Background: New York State has identified a list of controlled medications that require frequent monitoring and review. New York State law dictates that these medications, when disbursed in a hospital setting, must be reviewed and re-ordered on a weekly basis. In order to maintain compliance with New York State law, the Electronic Medical Record (EMR) within our hospital is designed to auto-discontinue controlled medications after a period of 7 days. Controlled substances must be renewed by a health care provider prior to auto-discontinuation if they are to remain on a patient’s medication list. Certain antiepileptic medications, such as phenobarbitol and lorazepam, are listed as controlled substances and require frequent review. Discontinuation of these medications may lead to significant morbidity/mortality in hospitalized patients. Auto-discontinuation of a benzodiazepine resulted in seizure in a patient admitted to our hospital. Here we report outcomes of a multidisciplinary task force aimed at minimizing unintended discontinuation of controlled substances.
Purpose: Minimize unintended discontinuation of controlled substances
Description: An interdisciplinary team of attending physicians, chief residents, pharmacists, nurses, members of the hospital quality team and technology professionals was formed. In addition to the existing electronic alerts for renewals, Thursday was designated as the day for providers to renew controlled substances. A notification email was sent to providers within the Internal Medicine and Cardiology departments. Weekly emails/pages were additionally sent by chief residents to members of house staff. A reference list of controlled substances was generated and posted in provider work areas and on an employee intranet site. A criteria-based list was then designed within the EMR to flag medications marked for discontinuation. Pharmacists reviewed the EMR-generated report on a weekly basis and either handed off information during rounds and/or distributed a notification email to key providers. Providers integrated this list into rounds to ensure continued awareness of patients receiving high risk medications. In order to capture fallouts, pharmacy endeavored to generate a list of auto-discontinued medications once per week on Fridays. This list was communicated with providers. In the 8 month period prior to initiation of this task force, 10 instances of unintended medication discontinuation were noted. Three such episodes were noted in the 5 months following development of this novel interdisciplinary monitoring system.
Conclusions: Here we report the generation and outcomes of a multidisciplinary task force aimed at minimizing unintended discontinuation of controlled substances. We are confident that systematic interdisciplinary monitoring will continue to reduce medication auto-discontinuation rates thereby reducing overall medication-related morbidity and mortality within our hospital system.