and meta‐analysis. Journal of clinical pharmacy and therapeutics, 41(2), 128-144.
Occurrence of medical discrepancies	Medical discrepancies occur due to natural errors as seen through the safety probes in the study		Medical discrepancies lead to reduction in on-time starts during surgery, anesthesia-related delays during surgery, and the rate of ICU admission.
Ability of medical practitioners to recognize medication discrepancies	Patients had a higher rate of detecting the discrepancies as compared to healthcare professionals
Need for healthcare professional education		Medical practitioners need training to follow and adhere to the critical pathways for improved patient outcomes
Interventions	There is a need for advanced interface designs Future research should focus on using technology to effectively enhance the HCPs and patients’ ability to detect discrepancies in medication	Use of critical pathways to improve patient outcome	The study implies that a PSH model is an effective way of improving operational outcomes in surgery for THA and TKA patients	Using the ePAQ-PO can lead to significant reduction in the time spent during assessment without affecting the patients’ satisfaction rates	Future research should focus on the effect of involving pharmacy technicians during medication reconciliation

 

 

 

 

Table 2

Primary Research Evidence

Citation	Question or Hypothesis	Research Design (include tools) and Sample Size	Key Findings	Recommendations/ Implications	Level of Evidence
Russ, A. L., Jahn, M. A., Patel, H., Porter, B. W., Nguyen, K. A., Zillich, A. J., … Simon, S. (2018). Usability evaluation of a medication reconciliation tool: Embedding safety probes to assess users’ detection of medication discrepancies. Journal of Biomedical Informatics, 82, 178–186	The study aimed at determining the efficacy of using usability probes in evaluating the usability of a previously developed electronic medication reconciliation tool. The article describes how using safety probes can help assess the efficacy of a tool in determining medication incongruities.	Research Design: Mixed-method design   Sample Size: A convenience sample of 20 healthcare professionals and 10 patients was used   Data Analysis: Descriptive statistics	≤50% of HCPs were able to detect the safety probes   Patients had a higher rate of detecting the discrepancies   Combined, the HCPs and the patients could detect 44.8% of the safety probes	There is a need for advanced interface designs Future research should focus on using technology to effectively enhance the HCPs and patients’ ability to detect discrepancies in medication	SORT 2
Friedman, S. (2018). Can Standardizing CABG care with clinical pathways reduce length of stay and hospital acquired infections? Seton Hall University DNP Final Projects. 25.	To develop and initiate a CABG clinical pathway that lower differences in care to enhance quality of services and improve patient outcomes for the patients	Research tools: Tableau®, Premier, CAHPS   Sample: Registered nurses and patients in the health facility where the pathway was implemented   Data Analysis: Conducted by the Tableau® and CAHPS programs for the LOS and HIA respectively	Immediately after the implementation of the pathway, the patient outcomes improved considerably The outcomes went back to baseline after two months due to reduction in momentum	The researcher recommends initiation of prophylactic treatment of atrial fibrillation and fast track extubation to reduce the length of stay further.
Vetter, T. R., Barman, J., Hunter, J. M., Jones, K. A., &Pittet, J. F. (2017). The effect of the implementation of preoperative and postoperative care elements of a perioperative surgical home model on outcomes in patients undergoing hip arthroplasty or knee arthroplasty. Anesthesia & Analgesia, 124(5), 1450-1458.	To evaluate the link between the preoperative and postoperative aspects of an initial PSH model and patient outcomes and financial/operative outcomes for THA or TKA patients	Research design: Retrospective observational design   Sample size: 1225 pre-PSH and 1363 post-PSH participants   Data Analysis: Conventional inferential statistical tests such as regression modeling	The pre-PSH group recorded 7.2% improvement in on-time starts during surgery, 5.8% reduction in anesthesia-related delays during surgery, and 2.2% reduction in the rate of ICU admission. The post-PSH group reports a $432 and $601 reduction in non-surgery costs for THA and TKA patients respectively	The study implies that a PSH model is an effective way of improving operational outcomes in surgery for THA and TKA patients
Taylor, S. Andrzejowski, J. Wiles, M. Bland, S. Jones, G. & Radley, S. (2018). A prospective observational study of the impact of an electronic questionnaire (ePAQ-PO) on the duration of nurse-led pre-operative assessment and patient satisfaction. PLoS One. 13(10)	Evaluating the impact of  ePAQ-PO on patient satisfaction and nurse consultation times in low-risk patients	Study design: Prospective observational study   Sample size: 86 patients; 43 in ePAQ-PO group and 43 in standard group	The ePAQ-PO group recorded a shorter consultation time   Both groups were equally satisfied in the services	Using the ePAQ-PO can lead to significant reduction in the time spent during assessment without affecting the patients’ satisfaction rates

 

Legend: HCPs- Healthcare Professionals; SORT- Strength of Recommendation Taxonomy; CABG- Coronary Artery Bypass Grafting; LOS- Length of Stay; HIA-Hospital Acquired Infection; THA- Total hip arthroplasty; TKA- Total knee arthroplasty; ePAQ-PO- electronic pre-operative assessment questionnaire.

5. Change model

• Rationale
• Application of phases to your setting
• Please use change model below

Kotter (1995)

Process for Leading Change·Establish a sense of urgency·Form a powerful guiding coalition·Create a vision·Communicate a vision·Empower others to act on the vision·Plan for and create short-term wins·Consolidate improvements and produce still more change·Institutionalize new approaches

adapted from: Dennison. R. D. (2013). Pass CCRN!, 4th ed. Elsevier, St. Louis, MO

 

6. Consistency between outcome, data collection, tool, variable, and test

• Collection
  • What are you measuring: Outcome(s)
  • How are you measuring your outcome: Data collection tool
  • In which groups are you measuring: Design
  • When are you measuring: Time of collection.
  • Who is measuring: Source owner
• Evaluation
  • Identification of dependent outcome Variable(s) with level of measurement(CTRL & click to follow link)
  • Data analysis/ test(s)