Implementation of a Standardized Approach to Improve the Pediatric Discharge Medication Process

Abstract

BACKGROUND AND OBJECTIVES: The pediatric inpatient discharge medication process is complicated, and caregivers have difficulty managing instructions. Authors of few studies evaluate systematic processes for ensuring quality in these care transitions. We aimed to improve caregiver medication management and understanding of discharge medications by standardizing the discharge medication process. METHODS: An interprofessional team at an urban, tertiary care children’s hospital trialed interventions to improve caregiver medication management and understanding. These included mnemonics to aid in complete medication counseling, electronic medical record enhancements to standardize medication documentation and simplify dose rounding, and housestaff education. The primary outcome measure was the proportion of discharge medication–related failures in each 4-week period. Failure was defined as an incorrect response on ≥1 survey questions. Statistical process control was used to analyze improvement over time. Process measures related to medication documentation and dose rounding were compared by using the χ2 test and process control. RESULTS: Special cause variation occurred in the mean discharge medication–related failure rate, which decreased from 70.1% to 36.1% and was sustained. There were significantly more complete after-visit summaries (21.0% vs 85.1%; P < .001) and more patients with simplified dosing (75.2% vs 95.6%; P < .001) in the intervention period. Special cause variation also occurred for these measures. CONCLUSIONS: A systematic approach to standardizing the discharge medication process led to improved caregiver medication management and understanding after pediatric inpatient discharge. These changes could be adapted by other hospitals to enhance the quality of this care transition.

Unlicensed/Off-Label Drug Prescriptions at Hospital Discharge in Children: An Observational Study Using Routinely Collected Health Data

“…Appropriate medication at hospital discharge is a vital aspect of an enhanced transition from inpatient to outpatient care in children experiencing different illnesses [9]. However, the hospital discharge process exhibits considerable variability and a substandard quality of care, frequently characterized by errors, omissions, duplications, and inconsistencies in pediatric discharge care [10][11][12].…”

Retention of discharge instructions using an interdisciplinary model for at‐risk children with cancer: A quality improvement initiative

“…Additionally, the increasing prioritization of outpatient management in healthcare has shifted responsibility for identifying and managing emergency situations and complications to caregivers. [7][8][9][10][11] This indicated to us that discharge teaching was a prime opportunity for intervention.…”

“…Misunderstandings of these instructions could lead to increased complications, requiring additional treatment and hospitalizations. Additionally, the increasing prioritization of outpatient management in healthcare has shifted responsibility for identifying and managing emergency situations and complications to caregivers 7–11 . This indicated to us that discharge teaching was a prime opportunity for intervention.…”

Explaining Variability in Electronic Health Record Effort in Primary Care Ambulatory Encounters

“…Like in the business domain, there are many other areas in health care systems where improving process standardization and reducing process variability has shown improved quality and/or reduced costs. [16][17][18][19][20] Although event logs are perhaps best suited for identification of patterns, time estimations of clinical events can provide insight into EHR tasks timing issues. Studies that have measured EHR time use find significant variability (high standard deviations) in the length of time physicians spent using the EHR.…”