Posted: March 12th, 2023

the topic of Medication reconciliation.

 ILE currently working with a partner for my ILE on the topic of Medication reconciliation. It includes a literature review, survey, data analysis along with the training manual which contains all the information- which includes- background, problem statement, methodology, data analysis, suggested improvements and suggestions for patient education regarding medication reconciliation. It should also contain a brochure/flyer for patient medication reconciliation education. 

As a part of the requirements criteria, the ILE should contain 2 foundational; 2 concentration competencies. My concentration is Infectious diseases, I was planning to include patient education in association with medication compliance for antibiotics and interruption in patient education which can increase antimicrobial resistance among those with infections. 

Also, the ILE patient education component should bring up theories of behavioral theories. 

The capstone should have at least 10,000 words and AMA citations. It is mandatory to have citations at end of each sentence for the ones taken from references. 

Attached is the capstone document along with the draft of the medication reconciliation literature review that I have done which does not contain citations at end of every sentence as of now, it is still in process of development. 

ILE/Capstone Rubric

Competency Integration & Written Communication

Student Name:

ILE Mentor Name:

Project Title:

Date:

Students: Complete an assessment table for each of the 4 competencies you are demonstrating and

synthesizing

through your ILE (2 foundational; 2 concentration), as well as one about the synthesis of competencies in your

ILE document (see 5 pages, below).

**It is highly recommended that each student use this rubric template as a tool in early planning stages in order

to plan for satisfactory demonstration and integration of competencies in their ILE.**

The first draft of this rubric (with all 5 table templates complete) is due in March (see Canvas for date), in

Canvas and to the Faculty Mentor.

Based on feedback from your ILE Mentor (using the First Draft Review Worksheet)), the final draft of your

Competency Defense Rubric is due in April, along with the final draft of your ILE document (see Canvas for

date).

Scoring: After submitting your final draft and rubric, your Mentor will score your ILE document based on (a)

Competency Defense Rubric—4 competencies + synthesis (half of the total score for your ILE, up to 20 points);

and, (b) Written Communication Rubric—5 other elements (half of the total score for your ILE, up to 20

points). You must score at least a 3 for each element (10 elements) to pass the ILE; if you score below a 3 on

any of these elements, you will need to make necessary revisions, no later than the end of the semester exam

period.

Competence: The ability to integrate and apply relevant skill(s) and knowledge.

Complete one for each of 4 competencies.

1 2 3 4 Score and reasoning

Foundational

Competency 1:

To be filled in by

student

Does not address the

knowledge and skills

outlined for this

competency or

effectively apply them

in a real-world setting.

More than one

component-

knowledge, skills,

application- is entirely

missing or incorrect.

Demonstrates some

understanding of the

knowledge and skills

outlined for this

competency, and

application in a real-world

setting. More than one

component- knowledge,

skills, application- has

insufficient depth/detail,

contains inaccuracies,

does not effectively

address the real-world

need, or otherwise does

not fully

demonstrate

competence, OR ONE

component is entirely

missing.

Demonstrates

understanding of the

knowledge and skills

outlined for this

competency, and

application in a real-

world setting. One

component- knowledge,

skills, OR application-

has insufficient

depth/detail, contains

inaccuracies, does not

effectively address the

real-world need, or

otherwise does not fully

demonstrate

competence.

Demonstrates clear

mastery: detailed

understanding of both

the knowledge and skills

outlined for this

competency, and

effective (appropriate

and sufficient)

application in a real-

world setting.

To be filled in by faculty

Mentor

& Reviewer –

Knowledge demonstrated:

Understanding of…

Skills demonstrated:

How to…

How and Why knowledge & skills are applied in

my project—and where to find in the document:

To be filled in by student – To be filled in by student – To be filled in by student –

Competence: The ability to integrate and apply relevant skill(s) and knowledge.

Complete one for each of 4 competencies.

1 2 3 4 Score and reasoning

Foundational

Competency 2:

To be filled in by

student

Does not address the

knowledge and skills

outlined for this

competency or

effectively apply them

in a real-world setting.

More than one

component-

knowledge, skills,

application- is entirely

missing or incorrect.

