Background: Ensuring compliance with CMS requirements for inpatient admission orders and improving medication reconciliation at discharge are crucial aspects of patient safety and regulatory adherence. However, challenges such as missing admission orders and medication errors during transitions of care persist. In response, we implemented two strategic EHR interventions, Best Practice Advisories (BPAs), to enhance workflows, patient safety, and efficiency.
Purpose: Our objective was to demonstrate how EHR-driven BPAs can significantly improve compliance with timely admission orders and medication reconciliation at discharge, leading to enhanced patient care and safety.
Description: For the first project, aimed at timely admission orders, we engaged key stakeholders and developed an EHR BPA that prompted clinicians to place an admission order before any other entry. The BPA was designed with input from stakeholders, vetted by the Physician Practice Council, and fine-tuned to accommodate urgent orders. Provider education and monitoring were integral to the project’s success.In the second project, we collaborated with our HIT team to strategically utilize our EHR for medication reconciliation at discharge. We introduced BPAs that warned providers when medication reconciliation was incomplete, provided a convenient link for reconciliation, and allowed “on-the-fly” reconciliation for new orders. A “hard stop” in the workflow ensured that nursing could not print the after-visit summary until reconciliation was complete.In the admission orders project, the introduction of the BPA led to a 90.7% immediate reduction in delayed admission orders, improving compliance with CMS requirements. Providers found the BPA non-intrusive, and feedback was positive. For medication reconciliation at discharge, our intervention increased compliance from 83.6% to 97.1%, moving us from the 12th percentile to the 77th percentile among EPIC organizations. Providers appreciated the additional checks and did not find the alerts burdensome.
Conclusions: Our study demonstrates that strategic EHR interventions, such as BPAs, can enhance workflow, patient safety, and efficiency. They significantly improve compliance with CMS requirements for admission orders and medication reconciliation at discharge. While these interventions are important first steps, further research will evaluate their impact on reducing medication errors and adverse events related to discharge medications. These findings can serve as a model for healthcare institutions aiming to leverage technology for enhanced patient care and regulatory compliance.
