Implementation of an electronic system for medication reconciliation

• HIT Description: Decision support More info...
  
• Purpose of Study: Evaluate feasibility and effect on patient safety of a medication reconciliation system.
  
• Years of study: 2004-2005
  
• Study Design: Pre-post
  
• Outcomes: Patient safety, satisfaction, healthcare efficiency & quality
  

• Settings: 48 bed medical unit of Wesley Medical Center, Wichita, Kansas
• Intervention: Electronic process for medication reconciliation using clinical patient care system (CPCS) at admission and discharge compared to paper system.
• Evaluation Method: Time studies were completed to determine personnel resources required. Patients were contacted after discharge to measure their satisfaction with medication counseling and instructions. Providers were surveyed on their satisfaction with the electronic medication reconciliation processes.
• Description: Electronic admission and discharge medication documentation is entered by nurses and pharmacists. It becomes part of the patients permanent electronic record. System generates four reports, two on pre-admission home medications and two on discharge medications.
• System Penetration: Only used in one unit of the hospital (adult general medical)
• Facilitators: Nurses and pharmacists attended education sessions before study initiation. A flow charge was created to guide nurses. Pharmacists attended a 3 hour hands-on, computer education sessions and an electronic medication order-entry evaluation. One-on-one physician education for some providers; informational posters.
• Barriers: The complexity of the process likely detracted from the staff's willingness and ability to capture interventions. Many MDs did not complete the discharge medication reconciliation report, even when prompted
• HIT System Sustainability: BR
• Long-term Cost: Would cost $180,000 annually, plus pharmacist benefits.
• Quality of Care and Patient Safety Outcome: Patients who had medications electronically reconciled reported a greater understanding of the medications, including how to take them and potential adverse events. Pharmacists made significantly more dosage changes after implementation.
• Changes in efficiency and productivity: Number of incomplete medications discovered and allergies identified decreased significantly.