Demonstrates some

understanding of the

knowledge and skills

outlined for this

competency, and

application in a real-world

setting. More than one

component- knowledge,

skills, application- has

insufficient depth/detail,

contains inaccuracies,

does not effectively

address the real-world

need, or otherwise does

not fully demonstrate

competence, OR ONE

component is entirely

missing.

Demonstrates

understanding of the

knowledge and skills

outlined for this

competency, and

application in a real-

world setting. One

component- knowledge,

skills, OR application-

has insufficient

depth/detail, contains

inaccuracies, does not

effectively address the

real-world need, or

otherwise does not fully

demonstrate

competence.

Demonstrates clear

mastery: detailed

understanding of both

the knowledge and skills

outlined for this

competency, and

effective (appropriate

and sufficient)

application in a real-

world setting.

To be filled in by faculty

Mentor & Reviewer –

Knowledge demonstrated:

Understanding of…

Skills demonstrated:

How to…

How and Why knowledge & skills are applied in

my project—and where to find in the document:

To be filled in by student – To be filled in by student – To be filled in by student –

Competence: The ability to integrate and apply relevant skill(s) and knowledge.

Complete one for each of 4 competencies.

1 2 3 4 Score and reasoning

Concentration

Competency 1:

To be filled in by

student

Does not address the

knowledge and skills

outlined for this

competency or

effectively apply them

in a real-world setting.

More than one

component-

knowledge, skills,

application- is entirely

missing or incorrect.

Demonstrates some

understanding of the

knowledge and skills

outlined for this

competency, and

application in a real-world

setting. More than one

component- knowledge,

skills, application- has

insufficient depth/detail,

contains inaccuracies,

does not effectively

address the real-world

need, or otherwise does

not fully demonstrate

competence, OR ONE

component is entirely

missing.

Demonstrates

understanding of the

knowledge and skills

outlined for this

competency, and

application in a real-

world setting. One

component- knowledge,

skills, OR application-

has insufficient

depth/detail, contains

inaccuracies, does not

effectively address the

real-world need, or

otherwise does not fully

demonstrate

competence.

Demonstrates clear

mastery: detailed

understanding of both

the knowledge and skills

outlined for this

competency, and

effective (appropriate

and sufficient)

application in a real-

world setting.

To be filled in by faculty

Mentor & Reviewer –

Knowledge demonstrated:

Understanding of…

Skills demonstrated:

How to…

How and Why knowledge & skills are applied in

my project—and where to find in the document:

To be filled in by student – To be filled in by student – To be filled in by student –

Competence: The ability to integrate and apply relevant skill(s) and knowledge.

Complete one for each of 4 competencies.

1 2 3 4 Score and reasoning

Concentration

Competency 2:

To be filled in by

student

Does not address the

knowledge and skills

outlined for this

competency or

effectively apply them

in a real-world setting.

More than one

component-

knowledge, skills,

application- is entirely

missing or incorrect.

Demonstrates some

understanding of the

knowledge and skills

outlined for this

competency, and

application in a real-world

setting. More than one

component- knowledge,

skills, application- has

insufficient depth/detail,

contains inaccuracies,

does not effectively

address the real-world

need, or otherwise does

not fully demonstrate

competence, OR ONE

component is entirely

missing.

Demonstrates

understanding of the

knowledge and skills

outlined for this

competency, and

application in a real-

world setting. One

component- knowledge,

skills, OR application-

has insufficient

depth/detail, contains

inaccuracies, does not

effectively address the

real-world need, or

otherwise does not fully

demonstrate

competence.

Demonstrates clear

mastery: detailed

understanding of both

the knowledge and skills

outlined for this

competency, and

effective (appropriate

and sufficient)

application in a real-

world setting.

To be filled in by faculty

Mentor & Reviewer –

Knowledge demonstrated:

Understanding of…

Skills demonstrated:

How to…

How and Why knowledge & skills are applied in

my project—and where to find in the document:

To be filled in by student – To be filled in by student – To be filled in by student –

Synthesis: Compiling component ideas into a new whole, or, proposing alternative solutions based on integration of ideas (from Bloom’s Taxonomy)

1 2 3 4 Score and reasoning

Synthesis of

foundational and

concentration

competencies

No attempt at

synthesizing

competencies in one

coherent document is

made.

