Accreditation Canada recognizes ambulatory medication reconciliation (AmbMR) as a required organizational practice to enhance patient safety. In 2013, the nephrology clinic was the pilot site for AmbMR for the organization. Our team embraced this initiative as patients with advanced chronic kidney disease (CKD) are at high risk for adverse drug events due to taking many medications and being cared for by multiple healthcare providers. Through multiple Plan Do Study Act (PDSA) cycles, our team developed an AmbMR form and process. The process involves completion of the Best Past Medical History (BPMH) with client and family participation.
An evaluation of AmbMR in the nephrology clinic was conducted over a 12 month period and revealed that medication discrepancies occurred in 80% of CKD patients. Nearly 40% of these were associated with the potential to cause moderate patient discomfort or clinical deterioration (The CANNT Journal 2016; 26: 29-33.) As a result of these findings, it was perceived that dialysis patients may derive benefit from AmbMR. In 2014, AmbMR was rolled out in all dialysis units and a second quality initiative was completed in 2016. The renal program team would like to be considered for this award as we believe we have been pioneers for AmbMR at the NSHA. Over the past four years, this innovative project have been developed, implemented, evaluated and created a sustainable model for AmbMR, surveyed community practitioners, shared innovative knowledge, fostered inter-professional partnerships, and provided leadership to other ambulatory care programs. Our findings provide evidence that AmbMR improves patient safety.