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A Comparison of the Efficiency and Effectiveness of Blank Versus Pre-populated Admission Medication

Reconciliation Order (MRO) Forms

Rajwant Minhas, B.Sc. (Pharm.) LMPS Resident

Project PreceptorsAnita Lo, FH Medication Reconciliation Facilitator

Laura Drozdiak, FH Medication Reconciliation FacilitatorMark Collins, Director of Pharmacy

Background

• Medication Reconciliation: A formal process in which accurate and complete medication information is transferred at interfaces of care1

– Reduces medication discrepancies by ~ 75%2

• In FH a blank Medication Reconciliation Order (MRO) form is used at admission

• No published studies have compared blank MRO form with one that is pre-populated with a patient’s PharmaNet record

1. Getting started kit: Medication Reconciliation Prevention of Adverse Drug Events. Safer healthcare now! 2007 May. 2. Hughes RG, editor. Patient safety and quality: an evidence-based handbook for nurses 2008 Apr.

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ObjectivesPurpose: To determine if pre-populated MRO form is more

effective and more efficient than the blank MRO form

Primary Outcome: Effectiveness: Compare number of medication discrepancies per patient

Secondary Outcomes:Effectiveness: Percent of charts with a complete MRO form within 24 hours of admission

Efficiency/Satisfaction: Healthcare workers’ satisfaction

Methodology

Longitudinal study, convenient sample at a 160 bed acute care hospital

Pre

Process Measure: •% of charts with MRO form•% of MRO forms complete•20 patients audited every 2 weeks

Go Live Date: Oct 17, 2011Post

Pre-implementation compared to post-implementation when special cause variation was identified

Outcome Measure: •# of undocumented intentional discrepancies •# of unintentional discrepancies•20 patients audited pre and post-implementation

Per patient

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MethodologyInclusion Criteria: • Patients admitted for > 24 hours• Patients admitted to medicine

Exclusion Criteria: • Unable to communicate in English• Unconscious patients without any family members or drug vials to

verify medication history• No PharmaNet record

Health care professionals surveyed to determine satisfaction rate

Statistical Analysis: Mann-Whitney U tests, Chi Square tests, Statistic Process Control (SPC)

Results: % MROs Completed

UCL

LCL

0

10

20

30

40

50

60

70

80

90

100

10/1

2/11

10/3

1/11

11/1

7/11

12/5

/11

12/1

3/11

12/2

9/11

1/14

/12

1/27

/12

1/28

/12

2/10

/12

2/11

/12

%

Go Live Date: Oct 17

UCL = Upper Control Limit

LCL = Lower Control Limit

Results: Average Number of Undocumented Intentional and Unintentional Discrepancies Pre and

Post Implementation Per Patient

0

1

2

Undocumented IntentionalDiscrepancies

Unintentional Discrepancies

Pre and post implementation

Ave

rage

num

ber o

f di

scre

panc

ies

per p

atie

nt

Pre

Post

P value: <0.013P value: 0.529

Results

Process Measure Pre Post P-value

% of charts with MRO form

15/20 = 75% 16/20 = 80% 0.075

% of MRO forms complete

4/20 = 20% 15/20 = 75% 0.001

Results: Overall Satisfaction Rate for Blank vs. Pre-populated Form

0

10

20

30

40

50

Not satisfied Somewhat satisfied Satisfied Very satisfied Not sure

Satis

fact

ion R

ate

(%)

Blank FormSatisfaction Rate

Pre-PopulatedForm SatisfactionRate

Response Rate = 15%

Limitations

• Restricted to a single site

• Longitudinal study design

Conclusion

• A pre-populated MRO form is more effective and efficient than a blank form as demonstrated by:– Higher completion rates – Fewer medication errors– Greater user satisfaction

References

1. Getting started kit: Medication Reconciliation Prevention of Adverse Drug Events. How-to guide [Internet]. Safer healthcare now! 2007 May [cited 2011 Jul 2]. Available from: http://www.ismp-canada.org/download/MedicationReconciliationGettingStartedKit-Version2.pdf

2. Hughes RG, editor. Patient safety and quality: an evidence-based handbook for nurses. Rockville <MD>: Agency for Healthcare Research and Quality <US>; 2008 Apr.