An Interdisciplinary Plan to Close Admission Medication Reconciliation Gaps on a Medical-Surgical Unit
Student Name
School of Nursing and Health Sciences, Capella University
NURS-FPX4005: Nursing Leadership: People, Processes and Organizations
Instructor Name
Month Day, Year
An Interdisciplinary Plan to Close Admission Medication Reconciliation Gaps on a Medical-Surgical Unit
This proposal asks the medical-surgical service line of a 310-bed nonprofit community hospital to fund a 26-week interdisciplinary pilot that moves the admission medication history from an unstructured nursing task to a defined pharmacy-technician process with nursing verification. A retrospective audit of 120 randomly sampled admissions to the 34-bed unit over eight weeks found that 46 of them, or 38 percent, carried at least one unintended discrepancy between the documented admission list and the patient's actual home regimen. Fourteen of those discrepancies involved a high-alert medication such as an anticoagulant, insulin, or a long-acting opioid, and a best possible medication history was completed within 24 hours in only 61 percent of admissions.
The objective is written so that it can be scored rather than admired: within 26 weeks, reduce admissions carrying at least one unintended medication discrepancy from 38 percent to below 15 percent, and complete a technician-obtained best possible medication history within 24 hours for at least 90 percent of admissions to the unit. Both measures already sit in the record, and both are auditable by chart review of a weekly random sample of 15 admissions, so the pilot can be judged without building a new reporting system. The organization already carries this obligation under the national patient safety goal for maintaining and communicating accurate medication information (The Joint Commission, 2023).
Three questions drive the pilot, each with a prediction that can be wrong. First, will a technician-obtained history reduce unintended discrepancies? The prediction is a fall below 15 percent by week 20, grounded in pooled evidence that pharmacist-led reconciliation reduces medication discrepancies at hospital transitions (Mekonnen et al., 2016). Second, will the added step slow admissions? The prediction is no measurable change in time from bed request to bed assignment, and a reduction of roughly ten minutes in nursing time per admission. Third, will the change hold? The prediction is that it holds only where a named owner and a standing audit outlive the pilot, which is why week 26 adherence is compared against week 12.
Change Theory and Leadership Strategies
Kotter's eight-step model fits this work because the barrier is organizational rather than technical: reconciliation has been everyone's job and therefore no one's (Kotter, 2012). The first three steps carry most of the weight here. Urgency is established with the unit's own audit rather than with national statistics, because 14 high-alert discrepancies on this unit in eight weeks moves a service line meeting in a way that a global figure does not. The guiding coalition is the interdisciplinary team described on the next page, sponsored by the nurse manager and co-signed by the hospitalist medical director. The vision is one sentence the team can repeat: every patient admitted to this unit has one verified medication list within 24 hours.
Kotter sequences the change; the Model for Improvement runs it. The pilot proceeds in Plan-Do-Study-Act cycles rather than as a single launch, starting with one technician, one hospitalist team, and five admissions a day for two weeks (Langley et al., 2009). Each cycle closes with the weekly audit and one documented decision: adopt, adapt, or abandon. Testing small protects the pilot from the failure mode that ends most unit projects, which is a full-scale rollout in week one that no one can adjust after staff have already decided it does not work. Short-term wins, Kotter's sixth step, come out of these cycles and are reported to the unit council as a number rather than as an impression.
The leadership strategy is transformational in intent and administrative in practice. The nurse manager sponsors the work and protects the time, while a staff nurse champion leads it, which matters because a change owned by a bedside nurse is harder for bedside nurses to dismiss. Three leadership behaviors are specified rather than assumed: the champion reports both measures at every unit council meeting, the sponsor removes one named barrier per cycle, and the medical director speaks first at the kickoff so that prescribers hear the request from a peer. Kotter attributes failed transformations to under-communicated vision and absent sponsorship rather than to insufficient enthusiasm, which is why these behaviors are written into the plan instead of left to temperament (Kotter, 2012).
