Performing a Medication Reconciliation in an Ambulatory Setting

Performing a Medication Reconciliation in an Ambulatory Setting

In the past three decades, there have been many medical errors together with the numerous adverse effects and drug reaction that have been prevalent within the healthcare continuum. Research has shown that there are close to five percent of deaths that take place in the united states alone that come from the adverse reaction towards the drug by the patients. This alarming number makes it one of the leading causes of deaths in the United States.  As a result, there is the need to have the most accurate forms of medication reconciliation as a method that can help in the protection of the patients from the possibilities of having the medical reaction. The results from the performance show that there is the significant number of the prescribed and the and the over the counter medicine record that is missing from the databases and the high number of potential drug interaction by the outpatients. It is therefore essential that the process of medication reconciliation should be performed to help with the situation as part of this project.

Key words:  Practicum project, medical reconciliation, adverse drug event, ambulatory patients, outpatients, inpatients, medical errors, drug admission, counter drugs.

Medication Reconciliation in an Ambulatory Care setting

Whether a patient has been admitted or operates as an outpatient in the outpatient facility in the medical practice, there is a huge significance in offering the most accurate medication list that is understood by the practitioners.   The increasing amount of medicine also comes with the transition of errors that takes place between the provides and the outpatients.  This leaves the same patients quite vulnerable to errors. The outpatients, especially those that deal with psychiatric treatments are quite vulnerable to the reaction towards the drugs that do not match their systems. Most of these drugs are powerful and hav to be administered I the right way.




The important medical errors together with the adverse effects that come with them have become a serious issue in the outpatient facilities and the skilled nursing facilities (McCarthy, Surown, Turple, Brown, Walsh, and  Rochon, 2016). The problem even increases when it comes to the provider’s practice that offer the services at the home settings.  The adverse drug events is a concerning issue as it results to more than seven hundred thousand emergency visits and more than one hundred thousand hospital hospitalizations every year. This is a concerning number considering the costs that are incurred in the emergency medication and hospitalization that could be easily avoided by performing a medical reconciliation (Almanasreh,  Moles, and Chen, 2016). Besides, about five percent of the patients that are getting hospitalized are also affected by adverse drug events.  Tye common inpatient errors also result in some patient suffering prolonged effects if they become ambulatory patients. The main aim of this project is to perform a medical reconciliation with an objective of reducing the medical errors that have existed in the past three decades in ambulatory patients. Through the use of the existing records, it is necessary and important to have well balanced and an accurate administration of drugs for the ambulatory patients to avoid the possibilities of having adverse drug effects (Phan, Williams, McElroy, Burton, Fu, and Khandoobhai, 2019).


The Goals, the Objectives and the Expected Outcomes of the project

The main goals of performing this  project are the following

To show the importance of performing the medical reconciliation in the outpatients and the ambulatory patients

To show the impacts of adverse drug effects on the ambulatory patients

To give the best strategies that can be used o analyze the most appropriate reconciliation programs

To give a well structured ambulatory medical reonciiation]

To prevent the errors that are experienced by the medical practitioners especially while they are administering the drugs.

To recommend the best practices of administering the over the counter drugs

To show the positives of having a  wl structured ambulatory reconciliation process in the ambulatory patients and the outpatients.

Objectives and expected outcomes

With the help of the management and other staff members, the evidence-based practice medication for the reconciliation projects are  implemented through the DNP students

The goal here is the fisty percent medication reconciliation rate of completion

The intervention also takes place in the three months between April and June.  After this, there is the Analysis of the results in relation to the objectives for the evidence-based practice.  This process is therefore supposed to stay in the ambulatory setting for further use in the place.



The constant medical errors that come from the diverse effects of drugs have led to the nation losing several billions of money every year. It has led to the continuous admission of the patients and the increased hospital stay (Turchin et al.,2018). Most importantly, it has led to the loss of innocent lives that can be saved by sim0ly having a successfully structured medical reconciliation.  This risk comes as a result of incomplete or inaccurate medical reconciliation. The lack of structured reconciliation also affects the ambulatory patients who find it difficult to adhere to the demand of the drugs. Thi is the rationale of this project where there is the development and reconstruction of medical reconciliation done on the ambulatory patients.





