Improving patient safety and efficiency of medication reconciliation through the development and adoption of a computer-assisted tool with automated electronic integration of population-based community drug data: the RightRx project

Abstract

Background and objective: Many countries require hospitals to implement medication reconciliation for accreditation, but the process is resource-intensive, thus adherence is poor. We report on the impact of prepopulating and aligning community and hospital drug lists with data from population-based and hospital-based drug information systems to reduce workload and enhance adoption and use of an e-medication reconciliation application, RightRx.

Methods: The prototype e-medical reconciliation web-based software was developed for a cluster-randomized trial at the McGill University Health Centre. User-centered design and agile development processes were used to develop features intended to enhance adoption, safety, and efficiency. RightRx was implemented in medical and surgical wards, with support and training provided by unit champions and field staff. The time spent per professional using RightRx was measured, as well as the medication reconciliation completion rates in the intervention and control units during the first 20 months of the trial.

Results: Users identified required modifications to the application, including the need for dose-based prescribing, the role of the discharge physician in prescribing community-based medication, and access to the rationale for medication decisions made during hospitalization. In the intervention units, both physicians and pharmacists were involved in discharge reconciliation, for 96.1% and 71.9% of patients, respectively. Medication reconciliation was completed for 80.7% (surgery) to 96.0% (medicine) of patients in the intervention units, and 0.7% (surgery) to 82.7% of patients in the control units. The odds of completing medication reconciliation were 9 times greater in the intervention compared to control units (odds ratio: 9.0, 95% confidence interval, 7.4-10.9, P < .0001) after adjusting for differences in patient characteristics.

Conclusion: High rates of medication reconciliation completion were achieved with automated prepopulation and alignment of community and hospital medication lists.

Figure 1.

Electronic medication reconciliation process.

Figure 2.

Prior to Admission tab. (A) Hover-over option to display more drug, prescribing physician, and dispensing pharmacy information; (B) link to open Vigilance Drug Knowledge Database in a new tab.

Figure 3.

Expanded view for modification or addition of drug information.

Figure 4.

Alignment of the community medication list and the in-hospital medications in the Discharge tab.Action buttons are for users to indicate status of medications at discharge, which are organized into bins (eg, continue, modify, stop). Reasons for any medication change to the community medications can be found in orange text below the community medication.

Figure 5.

List of reasons for discontinuing medications are available to be selected in a drop-list format when discontinuing a medication.

Figure 6.

(A) “Continue as previous” medications on the discharge prescription (version 1). Please note that the patient, physician, and pharmacist information are simulated examples.

Figure 6.

(A) “Continue as previous” medications on the discharge prescription (version 1). Please note that the patient, physician, and pharmacist information are simulated examples.