This NUR 400 Module 1 page contains one complete short paper applying tracer methodology to medication reconciliation across a care transition, with the trace, a findings table, a systems analysis and references. Searches like "nur 400 module 1 assignment", "nur400 module 1 short paper" and "nur 400 module 1 example" land here.
The NUR 400 Module 1 example, in full
One List, Four Handoffs: A Patient Tracer of Medication Reconciliation From the Emergency Department to a Medical Unit
[Student Name]
Southern New Hampshire University
NUR 400: Systems Leadership for Continuous Quality
Module One Short Paper
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
One List, Four Handoffs: A Patient Tracer of Medication Reconciliation From the Emergency Department to a Medical Unit
Accreditation surveyors do not evaluate a hospital by reading its policies. They pick a patient and follow that patient's care through the organization, asking staff at each stop to show what they did and why. This approach, called tracer methodology, reveals how systems work in practice rather than on paper (The Joint Commission, n.d.). Nurse leaders can borrow it to examine their own processes. This paper reports a tracer conducted by a charge nurse on a composite 34-bed medical unit, following the medication list of one patient admitted through the emergency department. Its purpose is to show how a list that was accurate at home became inaccurate within 24 hours of admission without anyone making an obvious mistake.
How the Tracer Was Conducted
The charge nurse selected the patient because he took more than ten medications and had moved through two departments in his first day, which made him a good test of the process. With the patient's and daughter's permission, she reviewed the emergency department and admission records, the medication administration record and the handoff notes, then spoke briefly with the triage nurse, the admitting hospitalist, the receiving floor nurse and the pharmacist. Each was asked the same three questions: where did your information about his medications come from, what did you do with it, and what did you expect the next person to do. The conversations were framed as learning about the process, not reviewing anyone's performance, and no names were recorded.
The Trace
The patient was a 77-year-old man with heart failure, atrial fibrillation, type 2 diabetes and chronic kidney disease, admitted for shortness of breath. He took 11 medications at home, managed by his daughter, who kept a printed list on the refrigerator.
Emergency department triage. The triage nurse asked the patient to name his medications. He named six and said his daughter had the list. The nurse documented those six as the home medication list, noting that the list was incomplete. The daughter arrived two hours later, after the patient had been moved to a hallway bed.
Admission orders. The admitting hospitalist, working from the emergency department list, continued five of the six medications and held one. The note indicated that home medications had been reviewed. The daughter's printed list, which she had given to a different nurse in the hallway, was placed in the patient's belongings bag.
Transfer to the medical unit. The emergency department handoff to the floor nurse focused on the patient's oxygen needs and diuretic response. Medications were described as reconciled. The floor nurse, admitting three patients that evening, did not see the printed list.
The next morning. The pharmacist conducting a routine review called the daughter, who read her list aloud. Five medications were missing from the record, including apixaban for atrial fibrillation and a reduced dose of metformin adjusted for kidney function, which the admission orders had listed at the full dose from an old pharmacy record.
Findings
The table below summarizes the discrepancies found and their potential for harm.
Table 1
Medication Discrepancies Identified in the Tracer
| Discrepancy | Where it began | Potential harm |
|---|---|---|
| Apixaban omitted | Triage list built from patient recall | Stroke risk from interrupted anticoagulation |
| Metformin ordered at full dose rather than reduced dose | Old pharmacy record used for admission orders | Lactic acidosis risk with reduced kidney function |
| Three other home medications omitted | Triage list incomplete; printed list not seen | Withdrawal effects or uncontrolled symptoms |
| Printed list separated from the record | List given to one nurse, stored in belongings | Loss of the best available source of truth |
| Reconciliation documented as complete | Admission and handoff notes | False reassurance for every later clinician |
Systems Analysis
The trace suggests that no one person caused the discrepancies. Instead, four system features combined. First, the process relied on patient recall at triage, the least reliable source for a patient taking many medications. Second, there was no defined place for a family's written list to go, so the best source of information ended up in a belongings bag. Third, the documentation template allowed a clinician to mark reconciliation as complete without confirming the source, which created false confidence at each handoff. Fourth, verification by a pharmacist happened only the next morning, after the first doses had been ordered.