Methodology and project design


This project uses qualitative quasi-experimental design were the participants are taken through the practical reconciliation poses together with the other participants.  The participants who had the appointments with their caregib=vers are asked whether they are wiling to be part of this reconciliation process for the better improvement of the medical provision (Smith et al., 2016). After they have accepted, they are then asked to provide their medical prescriptions to top determine whether they have followed the stated processes or not.  The records also show whether they have adhered to the subsequent appointments that they had been assigned so tat here can be an effective reconciliation. The patients and the caregivers are eventually reconciled to avoid the lack of compliance which is a danger to the patients (Armor, Wight, and  Carter, 2016). The people who are not available are contacted through the phones s their record are in the database. They, re then inquired if they re also willing to take part in the project.  The sample used is twenty theee patients who must be adults over eighteen years of age as required by the law.


Project design


The project will be the stepwise approach here the AHRQ medicine, and transition toolkit are used in the implementation. Since the current medical reconciliation is inefficient and ineffective, there is the need to use the evidence-based practice to improve ambulatory patient safety through the process of initiation.

Project population and site

This project takes place in the laboratory setting where the community members get the attention, especially the psychiatric setting where the outpatients get the psychiatric services such as psychotherapy, medical management, and interventions for substance abuse.  Being that this is a community setup, there is a significant number of patients who are under the Medicare or the Medicaid of the federal Medicaid. A total of fo 900 outpatients are to be served with 300 families undergoing stabilization (McCarthy et al., 2016). The compliance schedule with the appointments for the patients is one of the issues that are identified with these ambulatory patients. This is a group of a smaller core that can sometimes cancel their appointments with the providers of medical care. The lack of compliance is an issue that also happens o be linked with overdose and underdose. For the patients that do not ant to comply, they are likely to risk their lives by overtaking the drugs to compensate for the lack of compliance and adherence.



Literature review

One of the biggest concerns in this issue os the lack of the well structured and relevant ambulatory process making the ambulatory patients to the adverse drugs events.

The reaction from the drug events accounts to more than 135 billion dollars on a yearly basis. This amount is even higher than the amount that is spent on cardiovascular diseases together with diabetes, two of the most concerning issue in the united states as well (McCarthy et al., 2016). A medical reconciliation refers to the formal process that the healthcare professionals do in orde to have the complete discrepancies that can be possibly existing as well as informing the prescribing decisions so as to identify and to prevent tye possibilities of a medical error from occurring (Andrus, and Anderson, 2015).  This project involves the process of performing the medication reconciliation process within the ambulatory setting.  This includes implementing the evidence-based practice of the medication reconciliation and a protocol that follows the ample of twenty-three patients that are within the ambulatory setting. This shows how important it is to have a well structured ambulatory care that can help reduce the possibilities of having to experience these adversities. Higher risks that come with the discrepancies is also a concern especially for the medications that are offered at home. The patient population ranges from the children to the elderly who suffer from the lack of an effectively structured medical reconciliation (Andrus, and Anderson, 2015).




Anticipated results

From this project, it is expected that the renewed clinical relevance is for the patients who are not bringing the medications to the reconciliatory set ups.  Those who do not show up for the higher drug interactions that are necessary are also susceptible to other errors such as getting the wrong drugs or using them ins the wrong way.




This is a significant finding that is used in the treatment of the ost vulnerable population especially the behavior of the patients. When the medical issue come from the homebound patients especially those that are suffering from the psychological problems take place, then the healthcare officials had to find ways in dealing with them in the most relevant form (Andrus, and Anderson, 2015).  There re several reasons why the ambulatory patients are susceptible to the overdose or being readmitted because of the errors in the drug administration.this is because they can sometimes lack the finances that re needed to reach the point of collection of the drugs or to reach to the appointments that re meant for them. Substance abuse is also a problem that may require medical reconciliation (McCarthy et al., 2016). For the patients that have to use the drugs as required, the drug abuse can be the cause of the problem. The doctors and other medical practitioners may not be aware that the patients are using the drugs in her free time. This leads to more interactions in society. In overall, these findings are necessary as they also lead to better relations and increased performance by the clinician. The reconciliation can also help with the behaviors of the patients.
































