Automated E-mail Reminders Linked to Electronic Health Records to Improve Medication Reconciliation on Admission

Abstract

Introduction: Medication reconciliation can reduce medication discrepancies, errors, and patient harm. After a large academic hospital introduced a medication reconciliation software program, there was low compliance with electronic health record documentation of home medication reconciliation. This quality improvement project aimed to improve medication reconciliation on admission in 4 pediatric inpatient units by 50% over 3 months.

Methods: We used Lean Sigma methodology to observe medication reconciliation processes; interview residents, nurses, pharmacists, and families; and perform swim lane process mapping and Ishikawa Cause and Effect analysis. The improvement plan included education and automated e-mails sent to admitting residents who had not completed medication reconciliation within 24 hours of admission. The daily percentage of patients without medication reconciliation within 24 hours of admission, indicated by the presence of old prescriptions in Sunrise Prescription Writer (RxWriter) (Allscripts Healthcare Solutions, Chicago, Ill.) from prior admissions, was assessed from March 2015-June 2016. We constructed statistical process control charts and identified special causes.

Results: Key barriers included lack of knowledge about RxWriter and lack of accountability for completing medication reconciliation. The percentage of patients without medication reconciliation decreased from 32% at baseline to 22% with education (P < 0.001), to 15% with the use of automated e-mail reminders (P < 0.001). We sustained improvement over the following year. Statistical process control testing indicated shifts aligning with each stage of the study.

Conclusion: Provider-tailored, automated e-mail reminders linked to electronic health record with educational training significantly improved resident compliance with use of an electronic tool for documentation of home medication reconciliation on hospital admission.

Fig. 1.

Swim lane process map defining the process of home medication reconciliation and roles of patient, nurse, resident, and pharmacist. H&P, history and physical; MAR, medication administration record; OMR, outpatient medication review; OP, outpatient; PACU, postanesthesia care unit; POE, provider order entry.

Fig. 2.

Ishikawa cause and effect diagram for incomplete home medication reconciliation on hospital admission.

Fig. 3.

Automated e-mail reminder message sent to admitting resident physician for patients without medication reconciliation > 24 hours after admission.

Fig. 4.

SPC chart of the daily proportion of patients admitted to general pediatric units without documentation of home medication reconciliation in RxWriter after 24 hours of admission. LCL, lower control limit; UCL, upper control limit.