Revision Brief | FNP Scholarly Paper

Paper: Improving Medication Reconciliation to Reduce Polypharmacy in Older Adults

Assignment and source documents

Instructor requirement: “Examine a problem of interest and plan an intervention describing how it would be implemented in a healthcare setting.” Use the instructor’s heart-failure/SGLT2 sample paper as the primary guide for structure and implementation depth, and the attached outline and annotated feedback to identify gaps. Follow the actual rubric if any guidance conflicts.

Project facts to preserve

Setting: Dr. Aref Karbasi’s primary care clinic, where I completed clinical rotations; Dr. Karbasi has agreed to support the proposed project. Population: adults age 65+ taking five or more regular medications. I am the FNP student leading the proposed quality-improvement workflow under his supervision. The project is not yet reported as implemented; verify any university/QI approvals before patient data collection. Medication changes require physician authorization and appropriate clinical oversight.

Priority revisions

·        1 | Review the latest Word paper first. Retain accurate sections; correct only missing, weak, or repetitive content. Keep the focus on an implementable primary care project, not a second literature review.

·        2 | Select one suitable anchor study from the existing 15 included studies, if one supports a transferable medication reconciliation workflow. Explain what is adapted and what changes for this clinic. Do not invent a model or alter PRISMA counts without documented justification.

·        3 | Strengthen the Iowa Model section: explain its development/revision with citation and apply its stages to clinic prioritization, team, pilot, evaluation, and sustainability. Explain the FNP student/APRN role and physician supervision without overstating independent authority.

·        4 | Organize the intervention into four components: (a) preparation, baseline review, staff education, patient identification; (b) medication history, EHR reconciliation, discrepancy/PIM review, physician decisions; (c) updated list, teach-back, and follow-up; (d) evaluation and sustainability. Include ONE concise table specifying who, when, tool, and documentation. Keep workflow feasible for existing staff.

·        5 | Structure the SDOH discussion around relevant Healthy People 2030 domains, connecting cost, health literacy, language, access/transportation, and caregivers to medication use. Avoid forcing irrelevant domains or duplicating the introduction.

·        6 | Propose a feasible ~12-week pilot (subject to approval) with a justified target sample size and baseline/comparison plan. Include a clinically appropriate 1–2-week phone check after physician-approved medication changes, and acknowledge that longer-term withdrawal effects, falls, and hospitalization cannot be reliably evaluated in a short pilot.

·        7 | Define measurable outcomes: discrepancies per patient and percentage resolved; reconciliation completion; PIMs identified/appropriately changed; total medication count (without treating fewer drugs as automatically better); and safety concerns/restarts. Define teach-back success as correct explanation of reviewed medication name, purpose, dose, and frequency. State measurement timing and analysis; do not invent targets or results.

·        8 | Include concise implementation barriers, sustainability, and conclusion: time limits, incomplete lists, outside prescribers, patient concerns, staff resources, documentation templates, and repeat audits.

Evidence, style, and final checks

Preserve the 15-study literature review, actual PubMed/EBSCO search methods, PRISMA diagram, and table of evidence unless a verified error is found. New background/framework/guideline references may be added without being falsely counted as included review studies. Distinguish hospital evidence from primary care evidence. Verify every citation and reference, APA 7 title page/headings/indentation, and consistency across sections. Use natural graduate-level prose, avoid repeated definitions and unsupported claims, and do not fabricate clinic data or outcomes.