The possible Suggestions and the Future Recommendations

From this project, it can be seen that there is a massive gap that exists within the healthcare practice within the ambulatory patient care for medication reconciliation. Not only are there the possible performance act but also the existing knowledge gap in the organization. The reconciliation process is also part of the new patients that are being admitted . with education; this gap can be minimized so that there is increased adherence by the patients. There will be reduced instances of adverse effects of the wrong drugs. To reduce the errors from the medical practitioners, it is important o have a continuous and the most accurate medical reconciliation that is structured specifically for the ambulatory patients. With education, the patient’s nd the practitioners are also likely to respond positively as they become quite a tender process so as to improve the possibility of these errors and the increased costs on the government. Through the evaluation of this  Practicum project outcomes in terms of utility, the emphasis on the benefits of performing the reconciliation process is the most effective means of reducing these errors.  These outcomes have the potential impacts in the profession, a specialty for my Practicum organization’s environment where the outpatients and the ambulatory patients struggle with some of the initiatives for reconciliation.






In conclusion, the increasing rate of illnesses has increased the complexities that come with medication administration and the regimes in medicine.  The patients have to get the medications o help with the many illnesses. However, there is Patient that have medications that have been prescribed in the acute care facilities that do not adhere thereby opening the potential of increasing the riks that he patients are exposed to contacting the risk of adverse drugs event (ADE). The adverse drug reactions have also become a major issue in many cases that are preventable within the public and id a problem that leads to disability, increased illness, and even death.  Through accurately performing the medication reconciliation, for the ambulatory patients, this problem can be reduced or completely gets eliminated from society.


McCarthy, L., Su, X., Crown, N., Turple, J., Brown, T. E., Walsh, K., … & Rochon, P. (2016). Medication reconciliation interventions in ambulatory care: A scoping review. American Journal of Health-System Pharmacy73(22), 1845-1857.

Almanasreh, E., Moles, R., & Chen, T. F. (2016). The medication reconciliation process and classification of discrepancies: a systematic review. British journal of clinical pharmacology82(3), 645-658.

Phan, H., Williams, M., McElroy, K., Burton, B., Fu, D., & Khandoobhai, A. (2019). Implementation of a student pharmacist-driven medication history service for ambulatory oncology patients in a large academic medical center. Journal of Oncology Pharmacy Practice, 1078155219831066.

Turchin, A., Sosina, O., Zhang, H., Shubina, M., Desai, S. P., Simonson, D. C., & Testa, M. A. (2018). Ambulatory Medication Reconciliation and Frequency of Hospitalizations and Emergency Department Visits in Patients With Diabetes. Diabetes Care41(8), 1639-1645.

Smith, K. J., Handler, S. M., Kapoor, W. N., Martich, G. D., Reddy, V. K., & Clark, S. (2016). Automated communication tools and computer-based medication reconciliation to decrease hospital discharge medication errors. American Journal of Medical Quality31(4), 315-322.

Armor, B. L., Wight, A. J., & Carter, S. M. (2016). Evaluation of adverse drug events and medication discrepancies in transitions of care between hospital discharge and primary care follow-up. Journal of pharmacy practice29(2), 132-137.

Andrus, M. R., & Anderson, A. D. (2015). A retrospective review of student pharmacist medication reconciliation activities in an outpatient family medicine center. Pharmacy Practice13(1).

Andrus, M. R., & Anderson, A. D. (2015). A retrospective review of student pharmacist medication reconciliation activities in an outpatient family medicine center. Pharmacy Practice13(1).