Background: Medication reconciliation (MR) is foundational to patient safety during and after a hospital admission. Frequently, MR can be delayed at the time of hospital admission due to incomplete records, patient health literacy, barriers to patient communication such as language or mental status, and unavailability of family or primary care providers. Electronic health records (EHR) offer standardized tools to verify and record a patient’s medication list throughout the patient’s hospital course; however, use of these resources is variable. At our quaternary, academic urban center, inconsistent use of dedicated fields may lead to redundant work. We found a specific opportunity for improved EHR completion and verification rates for our general medicine teaching services (GMTS).
Purpose: We designed a project to perform a quality improvement (QI) to promote the use of the dedicated MR EHR tab and verification tool within a GMTS through the use of electronic education modules, performance dashboards, and gamification. Our goal was to measure the difference in MR tab use pre- and post- intervention, with the overall purpose of streamlining provider work and improving transitions of care for GMTS inpatients.
Description: A QI intervention was conducted from July 31st to November 3rd 2023 to increase the number of MR completed in the EHR tab. Onboarding of appropriate use for the MR tab in our EHR was provided for all incoming interns. This education was reinforced through distribution of this workflow and reviewed at the start of each inpatient rotation for the residents. Additionally, we disseminated a weekly dashboard to all residents for awareness of the MR completion rates for their teams. These dashboards were branded as a “Med Rec Monday” and were accompanied with reminders of how to correctly complete and verify MRs in the EHR tab. These interventions were built upon on a previous local QI effort that promoted MR completion through a bi-weekly competition among residents on the GMTS. This previous gamification, in which cookies were rewarded to the team with the highest percent of MR completion, was also continued. A report of all admission MRs completed by residents on the GMTS was reviewed for completeness of MR. An MR was counted as successfully complete only if the resident marked a specific drop-down menu as “Complete.” The MR completion rates were examined once a week as a point prevalence. In the three-month baseline period prior to intervention, the average completion rate of MRs among admissions to GMTS was 39.5%. Over the entire course of the project, MR completion rate was 62.4% on average (chi-sq=126.5, p< 0.0001). The highest MR completion rate was 75.2% through week 4 and completion rates remained above baseline through the intervention period with a rate of 60.5% in the last two weeks.
Conclusions: MR are variably recorded in the EHR, with potential downstream effects for providers and patients. This project successfully leveraged electronic learning to improve Medicine resident workflow through an education guide, weekly dashboard and biweekly positive gamification. While there was an increase in MR completion rates in the appropriate EHR tab from baseline, the long-term benefit of the interventions remains to be seen and will be tracked for long-term sustainability.
