Improving E-Prescribing Rates at Broadway Clinic

Improving E-Prescribing Rates at Broadway PracticeAttendings: Heidi Beutler, Mariellen Lane, John Rausch, Laura-Robbins-Milne, Nan SalamonRene Eis

Residents: Uchechi Azubuine, Dominique D. Bailey, Amy E. Dipilato, Jessica M. George, Pamela Good, Joseph A. Grillo, Anna F. Hays, Michelle S. Jamison, Erin A. Paul, Anoop V. Rao, Gauri R. Raval, Meg R. Ray, Arash Salavitabar, Kristen E. Schratz, Andrew M. Silverman, Katherine Still, Rebecca Tamez, Jennifer Taylor, Thomas Wallach

RNs: Sally Ortiz, Haydee Bayon, Becky Ofori

Registration Coordinator: Ingrid Miranda

MAs: Celia Mendez, Blanca Cordero, Reina Quiroz, Felipe Joaquin

PFAs: Conchita Laurencio, Evelyn Reyes, Shirley Laurencio, Iraida TorresGood morning thank you for coming. This year the Broadway Practice focused on increasing our e-prescribing rates.

1AIMTo increase the rate of e-Prescribing to 75% among all providersat the Broadway Clinic by the end of the academic year (June 2014)

Where we were:Broadway Rate: 48%Resident Rates- 45%Attending Rates- 51%Preferred pharmacy information: 41.9% of patients had a preferred pharmacy listed in Eclypsis

Resident rates were calculated from the period of July 1-end of August. And found that our e-prescribe rate were 45% for residents who could actually use e prescribe.

During this same time period Attending rates were- 51% so overall rate was about 48%

- In early August, we looked at the percent of patients with a preferred pharmacy entered and found this percentage was 41.9%. So our other goal was to increase this to more than 70%2Decreased medication errorsPrescribing error rates in children are estimated to be between 5% and 27% in a systematic review (Miller 2007)Two studies looking at the difference between handwritten and e-prescribed medications found a significant reduction in error rates (Jani 2008, Ammenwerth 2008)Some studies have shown that eliminating this step may also contribute to decreasing medication and dosing errors (Moniz 2011).e-prescribing nearly halved the risk of dispensing errors compared with EMR-generated paper script

Rationale for this project comes from the fact that

Dosing errors are the most common medication error in pediatrics with some estimates as high as 27%. This is very important as even a small change in the dosage of a medication can lead to serious side effects in children

When a prescription is generated and printed the pharmacist must enter information for that medication into system. Eliminating this step can decrease medication errors as was shown by Moniz 20113Increase communicationImmediate clarification

Allows for generic substitutionAvoiding higher copayments can improve medication adherence (Stenner 2010)

Pharmacies can give immediate feedback

E-prescribing Opens a direct line of communication between provider and pharmacist, allowing for immediate clarification of medication, dose, route, and reason for use. And also willingness for generic substitution

Pharmacies can give immediate feedback about medication availability, before the patient even gets there. So if there is a problem the doctor has already spoke with pharmacist before patient arrives to get medication therefore decreasing wait times.

4Barriers to e-PrescribingBeforeAfter

n=15n=1n=5

n=13n=4n=6n=2

Before we decided on interventions we had to determine barriers. Pre intervention surveys were sent out in block 5 and showed residents felt e-prescribing took too long and many residents including myself were not able to e-prescribe. By block 10 everyone realized it actually doesnt take longer and pretty much everyone was able to e-prescribe. Parents not knowing their pharmacy still continued to be an issue.5Interventions at BroadwayEducation:Provider education on benefits of ePrescribingProvider review of how to ePrescribeMAs, Nurses and PFAs were taught how to input pharmacy information

Our interventions were split into three catergories Education, Access and giving Feedback

Education- didactic sessions about the rationale and literaturesupporting e-prescribing were given to all providers, PFAs, andnurses.

In addition an instruction sheet on how to enter a preferred pharmacy was hung at each PFA and nurse's cubicle and providers were given a review of how to e-prescribe.6Feedback and AccessResident E-Rx report cards

Pharmacy map

Staff input of preferred pharmacy

Televox message updated

Feedback-Attendings and NP were receiving report cards since March of last yearResidents first report cards were sent out in late OctoberIncreased Access to information:Developed a map with surrounding Zip Codes that included the most common pharmacies and these were placed in exam roomsPFA/MA and nursing all in serviced to directly enter preferred pharmacy into RX writerTelevox message was updated to include reminder to bring pharmacy info to appointments

7Preferred Pharmacies

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Televox Message

This slide is a run chart that summarizes how the preferred pharmacy rates changed with each PDSA cycles.

The main point to take from this chart is that significant improvements occurred after report cards were given out to residentsDistribution of pharmacy lists

10Parent OpinionsPre survey Block 6: 1 had never gotten an e-prescription 1 preferred paper prescriptions because they don't have a single pharmacy that they like yet3 said e-prescriptions are betterPost survey Block 9: 8 pts knew of ePrescribe services and preferred it its easier, its faster, I used to lose all those paper ones.

Throughout the year we did random surveys of parents in waiting room initially few parents knew about option to e-perscribe, but felt it would be a good option.11ACN Preferred Pharmacy Rates3/17-3/21Data collected from chart review over one week in April showed that Broadway was similar to other ACN Clinics with regards to entering preferred pharmacies12ACN Resident e-Prescription RatesFeb-March 2014Broadway e-Prescription RatesFeb-March 2014When we look at Broadway practice based on level of training this chart shows that senior level providers have higher rates of e-prescribing. Most recent e-prescribe rates were about 71.5% for total clinic.14Spread the Word!Pharmacy Map

Resident eRx rates

Staff Training

Reporting Problems

So how can we spread the word?

Pharmacy Map can easily be distributed to other clinics

Coming soon each resident will receive their specific rates and the average for their clinic. So you know how you are doing.

Power point presentations used for Didactic sessions can be distributed along with instructions on how to enter preferred pharmacy

For any residents who are not able to eRx they should send NPI and CWID to Dr. Robbins?

15Preferred Pharmacy Column

There is now a pharmacy column the user can add to their patient list where the Preferred Pharmacy will appear. This tab will show the most recent pharmacy that was entered. 16