The pattern is common. In a study of patients admitted to a general medicine service, more than half had at least one unintended medication discrepancy at admission, most often omission of a regularly used medication, and a substantial share of those discrepancies had the potential to cause moderate or severe harm (Cornish et al., 2005). When researchers systematically reviewed the reconciliation practices hospitals have tested, they found that interventions with a strong role for pharmacists and well-designed information technology were among the most effective at reducing discrepancies (Mueller et al., 2012). Both findings fit this trace: the pharmacist found the errors, but too late, and the record's design allowed incomplete information to look complete.
Next Steps for the Unit
Several changes follow from the tracer. The emergency department and medical unit could adopt a rule that the home medication list is not marked complete until at least two sources have been checked, such as the patient or family plus a pharmacy fill history. A clearly labeled folder or scanning step for family-provided lists would keep written lists with the record rather than with belongings. Pharmacy technicians trained in medication history taking could be scheduled in the emergency department during the evening hours when most admissions occur. Finally, the unit's handoff tool could include a line stating the source of the medication list, so that the receiving nurse knows how much to trust it. The charge nurse plans to repeat the tracer with two more patients to see whether the same gaps appear before bringing the findings to the unit's quality council.
Conclusion
A single patient tracer revealed how an accurate home medication list became five omissions and one dosing error within a day, through recall-based documentation, a lost written list, a template that allowed incomplete lists to look complete and delayed pharmacist review. None of these were individual failures; all were features of the system. Tracer methodology gives nurse leaders a practical way to see such gaps and to design changes that make the right action the easy one.
References
Cornish, P. L., Knowles, S. R., Marchesano, R., Tam, V., Shadowitz, S., Juurlink, D. N., & Etchells, E. E. (2005). Unintended medication discrepancies at the time of hospital admission. Archives of Internal Medicine, 165(4), 424-429. https://doi.org/10.1001/archinte.165.4.424
Mueller, S. K., Sponsler, K. C., Kripalani, S., & Schnipper, J. L. (2012). Hospital-based medication reconciliation practices: A systematic review. Archives of Internal Medicine, 172(14), 1057-1069. https://doi.org/10.1001/archinternmed.2012.2246
The Joint Commission. (n.d.). Tracer methodology. https://www.jointcommission.org
How this NUR 400 Module 1 example is structured
A tracer paper is only as good as the path it follows, so this one is organized in the order of the patient's journey. It opens by explaining what a tracer is and why it looks at systems rather than individuals. The trace itself follows the medication list through four handoffs, noting at each one who touched it and what changed. A table summarizes the discrepancies, their causes and their potential for harm. The analysis section groups those causes into system themes, using published evidence on how often medication discrepancies occur at admission and which reconciliation practices work, and the conclusion proposes next steps for the unit.
Get NUR 400 Module 1 written to your instructions
Upload the NUR 400 Module 1 instructions and rubric and a sentence about the process or patient path you want to trace. The desk returns a sample paper to that brief within 24 to 48 hours, free the first time. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
NUR 400 Module 1 questions, answered
What does NUR 400 Module 1 usually cover?
The course opens with the foundations of quality and systems thinking: how health care quality is defined and measured, the leader's role in continuous improvement, and tools used to examine care processes. An early assignment may ask you to apply one of those tools, such as a tracer or process map, to a real process in your practice.
What is tracer methodology?
Tracer methodology follows the experience of a single patient, or a single process, through the organization, interviewing staff and reviewing records at each step. It is used by accreditation surveyors to see how systems actually work in practice. Nurse leaders can use it internally to find gaps before a surveyor or a patient finds them.
Should a tracer paper name the staff involved?
No. A tracer looks at systems, so describe roles, not individuals, and remove anything that could identify patients or staff. Framing findings as system gaps rather than personal errors also makes the paper more useful and more consistent with a quality improvement mindset.