Inhaled Medication Reconciliation in the Electronic Medical Record

Abstract

Background:

The prevention of medication errors was a TJC priority, per the 2017 National Patient Safety Goals. The literature states that medication errors are quite common, and that 40% are related to inadequate medication reconciliation. In general, there should be 'one truth' or list of home medications in the electronic medical record (EMR). Our EMR contains 4 areas for documentation of home medications. Previously, our RTs lacked access to one area - the 'External Rx History' - which links to an OP pharmacy data repository. Per pharmacy, this is the most accurate data related to home medications. Our RTs rely on home inhaled medications as the foundation for our inhaled medication (bronchodilator and inhaled steroid; BDT) protocol, and discrepancies in EMR and patient reporting can influence appropriate in-hospital ordering of these drugs.

Methods:

We retrospectively reviewed the EMRs of a convenience sample of patients placed on our bronchodilator protocol (N=30) (IRB - 2571). Using structured intake, we reviewed 'Inpatient Summary', 'Transition of Care', 'Document Med by Hx', and 'External Rx History', for consistency of information across charting areas. We also sought to determine whether 1) Home inhaled medications were congruent with inpatient orders, 2) Any outpatient inhaled medications were omitted, and 3) Transition of care included appropriate discharge inhaled medications. Descriptive statistics were used to summarize data.

Results:

A total of 30 charts were reviewed. The inpatient summary matched the External Rx History in 72% of cases (n=29, with data missing for 1 subject), and congruency of our BDT with home inhaled meds was only 63%. Thirty percent of subjects had an outpatient-inhaled medication omitted from inpatient orders, and there were discrepancies in the Transition of Care inhaled medication list in 60% of subjects. Only 11% of subjects had congruence among all sources of inhaled medication reconciliation across designated areas within the EMR.

Conclusions:

Multiple areas to display home medications leads to a lack of consistency and congruence within the EMR.

Graph shows the consistency of inhaled medication reconciliation across available areas within the electronic medical record (EMR). OP = Outpatient BDT = Bronchodilator Therapy Protocol Ext Rx Hx = External Medication History; obtained via pharmacy data repository linked to outpatient pharmacies.