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

1. 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 Preceptors Anita Lo, FH Medication Reconciliation Facilitator Laura Drozdiak, FH Medication Reconciliation Facilitator Mark Collins, Director of Pharmacy

2. 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.

3. Objectives Purpose: 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

4. Methodology Longitudinal study, convenient sample at a 160 bed acute care hospital • Outcome Measure: • # of undocumented intentional discrepancies • # of unintentional discrepancies • 20 patients audited pre and post-implementation • Process Measure: • % of charts with MRO form • % of MRO forms complete • 20 patients audited every 2 weeks Per patient Post Pre Go Live Date: Oct 17, 2011 Pre-implementation compared to post-implementation when special cause variation was identified

5. Methodology Inclusion 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)

6. Results: % MROs Completed UCL = Upper Control Limit LCL = Lower Control Limit Go Live Date: Oct 17

7. Results: Average Number of Undocumented Intentional and Unintentional Discrepancies Pre and Post Implementation Per Patient P value: 0.529 P value: <0.013

8. Results

9. Results: Overall Satisfaction Rate for Blank vs. Pre-populated Form Response Rate = 15%

10. Limitations • Restricted to a single site • Longitudinal study design

11. 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

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