A Quality Improvement Initiative to Improve Pediatric Discharge Medication Safety and Efficiency

Lisa M Ring; Jamie Cinotti; Lisa A Hom; Mary Mullenholz; Jordan Mangum; Sameeya Ahmed-Winston; Jenhao Jacob Cheng; Ellie Randolph; Ashraf S Harahsheh

doi:10.1097/pq9.0000000000000671

A Quality Improvement Initiative to Improve Pediatric Discharge Medication Safety and Efficiency

Pediatr Qual Saf. 2023 Jul 10;8(4):e671. doi: 10.1097/pq9.0000000000000671. eCollection 2023 Jul-Aug.

Authors

Lisa M Ring^{1

2

3}, Jamie Cinotti⁴, Lisa A Hom^{1

2}, Mary Mullenholz¹, Jordan Mangum¹, Sameeya Ahmed-Winston⁵, Jenhao Jacob Cheng¹, Ellie Randolph⁴, Ashraf S Harahsheh^{1

2}

Affiliations

¹ Children's National Heart Institute, Children's National Hospital, Washington, D.C.
² Department of Pediatrics, George Washington School of Medicine and Health Sciences, Washington, D.C.
³ Department of Advanced Practice Providers, Children's National Hospital, Washington, D.C.
⁴ Global Services, Children's National Hospital, Washington, D.C.
⁵ Division of Bone Marrow Transplant, Children's National Hospital, Washington, D.C.

Abstract

Medication errors are a leading safety concern, especially for families with limited English proficiency and health literacy, and patients discharged on multiple medications with complex schedules. Integration of a multilanguage electronic discharge medication platform may help decrease medication errors. This quality improvement (QI) project's primary aim (process measure) was to increase utilization in the electronic health record (EHR) of the integrated MedActionPlanPro (MAP) for cardiovascular surgery and blood and marrow transplant patients at hospital discharge and for the first clinic follow-up visit to 80% by July 2021.

Methods: This QI project occurred between August 2020 and July 2021 on 2 subspecialty pediatric acute care inpatient units and respective outpatient clinics. An interdisciplinary team developed and implemented interventions, including integration of MAP within EHR; the team tracked and analyzed outcomes for discharge medication matching, and efficacy and safety MAP integration occurred with a go-live date of February 1, 2021. Statistical process control charts tracked progress.

Results: Following the implementation of the QI interventions, there was an increase from 0% to 73% in the utilization of the integrated MAP in the EHR across the acute care cardiology unit-cardiovascular surgery/blood and marrow transplant units. The average user hours per patient (outcome measure) decreased 70% from the centerline of 0.89 hours during the baseline period to 0.27 hours. In addition, the medication matching between Cerner inpatient and MAP inpatient increased significantly from baseline to postintervention by 25.6% (P < 0.001).

Conclusion: MAP integration into the EHR was associated with improved inpatient discharge medication reconciliation safety and provider efficiency.