(P43) Medication-Reconciliation Quality Improvement With a Reverse Hand-Off at a Nursing-Home

Objective/Aim: By the end of 11/2022, we will increase the rate of reverse hand-offs performed by accepting providers at the skilled nursing facility by 50% as a process measure.

Background: Medication reconciliation (Med-Rec) errors commonly occur during the transition of care from a hospital to a skilled nursing facility. We aim to improve Med-Rec by using an EMR chat function to initiate a reverse hand-off between providers.

Quality Improvement Methods: We created a process map to identify the areas contributing to Med-Rec errors. We categorized the pertinent processes. A: Error in the discharge documents. B: Error in the administrative process. C: Error of final Med-Rec at the skilled nursing facility.
42 admissions from a single hospital partner were reviewed from 9/2021-9/2022. Data were collected by chart review of the electronic medical records and paper charts of both facilities.

Results: 42 patient records were reviewed. Errors in discharge documents were present in 30.9% of admissions. Examples included discrepancies between the discharge summary and the medication list (A). Errors in the administrative process were present in 2.3% of cases. Examples included patients at the skilled nursing facility with missing hospital discharge documents (B). Admission order errors related to discharge documents were identified in 11.9% of cases, whereas the independent errors not related to discharge documents were only 2.3% (C).

Conclusions: 30.9% of skilled nursing facility admissions had errors in hospital discharge documents; 61% of those cases were identified by the accepting providers and corrected on admission. The corrections were identified by the accepting providers by accessing the hospital medical record directly or by calling the hospital provider to clarify. The process of the accepting provider calling the sending provider (“reverse hand-off”) was very effective, especially when there were concerns about discharge documents error (A).
Intervention and PDSA:
The reverse hand-off was noted to be effective at preventing medication errors. However, a reverse hand-off was done in only 30% of the 10 most recent admissions. For this reason, a secondary option for performing a reverse hand-off was selected as an intervention: using an EMR chat function. We surveyed the providers at the skilled nursing facility. The survey response rate was 90%, and it revealed that 40% of the providers did not know how to use the chat function in the EMR. We worked with the providers to enable their chat access and demonstrated how it could be used to communicate with the sending providers. A repeat survey was conducted 2 weeks later, which showed an 80% response rate with one successful “reverse hand-off” case using the chat function in the EMR out of the 11 admissions (9.0%) over 1 week. Even though this repeat survey did not show a significant change in the “reverse hand-off” rate, all of the providers at the nursing home are now aware of how to use the chat function of EMR to contact the sending providers (previously only 60%). The rates of the “reverse hand-off” (process measure) and Med-rec errors are expected to decrease over time (outcome measure).