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Baptist Health South FloridaScholarly Commons @ Baptist Health South Florida
All Publications
6-17-2016
Strategies to Improve the Use of ElectronicPrescriptionRosa FilomenoHomestead Hospital, [email protected]
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CitationFilomeno, Rosa, "Strategies to Improve the Use of Electronic Prescription" (2016). All Publications. 2693.https://scholarlycommons.baptisthealth.net/se-all-publications/2693
Strategies to Improve the Use of
Electronic Prescription Jessy Varkey MSN,RN, Larissa C. Vega BSN, CMSRN, CPHQ, Rosa Filomeno MSN, CMSRN and Kathie C. Trivett BSN, CCRN
Homestead HospitalIntroduction /Background
Plan
Do
Check
Electronic prescribing (E-scripts) is a system within the
Electronic Healthcare Record (EHR) which provides
the ability for physicians to electronically send
prescriptions directly to the patients pharmacy. The
utilization of E-scripts increases patient safety,
decreases transcription errors and complies with
Stage 2 Meaningful Use requirements.
After the initial implementation of E-scripts at
Homestead Hospital, only 4 out of 45 Health Care
Providers (HCPs) utilized the system. This triggered
the Meaningful Use (MU) team to conduct a
Performance Improvement (PI) project to identify the
barriers for use and improve compliance in utilization
of the system.
The Plan Do Check Act (PDCA) model for performance improvement was used to
guide the development and implementation of the project.
In order to identify barriers, MU team interviewed
physicians and staff to identify what challenges
existed with using the system. Once challenges were
identified, an interdisciplinary team was developed to
implement various strategies to overcome challenges
and increase compliance of HCPs using E-scripts to
over 20% for all inpatient discharges.
•Collaborate with Pharmacy & Nursing to ensure that
patient’s retail pharmacy was entered into all
inpatients EHRs.
•Provided one on one training to all HCPs to increase
their competence and confidence with E-scripts
system.
• MU team provided daily assistance to HCPs, nurses,
and pharmacists with technical issues.
• MU Team confirmed successful transmissions of
E-scripts to retail pharmacies which increased the
physicians trust in using the E-script system.
• When compared, the MU supported physician group did better at adopting the new escript technologies than the CBT physicians group.
Act
•Escripts continues to reduce errors in transcriptions.
•Retail pharmacy entry rates continue to be
maintained due to an interdisciplinary team approach.
• CBT may not be sufficient when implementing
escripts and may require multidisciplinary strategies
utilized by the Homestead Hospital Meaningful Use
team.
•The MU team will continue to strive to increase
escript rates beyond 50% for all inpatient discharges
and develop strategies to increase escript rates for
Charity Care patients.
•Results are to be disseminated internally and
externally.
PTT-INR “The Project Think Tank for Innovation in Nursing Research”-Consultation
Homestead Hospital Hospitalist Physicians
CMS.gov (2015), EHR Incentive Programs: 2015 through 2017 (Modified Stage 2) Overview.
Retrieved: April 15, 2016, from https://www.cms.gov/Regulations-
andGuidance/Legislation/EHRIncentivePrograms/Downloads/2015_EHR2015_2017.pdf
November2015
December2015
January2016
February2016
March 2016 April 2016 May 2016
E-scribe rate 20 29.8 40.9 42.5 43.9 48.2 57.5
20
29.8
40.9 42.5 43.948.2
57.5
0
10
20
30
40
50
60
70
80
90
100
Pe
rce
nta
ge
E-script Rate
The MU Team collaborated with pharmacy department and it was agreed that
the pharmacy tech would initially enter the retail pharmacy name for all patients
being admitted and the admitting nurse would then confirm and verify the
information on admission. This intervention increased the retail pharmacy entry
rate from less than 60% to over 95% and has been sustained over 5 months.
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Pe
rce
nta
gePharmacy Entry Rate
Pharmacy entry percentage Goal = 95%
Go live 11/17/2016
Nurses re-educated
29%
22%18%
16%
7%
5%
Barriers to Using E-scripts
No Pharmacy inE.H.REducation/ITSupportTrust in System
Charity Care
System Issues
Pharmacy Began entering Retail Pharmacy in ED
0
10
20
30
40
50
60
70
80
90
100
November December January February March April May
MU Support Group 22 31 42 43 44 49 58
CBT Group 0 0 0 0 0 0 24
2231
42
43
4449
58
0 0 0 0 0 0
24Pe
rce
nta
ge o
f E-
scri
be
Comparison between CBT group and MU supported group
•Escript rates improved from less than 20% to over 57% by implementing various
strategies which included one to one teaching, training, reinforcement, computer
support, coaching, and verification of escripts to retail pharmacies.
Acknowledgements
References
