School of Medicine and Health Sciences Poster Presentations

Title

Reducing Electronic Medical Record Pop-Ups and Improving Admission Medication Reconciliation Completion at George Washington University Hospital

Document Type

Poster

Abstract Category

Quality Improvement

Keywords

Medication reconciliation, Quality improvement, Medication History, Electronic Medical Record

Publication Date

Spring 5-1-2019

Abstract

Timely and accurate completion of admission medication reconciliation (med rec) is an invaluable step in the prevention of medication errors during hospitalization and adverse outcomes after discharge. Furthermore, maintaining and communicating accurate medication information is a Joint Commission National Patient Safety Goal. Electronic Medical Record (EMR) pop-up messages are utilized to increase awareness of incomplete med recs. Despite these pop-ups, approximately 25% of daytime admissions to the General Internal Medicine (GIM) service at George Washington University Hospital (GWUH) do not have a documented, complete med rec. The aim of this quality improvement initiative was to increase the percentage of med recs completed within 24 hours of admission to a GIM team at GWUH to >90% over six months. The EMR of newly admitted GIM patients was reviewed for absence of med rec pop-ups, which served as an initial indicator of a completed med rec. After establishing baseline med rec completions rates, in-person and email reminders were sent to call teams regarding utilization of a med rec column on their personal Admission Tracker Boards (ATBs). The study was then expanded to all six GIM call teams and definition of "complete admission med rec" was revised to include completion of both "Documentation of Medication History" and "Admission Reconciliation," as identified by the presence of green check marks within the EMR. A second intervention standardized ATBs across all call teams. Feedback on standardized ATBs was obtained via post-intervention in-person interviews with each call team. Finally, all GIM residents were surveyed to identify individual perceptions on what constitutes a "complete med rec" and to identify barriers to completing these med rec components within the EMR. Baseline med rec completion rates for day call teams were 71% (n=28 admissions) vs. 92% (n=13) after implementing our initial intervention. After expansion to include all six call teams and revision of the definition of admission med rec, completion rates were 81% for "Documentation of Medication History" and 83% (n=63) for "Admission Reconciliation." After standardization of ATBs, completion rates were 80% (n=50) and 88% (n=50). Survey data pertaining to feedback on standardized ATBs and barriers to med rec was compiled and reviewed. Our study led to a decrease in frequency of EMR pop-ups and an increase in med rec completion. Importantly, our study highlighted gaps in resident knowledge regarding the med rec process, including uncertainty regarding what constitutes adequate documentation of a medication history. Further analysis of the barriers to documenting both a medication history and admission reconciliation are necessary to ensure completion of these metrics, and to provide accurate discharge medication lists to patients and outpatient providers.

Open Access

1

Comments

Presented at Research Days 2019.

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Reducing Electronic Medical Record Pop-Ups and Improving Admission Medication Reconciliation Completion at George Washington University Hospital

Timely and accurate completion of admission medication reconciliation (med rec) is an invaluable step in the prevention of medication errors during hospitalization and adverse outcomes after discharge. Furthermore, maintaining and communicating accurate medication information is a Joint Commission National Patient Safety Goal. Electronic Medical Record (EMR) pop-up messages are utilized to increase awareness of incomplete med recs. Despite these pop-ups, approximately 25% of daytime admissions to the General Internal Medicine (GIM) service at George Washington University Hospital (GWUH) do not have a documented, complete med rec. The aim of this quality improvement initiative was to increase the percentage of med recs completed within 24 hours of admission to a GIM team at GWUH to >90% over six months. The EMR of newly admitted GIM patients was reviewed for absence of med rec pop-ups, which served as an initial indicator of a completed med rec. After establishing baseline med rec completions rates, in-person and email reminders were sent to call teams regarding utilization of a med rec column on their personal Admission Tracker Boards (ATBs). The study was then expanded to all six GIM call teams and definition of "complete admission med rec" was revised to include completion of both "Documentation of Medication History" and "Admission Reconciliation," as identified by the presence of green check marks within the EMR. A second intervention standardized ATBs across all call teams. Feedback on standardized ATBs was obtained via post-intervention in-person interviews with each call team. Finally, all GIM residents were surveyed to identify individual perceptions on what constitutes a "complete med rec" and to identify barriers to completing these med rec components within the EMR. Baseline med rec completion rates for day call teams were 71% (n=28 admissions) vs. 92% (n=13) after implementing our initial intervention. After expansion to include all six call teams and revision of the definition of admission med rec, completion rates were 81% for "Documentation of Medication History" and 83% (n=63) for "Admission Reconciliation." After standardization of ATBs, completion rates were 80% (n=50) and 88% (n=50). Survey data pertaining to feedback on standardized ATBs and barriers to med rec was compiled and reviewed. Our study led to a decrease in frequency of EMR pop-ups and an increase in med rec completion. Importantly, our study highlighted gaps in resident knowledge regarding the med rec process, including uncertainty regarding what constitutes adequate documentation of a medication history. Further analysis of the barriers to documenting both a medication history and admission reconciliation are necessary to ensure completion of these metrics, and to provide accurate discharge medication lists to patients and outpatient providers.