Twelve-week project to improve medication reconciliation at hospitals in Wellington, New Zealand.

Inaccurate prescribing of medications on admission to hospital exposes patients to significant risk, both during the admission and at discharge. Initial data at Capital and Coast District Health Board (CCDHB, Wellington, New Zealand) showed that 0% of medication reconciliations initiated by pharmacy were completed correctly. A widespread lack of awareness of existing processes and communication differences between doctors and pharmacists were identified as root causes of the problem. A 12-week quality improvement project collected baseline data and then three interventions were carried out aiming to improve the rate of completed medication reconciliation. The interventions were education of house surgeons (junior hospital doctors), standardisation of pharmacist practice and a redesigned paper notification system. After three plan, do, study, act cycles our results showed an improvement in the rate of completed medication reconciliations from 0% to 37% and an improvement in pharmacist uptake of text messaging from 30% to 88%. The rate of partially completed reconciliations (where discrepancies were reconciled but documentation was not completed) fell from 82% to 37%. We were not able to show an increase in proportion of discrepancies rectified (in fact a decrease occurred) due to our data collection methodology. The interventions made have improved the quality of medication reconciliations at CCDHB and are likely sustainable in the longer term.