Team Collaboration Strategy and Required Organizational Resources
The team is seven people with written roles: the staff nurse champion as project lead, the nurse manager as sponsor, a clinical pharmacist for verification and escalation, a certified pharmacy technician to obtain histories, the hospitalist medical director for prescriber engagement, the admissions lead for capture of pharmacy and prior-hospital sources, and an informatics analyst for the report build. Collaboration runs on a TeamSTEPPS structure rather than on availability: a two-minute brief at the start of each technician shift, a standing fifteen-minute weekly huddle with a fixed agenda, and a debrief closing every improvement cycle (Agency for Healthcare Research and Quality, 2023). Each role carries a named alternate, because the most common way a huddle dies is a single absence.
The pilot requires $20,979 over 26 weeks, and the largest line is the only one that buys the change itself. A 0.5 FTE certified pharmacy technician at 20 hours a week for 26 weeks costs $12,740 in wages at $24.50 an hour, plus $3,567 in benefits at 28 percent, for a subtotal of $16,307. Nursing education adds $1,722, one paid hour for each of the unit's 42 nurses at an average $41 an hour. The informatics build for a reconciliation status report is 30 analyst hours at $85, or $2,550. Audit tools and printed job aids account for $400. No new software is purchased and no capital request is attached, which is deliberate: this proposal asks for labor, not for a product.
Against that request sits the cost of the current state. Fourteen high-alert discrepancies reached the record in eight weeks, and a discrepancy involving an anticoagulant or insulin is the precondition for harm that lengthens a stay rather than a clerical annoyance. The classic United States costing study placed the incremental hospital cost of one preventable adverse drug event at $4,685 in 1997 dollars, a figure that understates today's cost by a wide margin (Bates et al., 1997). Preventing five such events across 26 weeks returns the pilot's full cost on the 1997 figure alone. Approval is requested for the labor lines above, with a decision point at week 12: continue, adapt, or stop, on the evidence of the unit's own audit.
References
Agency for Healthcare Research and Quality. (2023). TeamSTEPPS 3.0 pocket guide. Agency for Healthcare Research and Quality.
Bates, D. W., Spell, N., Cullen, D. J., Burdick, E., Laird, N., Petersen, L. A., Small, S. D., Sweitzer, B. J., & Leape, L. L. (1997). The costs of adverse drug events in hospitalized patients. JAMA, 277(4), 307-311.
The Joint Commission. (2023). National patient safety goals: Hospital accreditation program. The Joint Commission.
Kotter, J. P. (2012). Leading change. Harvard Business Review Press.
Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass.
Mekonnen, A. B., McLachlan, A. J., & Brien, J. E. (2016). Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: A systematic review and meta-analysis. BMJ Open, 6(2), e010003. https://doi.org/10.1136/bmjopen-2015-010003
How this NURS FPX 4005 Assessment 3 example is structured
The proposal is ordered the way a funder reads one. The first body page states the problem in the unit's own audit numbers and converts it into an objective with a threshold and a deadline, then commits to three predictions that can be proved wrong. The second page names the change engine, Kotter for the organizational sequence and Plan-Do-Study-Act for the testing, and specifies leadership behaviors instead of leadership adjectives. The third page gives the team written roles, a collaboration structure taken from TeamSTEPPS, and the budget as line items that add up to one number. This NURS FPX 4005 Assessment 3 example was written for the RN-to-BSN Nursing Leadership: People, Processes and Organizations course at Capella University, and its evaluation plan is built from measures the record already contains.
NURS-FPX4005 Assessment 3 questions, answered
What makes an objective strong enough for NURS FPX 4005 Assessment 3?
A number, a direction, and a date. An objective to improve medication safety cannot be scored. An objective to reduce admissions carrying at least one unintended discrepancy from 38 percent to below 15 percent within 26 weeks can be. Say where the data will come from, because a scorer checks whether you could actually measure what you promised.
Does the plan proposal really need a budget?
The resources criterion asks what the plan needs, and money is the most legible form of that answer. List labor by hours and rate, add education time, add any build hours, and total it. A pilot that admits it costs $20,979 reads as serious, while a plan that says minimal additional resources reads as unexamined.
Should I use Kotter or PDSA for the change theory?
They answer different questions, and using both is defensible if you say why. Kotter sequences the organizational work: urgency, coalition, vision, short-term wins. Plan-Do-Study-Act runs the testing inside that sequence. Name one as the frame and the other as the method, then tie each step to something your plan actually does on your unit.
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