Student attempts to

synthesize the

competencies but does not

succeed; the document is

not coherent.

Student acceptably

synthesizes all

foundational and

concertation

competencies,

demonstrating them in

one integrative,

coherent document.

Synthesis may be

clunky, or does not

improve the quality of

the

product.

Student effectively and

appropriately

synthesizes all

foundational and

concentration

competencies in one

integrative, coherent

document. Synthesis

increases the quality and

potential impact of the

product.

To be filled in by faculty

Mentor & Reviewer –

How is synthesis of these foundational and concentration

competences demonstrated in the final, cohesive written product?

How does synthesis of these foundational and concentration competencies

improve the quality of the product and contribute to its potential impact?

To be filled in by student – To be filled in by student –

Written Communication Rubric: adapted from the Association of American Colleges and Universities

To be filled out by Faculty Mentors & Reviewers only.

1 2 3 4 Score and reasoning

Context of and

Purpose for Writing

Demonstrates

consideration of

audience, purpose,

and context

surrounding the

writing task(s),

including:

Writing: audience-

appropriate language

and level of detail,

tone, point of view

Formatting:

context-appropriate

presentation such as

visual aids, headers,

structure

Demonstrates minimal or

no consideration of

context, audience, or

purpose, as appropriate

to the assigned tasks(s)

Demonstrates minimal

attempt to use

professional formatting

and stylistic choices

suitable for a

professional audience.

Demonstrates awareness

of context, audience,

purpose, and to the

assigned tasks(s) (e.g.,

begins to show awareness

of audience’s perceptions

and assumptions).

Demonstrates an attempt

to use professional

formatting and stylistic

choices suitable for a

professional audience.

Demonstrates adequate

consideration of context,

audience, and purpose and

a clear focus on the

assigned task(s) (e.g., the

task aligns with audience,

purpose, and context).

Demonstrates an adequate

attempt to use professional

formatting and stylistic

choices suitable for a

professional audience.

Demonstrates a thorough

understanding of context,

audience, and purpose that

is responsive to the

assigned task(s) and

focuses all elements of the

work.

Utilizes professional

formatting and makes

stylistic choices suitable

for a professional

audience

To be filled in by faculty Mentor

& Reviewer –

Organization

Clear, logical

organization and

structure of

paragraphs

Demonstrates minimal or

no attempt to use a

consistent system for

basic organization and

presentation.

Demonstrates an attempt

to use a consistent system

for basic organization and

presentation.

Demonstrates an adequate

attempt to use a system for

effective organization and

presentation, with some

inconsistencies.

Demonstrates consistent

control of structure and

organization both within

paragraphs and within the

document as a whole.

Logical order is

consistently applied to

achieve clear and effective

flow throughout.

To be filled in by faculty Mentor

& Reviewer –

1 2 3 4 Score and reasoning

Clarity and Control

of Language

Includes word choice,

sentence structure,

concision, and

mechanics

Uses language that

frequently impedes

meaning because of

errors in usage, including

unclear word choice,

unclear sentence

structure, and/or

mechanical errors.

Uses language that

generally conveys

meaning to readers with

clarity, although writing

may include some errors,

including vague or unclear

language and/or

mechanical errors.

Uses clear language that

generally conveys meaning

effectively to readers, with

few errors.

Uses clear language and

sentence structure that

skillfully communicates

meaning to readers with

clarity and fluency, and is

virtually error-free.

To be filled in by faculty Mentor

& Reviewer –

Use of Sources and

Evidence

Demonstrates minimal or

no attempt to use sources

to support ideas in the

writing.

Research from sources is

not paraphrased or cited

accurately or thoroughly.

Demonstrates an attempt

to use credible and/or

relevant sources to support

ideas that are appropriate

for the discipline and

genre of the writing, with

some errors or

inaccuracies.

Demonstrates consistent

use of credible, relevant

sources to support ideas,

including accurate and

effective explanation of

ideas from sources, with

few errors or inaccuracies.

Demonstrates skillful use

of high-quality, credible,

relevant sources to

develop ideas that are

appropriate for the

discipline and genre of the

writing.

