Improving E-Prescribing Rates at Broadway Practice Attendings:

Improving E-Prescribing Rates at Broadway Practice Attendings: Heidi Beutler, Mariellen Lane, John Rausch, Laura-Robbins-Milne, Nan Salamon Rene 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 Torres

AIM To increase the rate of e-Prescribing to 75% among all providers at 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

Decreased medication errors Prescribing 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

Increase communication Immediate clarification Allows for generic substitution Avoiding higher copayments can improve medication adherence (Stenner 2010) Pharmacies can give immediate feedback

Barriers to e-Prescribing Before After n 15 n 13 n 4 n 6 n 2 n 1 n 5

Interventions at Broadway Education: Provider education on benefits of ePrescribing Provider review of how to ePrescribe MAs, Nurses and PFAs were taught how to input pharmacy information

Feedback and Access Resident E-Rx report cards Pharmacy map Staff input of preferred pharmacy Televox message updated

Preferred Pharmacies 10463 10034 10468 10040 10033 10453 10457 10032 10452 10456 10458

Televox Message

Parent Opinions “Pre” 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 yet 3 said e-prescriptions are better “Post” survey Block 9: 8 pts knew of ePrescribe services and preferred it “its easier,” “its faster,” “I used to lose all those paper ones.”

ACN Preferred Pharmacy Rates 3/17-3/21 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 1 Broadway Audobon 181st Rangel

ACN Resident e-Prescription Rates Feb-March 2014 0.70 0.60 0.50 0.40 0.30 0.20 0.10 0.00 1 Broadway Audobon 181st Rangel

Broadway e-Prescription Rates Feb-March 2014 0.80 0.70 0.60 0.50 0.40 0.30 0.20 0.10 0.00 1 PGY1 PGY2 PGY3 Attending

Spread the Word! Pharmacy Map Resident eRx rates Staff Training Reporting Problems

Preferred Pharmacy Column