Background: Electronic prescribing (eRx) at discharge enhances safety and quality of care transitions. It results in improved medication adherence and a decreased chance of readmission. Stage 3 Meaningful Use goals include discharge eRx rates of greater than 25%. As of September 2017, our large academic medical center had a year-to-date discharge eRx rate of 18.3%, which we identified as an opportunity for improvement. Our “Meds To Beds” (MTB) program utilizes the hospital-based outpatient pharmacy to deliver prescriptions directly to the patient prior to discharge. Prior to our intervention, MTB was a paper-based prescription process. For our first phase in the PDSA cycle to improve discharge eRx rates, we aimed to analyze and convert the MTB workflow to an eRx-based process.
Purpose: To implement an eRx workflow for MTB on six resident-staffed general medicine floors and assess its impact on eRx rates.
Description: Eight housestaff teams participated in the intervention on 6 nursing units with an average daily census of 108 patients. We performed a root cause analysis of barriers to using MTB and eRx by housestaff. Controlled substance prescriptions and prescriptions for outpatient testing were excluded. The main barriers were missing eRx profile accounts for a subset of intern prescribers and lack of knowledge about the eRx workflow. We worked with information services analysts to identify and correct prescriber profiles, pharmacy staff to accept inpatient eRx, and case management to transfer a patient demographics face sheet to the pharmacy. We established two separate educational campaigns for interns and residents. Additionally, we solicited regular feedback and included reminders to implement the new workflow.
Conclusions: Monthly discharge prescriptions pre- and post-intervention were 1114 and 1275 respectively. There was a significant increase in discharge eRx rate (29% vs 53%, p < 0.05) and total eRx sent to our in-house pharmacy (86 vs 311, p=0.03). The eRx rate of the MTB program after the intervention increased from 3.4% to 94% (see Table 1). Nine MTB prescriptions were sent electronically to area pharmacies due to incorrect destination choice. Housestaff was generally satisfied with the MTB eRx workflow. The hospital-based outpatient pharmacy represents an important opportunity to improve discharge eRx rates for hospitals participating in Medicare and Medicaid Electronic Health Record incentive programs. Based on our initial success with the redesigned MTB workflow, we plan to expand the initiative to all hospital units as well as other teaching hospitals within our health system.
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