The purpose of this research tested the effectiveness of two medication safety improvements aimed at reducing adverse drug events (ADEs) with patients using anticoagulants, diuretics, or digoxin, and improving documentation of ADEs in rural facilities. Three hospitals, six rural clinics, four retail pharmacies, an education center, and the university used a committee of health professionals to guide project activities. The hospital and community ISMPs were used to assess existing work processes. Interventions included adoption of four protocols to support dosing and monitoring of warfarin, low-molecular weight heparin, diuretics and digoxin; PDAs and desktop computer web software to increase drug-drug interaction profiling beyond pharmacies; and patient education on carrying medication lists, getting medications checked for interactions, completing laboratory tests, and knowing when to call for help. A pre-post secondary data analysis of administrative hospital data sets evaluated the change in number of ICD-9CM event codes for anticoagulants, diuretics and digoxin during the year prior to interventions and the year the intervention activities were performed. The findings demonstrated coded ADEs in 0.308% of interventional site and 0.386% of control site patients prior to interventions. During intervention year, the ADEs reduced to 0.19% at intervention site and 0.52% at control site. The number of anticoagulant ADEs were significantly less within the intervention site (0.013, Fisher Exact test). The ADEs with diuretics (p=0.19) and digoxin (p=0.11) were less at the intervention site but not significant. Ninety percent of participants carried medication lists, profiled medications for interactions, and completed prescribed lab tests. The drug-drug interaction checking and common protocols among providers promoted repeatable medication safety procedures and messages to patients. The use of PDAs in the clinic setting allowed physicians, physician assistants and nurse practitioners to profile medications for potential interactions while with the patient.
Session #1125 - Nursing Informatics Research: Supporting Patient Safety and Quality of Care
The 29th Annual MNRS Research Conference (April 1-4, 2005)