Quality improvement interventions increased electronic prescribing in the pediatric inpatient setting, a rate that was sustained for an additional 6 months despite the addition of new interns, according to recent findings.
“Recently, the US News and World Report began including [meaningful use] status in their hospital rankings, with hospitals receiving up to two points based on [meaningful use] certification,” Jennifer Fuchs, MD, from the department of pediatric hospital medicine, Texas Children’s Hospital, and colleagues wrote. “With this change, there has been increased focus on inpatient hospital [meaningful use] metrics, such as [electronic prescribing], but often without the corresponding involvement of the front-line providers that directly affect these metrics. In addition, many barriers have hindered the rapid adoption of e-prescribing systems, most notably the complexity of integrated electronic systems and physician resistance to change.”
Fuchs and colleagues sought to increase e-prescribing frequency of discharge prescriptions at Texas Children’s Hospital to 40%, as well as identify barriers to this initiative and frequency of errors in e-prescribing. They conducted surveys and focus groups involving the pediatric hospital medicine (PHM) service at the hospital that used a bundle of quality improvement interventions. The improvement interventions pulled from surveys, and focus groups produced three series including provider education, changes in patient registration workflow and electronic health record changes.
Providers ordered 6,148 discharge prescriptions for patients discharged from the PHM between July 2014 and June 2015. Among these prescriptions, providers wrote 3,430 prior to an applied intervention; further, average e-prescribing frequency at baseline was 7.4%.
At the end of the study in December 2015, Texas Children’s Eligible MU Measure H205 increased from 5% to 16% and the frequency of e-prescription errors on the PHM service remained unchanged at less than 2%. In addition, EHR interventions and education bundles increased e-prescribing frequency to 48.9%.
“As e-prescribing frequency increased, e-prescribing errors remained low, reflecting no adverse impact on patient safety,” the researchers wrote. “The interventions likely succeeded in changing practice because they directly addressed barriers and concerns raised by front-line providers and combined education with hard-wired EHR rates.” – by Kate Sherrer
