Background and Significance: According to the Institute of Medicine (IOM), medication-related errors lead to mortality and adverse effects such as allergic reactions, avoidable side effects, drug interactions, and unnecessary cost (IOM, 2000). Even with the predominant use of computerized provider order entry (CPOE) and clinical decision support systems (CDSS), medication discrepancies are still problematic today. There is substantial evidence available to demonstrate the benefits of using a transition of care (TOC) team for timely, appropriate medication reconciliation (MR) utilizing multiple intervention modalities. Purpose: This quality improvement (QI) project attempted to determine if the implementation of a TOC team utilizing a telephone-based MR system in a geriatric primary care setting improved identification of medication discrepancies and improved seven-day follow-up (FU) appointments following an inpatient admission. Methods: The TOC team at the geriatric primary care clinic was educated about the improved MR intervention tool and data collection process via a PowerPoint presentation. The data was collected via an Excel spreadsheet and analyzed for improvement upon identified medication errors and follow-through with timely FU appointments. The plan-do-study-act (PDSA) cycle was utilized for implementation. Results: A QI project was implemented in a geriatric primary care setting including 74 patients, 18 of which received the intervention. The implementation was carried out over a total of 12 weeks. Error identification increased from 0.71 errors per patient in the control group to 1.22 in the intervention group. Of the patients contacted via MR phone calls, 88.8% scheduled FU appointments; only 38.8% were within the goal time frame of seven days. The average time to FU during the implementation period was 9.1 days. Conclusion: The TOC team utilizing a telephonic MR improved identification of medication errors and overall FU rates. However, the TOC team did not positively impact the seven-day FU during MR from an inpatient hospitalization visit back to the outpatient setting. Results also indicated an improvement in the time spent per phone call. Keywords: care transition, transition of care team, medication reconciliation, seven-day follow-up, outpatient/ambulatory primary care.
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