"Clinical Importance of Medication History" is a wonderful example of a paper on Surgery and Rehabilitation. My practicum project was based on how to improve the safety of patients scheduled for elective surgery by adding medication history during the pre-admission phone calls. Studies show that nurses and other healthcare providers do not utilize pre-admission phone calls to ask patients about their medical history. Instead, they wait until the scheduled date of surgery, and this causes a lot of confusion and collection of inaccurate medication history. In this practicum project, I conducted the proposed in-person observation of a hospital to investigate how preoperative nurses collected medical history from patients scheduled for elective surgery.
The aim of conducting an in-person observation was to engage directly in what senior perioperative nurses applied in practice so that I can identify and evaluate the needed changes that would improve the safety of patients. While at the hospital, I inquired and observed how preoperative RNs collected medication history through pre-admission phone calls. The nurse I approached informed me that pre-admission phone calls were conducted one to three days before elective surgery.
I followed closely how the RNs conducted the pre-admission phone calls and learned that the aim was to confirm the time of arrival for surgery, review of medical history, and verify the patient’ s details, and provide instructions on how patients should prepare for the surgery. However, the RNs barely emphasized the medication history, including the specific drugs used by patients, drugs that patients should avoid taking, and why they should avoid them while preparing for surgery. I realized that most of the medication history was taken on admission on the day of surgery.
The preoperative nurses could review all patient information, including the medication history, baseline vital signs, and completeness of the patient medical records. However, there was a tendency to forget some vital aspects of medication history since preoperative nurses focused more on preparing patients for the planned surgery (Gleason et al. , 2010). Also, nurses realized that some patients awaiting surgery had taken medications that are not recommended before surgery, such as warfarin and aspirin, and this brought more confusion due to the fear of patient safety during and after the surgical procedure.
Therefore, there was a need to come up with a pre-admission medical history evidence-based practice to avoid such inconveniences on the admission surgery. I was only a student doing a practicum project among qualified RNs, and convincing them that I had a proposal to change the current medication history protocol required a comprehensive approach. Also, I need to involve a better educative activity that would help me capture the attention of preoperative nurses. First of all, I needed to engage closely with preoperative nurses so that they can hear about my proposed process of change.
I was glad that the administration allowed me to hold a meeting with the nurses to air out my thoughts about collecting full medication history during pre-admission phone calls. During the first meeting with preoperative nurses, I realized that there were several reasons that made them not collect full medical history during pre-admission phone calls. One reason was due to a lack of sufficient time to discuss with patients on the phone. Nurses are always busy handling patients who have been admitted to the hospital and so they have to take only part of the medical history.
I was glad that nurses agreed to collaborate with me, and so we scheduled another meeting that involved training on the proposed pre-admission medical history workflow. The major aspects of the proposed pre-admission medication history included calling the patient one to three days before admission, as usual, followed by a comprehensive assessment of the patient and the development of a plan of care. The RN also discusses with the patient the time of arrival, instructions on how to prepare for the elective surgery, and offer a chance for the patient to ask questions.
The most important part of the proposed pre-admission medication history involves collecting a complete medication history, including the current list of medications (Nickless & Davies, 2016). Obtaining a list of current medications helps the preoperative nurse to discontinue the patient from taking medications that may increase the risk of patient safety during surgery. The plan of training about the proposed pre-admission medication history involved identifying a core group of preoperative RNs to take part in the training, recruiting a champion to lead other nurses in training, and identifying the target group of patients whose medical history was taken using the proposed pre-admission medication history evidence-based approach.
Also, nurses collaborated with the pharmacy department to confirm medications that should be taken by patients scheduled for elective surgery (Tam et al. , 2005). After the training, we waited for the admission of the patients whom we assessed using the proposed pre-admission medication history evidence-based approach. The evaluation showed that preoperative RNs found it easier to plan and prepare patients whose complete medical history had been taken during the pre-admission phone call. In conclusion, my practicum project was successful as I managed to observe the current pre-admission medical history practices and how they affect the safety of patients scheduled for elective surgery.
I also managed to engage with the preoperative RNs team in testing the proposed pre-admission medication history evidence-based approach. As such, I appreciate that they agreed to collaborate in the project, and they contributed highly to its success. I also appreciate the contribution of the preceptor to the success of the project by providing enough time and reliable sources of reference regarding the practicum project topic.
Gleason, K. M., McDaniel, M. R., Feinglass, J., Baker, D. W., Lindquist, L., Liss, D., & Noskin, G. A. (2010). Results of the Medications at transitions and clinical handoffs (MATCH) study: an analysis of medication reconciliation errors and risk factors at hospital admission. Journal of General Internal Medicine, 22(5), 441-447. https://doi.org/10.1007/s11606-010-1256-6
Nickless, G. & Davies, R. (2016). How to take accurate and detailed medication history. The Pharmaceutical journal.
Tam, V. C., Knowles, S. R., Cornish, P. L., Fine, N., Marchesano, R., & Etchells, E. E. (2005). Frequency, type, and clinical importance of medication history at admission to hospital: a systematic review. CMAJ