RoseMarie Lara, DNP, AC-NP

Abstract:

Background: The literature has shown that at least one medication discrepancy occurs in 75% ofhospital-to-skilled nursing facility (SNF) admissions. Medication discrepancies are responsible for over 1.5 million adverse drug events costing the United States health care system over $3.5 billion. The use of an electronic health record (EHR) to minimize medication discrepancies lends one of many avenues for further studies to evaluate means of reducing these discrepancies thereby improving patient care and outcomes. Objectives: This pre and post study design project evaluated the efficacy of an EHR on decreasing medication discrepancies during transition of care (TOC) of patients from the hospital to the SNF. Methods: Evaluation of the impact of a iii practice change (implementing the new EHR) focused on comparing medication discrepancies on patients admitted to one SNF from two related Los Angeles area hospitals. The pre-EHR group was compared to the post-EHR group for number and type of medication discrepancies. Documents reviewed included the hospital discharge (DC) summary, the hospital interfacility transfer summary, and finally the SNF admission orders for accuracy of medication lists. Results: Four types of medication discrepancies were significantly lower in the post-EHR sample compared to the pre-EHR sample. Specifically, discrepancies were lower post-EHR for omissions (p = .03), additions (p = .004), incorrect doses (p = .04), and missing frequencies (p = .01). Although the chi square analysis was not statistically significant at the p=.05 level, from a clinically significant standpoint two times as many post-EHR patients (34.1% versus 16.3%) had no medication discrepancies compared to pre-EHR patients. These results provide an indication that further projects exploring the implementation of an EHR to reduce medication discrepancies may be a valuable tool to aid in and improve patient care and outcomes specifically in relation to maintaining accurate medication lists. Conclusion: An EHR implemented into routine SNF care can reduce medication discrepancies on patients being admitted to the SNF from the hospital when used by SNF nurses to input newly admitted patient medication lists. Keywords: skilled nursing facility, medication errors, transition of care, medication reconciliation. 

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