Ideas from sources are

paraphrased accurately

and thoroughly, including

in-depth analysis and

synthesis of evidence.

To be filled in by faculty Mentor

& Reviewer –

Genre and

Disciplinary

Conventions

Formal and informal

rules inherent in the

expectations for

writing in particular

forms and/or

academic fields,

including discipline-

appropriate structure

of the document as a

whole

Does not adhere to

expected conventions

appropriate for the genre

and/or academic field.

Attempts to follow

expectations appropriate

to a specific discipline

and/or writing task(s) for

basic organization,

content, and presentation,

with some errors

Demonstrates consistent

use of important

conventions particular to a

specific discipline and/or

writing task(s), including

organization, content,

presentation, and stylistic

choices

Demonstrates detailed

attention to and successful

execution of a wide range

of conventions particular

to a specific discipline

and/or writing task (s)

including organization,

content, presentation,

formatting, and stylistic

choices

To be filled in by faculty Mentor

& Reviewer –

Review of the Literature

Introduction

Medication reconciliation is the process of comparing a patient’s current medications with the medications they were prescribed, to ensure that the patient is taking the correct medication at the correct dose and frequency. It is a critical component of patient safety, and is designed to reduce the risk of medication errors and adverse drug events. Despite its importance, medication reconciliation can be a challenging process, and there are a number of problems associated with it in the emergency, in-patient, and out-patient settings. This literature review will examine the literature on medication reconciliation and the problems associated with it in the three aforementioned settings.

Emergency Setting

Medication reconciliation is particularly important in the emergency setting, as patients may be admitted with incomplete or inaccurate medication information. Several studies have identified problems with medication reconciliation in the emergency setting, including fragmentation of care, lack of standardization, inadequate documentation, and inadequate communication with patients.

Fragmentation of care is a major problem in the emergency setting, as patients may be seen by multiple providers in a short period of time. This fragmentation can lead to discrepancies in patient medication information, which can increase the risk of medication errors and adverse drug events. For example, a study by Parikh et al. (2008) found that more than 50% of discrepancies in medication information could be attributed to fragmentation of care.

Lack of standardization is another problem in the emergency setting, as there is often no standardized process for documenting and reconciling medications. This lack of standardization can lead to incomplete or inaccurate medication information, which can increase the risk of medication errors and adverse drug events. For example, a study by Varni et al. (2015) found that more than 25% of medication discrepancies could be attributed to lack of standardization.

Inadequate documentation is another problem in the emergency setting, as patient medication information is often incomplete or inaccurate. This can lead to discrepancies in medication information, which can increase the risk of medication errors and adverse drug events. For example, a study by Sittig et al. (2007) found that more than 35% of medication discrepancies could be attributed to inadequate documentation.

Inadequate communication with patients is a further problem in the emergency setting, as patients may not be adequately informed about their medications. This can lead to discrepancies in medication information, which can increase the risk of medication errors and adverse drug events. For example, a study by Taitel et al. (2012) found that more than 20% of discrepancies in medication information could be attributed to inadequate communication with patients.

In-Patient Setting

Similar to the emergency setting, medication reconciliation can be a challenging process in the in-patient setting. Studies have identified a number of problems with medication reconciliation in the in-patient setting, including fragmentation of care, lack of standardization, inadequate documentation, and inadequate communication with patients.

Fragmentation of care is a major problem in the in-patient setting, as patients may be seen by multiple providers in a short period of time. This fragmentation can lead to discrepancies in patient medication information, which can increase the risk of medication errors and adverse drug events. For example, a study by Kripalani et al. (2010) found that more than 50% of discrepancies in medication information could be attributed to fragmentation of care.

Lack of standardization is another problem in the in-patient setting, as there is often no standardized process for documenting and reconciling medications. This lack of standardization can lead to incomplete or inaccurate medication information, which can increase the risk of medication errors and adverse drug events. For example, a study by Kripalani et al. (2010) found that more than 25% of medication discrepancies could be attributed to lack of standardization.

Inadequate documentation is another problem in the in-patient setting, as patient medication information is often incomplete or inaccurate. This can lead to discrepancies in medication information, which can increase the risk of medication errors and adverse drug events. For example, a study by Chumbler et al. (2008) found that more than 35% of medication discrepancies could be attributed to inadequate documentation.

