CASE STUDY: MedsTracker is key component of patient safety strategy at Alegent Health
“Why do you have doctors? For their critical thinking skills. Our goal was to automate as many steps as we could, to make using the computer as easy as possible, so our physicians have time for critical thinking.”
Problem
Well regarded for its high quality standards, Alegent Health recognized the need for a more effective and consistent medication reconciliation solution during a visit from The Joint Commission.
Alegent created a “homegrown” solution, with nurses entering medications using free-text entry. Alegent also instituted a regular audit to check whether discharge instructions were ccurate, including spelling and whether the prescription was complete and used patient-friendly language. Initial results were disappointing, with only 15 to 20 percent of discharges deemed complete. The EMR was cumbersome, home lists still had to be matched with the EMR at discharge, and a large number of reconciliations had to be done by telephone. Physicians could be required to juggle up to 20 pieces of paper to complete a single reconciliation. However, with diligence, reconciliation rose to 60 percent – and there it stayed.
Solution
Medication reconciliation fit with system initiatives to go green, improve patient safety, and improve the quality of discharge instructions to help reduce readmission rates. Recognizing that improperly taking medications is a major contributor to readmissions, Alegent searched for an electronic medication reconciliation solution to meet three criteria: it had to be 1) easy for physicians to use, 2) extremely accurate, and 3) easy for patients to understand. The overall goal was to automate as many steps as possible, so physicians would have more time for critical thinking.
Alegent chose MedsTracker, contracting with Design Clinicals to implement the web-based software solution at its five core hospitals in the metro area: Bergan Mercy Medical Center, Lakeside Hospital and Emmanuel Medical Center (Omaha, NE); Mercy Hospital (Council Bluffs, IA) and Midlands Hospital (Papillion, NE). Midlands, at 131 beds, was selected as the first site for its manageable size. Alegent wanted to test physician and staff acceptance before proceeding to its other hospitals, and saved the tertiary centers for final go-live.
Results
MedsTracker went live at Midlands Hospital in January 2010. On day two, 100 percent of admissions and discharges were reconciled electronically. Monthly random chart audits, with scores based on the accuracy of the medication list sent home with the patient at discharge, showed MedsTracker was a resounding success.
Prior to implementation, numbers were stagnating at 60 percent. In the first month following go-live, the average score jumped to 96 percent complete, with the remaining four percent extremely close (e.g., just missing the dose; there were no wrong medications). Metrics were set, and met in just three weeks: 15 percent or less telephone reconciliations; 85 percent of reconciliations done by physicians on the floor.
Doctors remain enthusiastic, especially about e-prescribing capability, which has drastically reduced calls from pharmacists to clarify discharge medications. When the discharge medication list wasn’t making it into the discharge summary, doctors asked to place in the electronic record, “Refer to MedsTracker document.” An upgrade will automatically import the MedsTracker discharge medication sheet into the discharge summary document.
