Background: Medication discrepancies, such as incorrect doses, schedules or omitted medications, during hospital admission are common, with studies indicating they occur in over half of admissions. Such errors can result in serious consequences during hospitalization and can be perpetuated at the time of discharge. A medication list is frequently available to admitting providers in the electronic medical record (EMR), but its accuracy should not be taken for granted. While confirmation with a secondary source can make medication lists more accurate, this is not standard practice for admitting physicians. We sought to determine if use of audit and feedback techniques with financial incentive would increase the percentage of patients admitted to the hospitalist service who had EMR medication lists confirmed by a secondary source.
Methods: Between 10/2014 and 6/2015, several random convenience samples of admission notes for patients admitted to the hospitalist service were audited for documentation of corroboration of medication list with a secondary source. Regular hospitalist educational conferences starting 11/2014 included results of these audits, case reports, and sharing of best practices by high performers. A financial incentive program tied to performance was announced.
Results: In 10/2014 audits found 11 of 96 (11%) hospitalists’ admission medication lists had documentation of corroboration at baseline. Subsequent audits revealed this increased to 23% (23 of 86) in January 2015, 53% (17 of 32) in April 2015, and 73% (81 of 111) in June 2015. See Figure 1.
Conclusions: An educational program coupled with a monetary incentive can result in improved hospitalist documentation of confirmation of EMR medication lists at the time of admission. Continued study is needed to determine if this improves patient outcomes.