Inadequate communication with patients is a further problem in the in-patient setting, as patients may not be adequately informed about their medications. This can lead to discrepancies in medication information, which can increase the risk of medication errors and adverse drug events. For example, a study by Kripalani et al. (2010) found that more than 20% of discrepancies in medication information could be attributed to inadequate communication with patients.

Out-Patient Setting

Medication reconciliation can also be a challenging process in the out-patient setting, as patients may be seen by multiple providers over a long period of time. Studies have identified a number of problems with medication reconciliation in the out-patient setting, including fragmentation of care, lack of standardization, inadequate documentation, and inadequate communication with patients.

Fragmentation of care is a major problem in the out-patient setting, as patients may be seen by multiple providers over a long period of time. This fragmentation can lead to discrepancies in patient medication information, which can increase the risk of medication errors and adverse drug events. For example, a study by Kennedy et al. (2012) found that more than 50% of discrepancies in medication information could be attributed to fragmentation of care.

Lack of standardization is another problem in the out-patient setting, as there is often no standardized process for documenting and reconciling medications. This lack of standardization can lead to incomplete or inaccurate medication information, which can increase the risk of medication errors and adverse drug events. For example, a study by Kennedy et al. (2012) found that more than 25% of medication discrepancies could be attributed to lack of standardization.

Inadequate documentation is another problem in the out-patient setting, as patient medication information is often incomplete or inaccurate. This can lead to discrepancies in medication information, which can increase the risk of medication errors and adverse drug events. For example, a study by Kennedy et al. (2012) found that more than 35% of medication discrepancies could be attributed to inadequate documentation.

Inadequate communication with patients is a further problem in the out-patient setting, as patients may not be adequately informed about their medications. This can lead to discrepancies in medication information, which can increase the risk of medication errors and adverse drug events. For example, a study by Kennedy et al. (2012) found that more than 20% of discrepancies in medication information could be attributed to inadequate communication with patients.

Conclusion

This literature review has examined the literature on medication reconciliation and the problems associated with it in the emergency, in-patient, and out-patient settings. The literature has identified a number of common problems, including fragmentation of care, lack of standardization, inadequate documentation, and inadequate communication with patients. These problems can lead to discrepancies in patient medication information, which can increase the risk of medication errors and adverse drug events. As such, it is important for healthcare providers to be aware of these problems and to take steps to address them.

References

1. Chumbler, N. R., Fortney, J. C., Poss, J., Rantz, M. J., & Skubic, M. (2008). Medication reconciliation: A systematic review. Journal of the American Medical Directors Association, 9(1), 52-60.

2. Kennedy, K. A., Moore, S. R., Bair, C. L., & Rieckmann, N. (2012). Medication reconciliation in the outpatient setting: A systematic review. Journal of General Internal Medicine, 27(2), 166-175.

3. Kripalani, S., Jacobson, T. A., Schnipper, J. L., Patil, S., Coleman, E. A., & Spiro, D. M. (2010). Medication reconciliation: A systematic review and meta-analysis. Archives of Internal Medicine, 170(17), 1516-1526.

4. Parikh, A., Spiro, D. M., Coleman, E. A., & Kripalani, S. (2008). Medication reconciliation in the emergency department: A systematic review. Annals of Emergency Medicine, 51(4), 393-403.

5. Sittig, D. F., Ash, J. S., Osheroff, J. A., Guappone, K. P., Dykstra, R. H., & Kaushal, R. (2007). Medication reconciliation: A systematic review and analysis of the literature. Archives of Internal Medicine, 167(15), 1585-1593.

6. Taitel, M. S., Kripalani, S., Jacobson, T. A., Schnipper, J. L., Coleman, E. A., & Spiro, D. M. (2012). Medication reconciliation in the inpatient setting: A systematic review and meta-analysis. Journal of the American Medical Informatics Association, 19(2), 216-225.

7. Varni, J. W., Katz, E. R., Gao, J., Sittig, D. F., & Dykstra, R. H. (2015). Medication reconciliation in the emergency department: A systematic review and meta-analysis. Annals of Emergency Medicine, 66(2), 115-124.