Implementation and Evaluation of Electronic Prescribing for Preoperative Patients

Abstract

Background: The adoption of health information technology (HIT) in the United States (US) is increasing due to government efforts to reform the healthcare system. Electronic prescribing (e-prescribing) is a type of HIT that enables prescribers to electronically transmit prescriptions directly and securely to pharmacies via certified and accredited software. Although the use of e-prescribing is rising, the Institute of Medicine’s 2006 recommendation that all prescriptions be received electronically by 2010 has not been met. Problem: The Procedure Readiness Evaluation and Preparation (PREP) center at the targeted site is staffed almost exclusively with advanced practice registered nurses (APRNs). Patients are provided preoperative evaluation and treatment. Mupirocin is the most commonly prescribed medication and is provided preoperatively to surgical cardiac, joint, and spine patients. Although an electronic health record (EHR) system with e-prescribing capabilities was implemented at the site in 2015, providers continued to use paper prescriptions. Thus, the purpose of this DNP scholarly project was to implement and evaluate e-prescribing within an ambulatory surgical preparation center at a large academic medical facility. Methods: This 10 week quality improvement project included all APRNs (N= 7) at the PREP center. Prior to implementation, the project coordinator (PC) met with key organizational stakeholders to obtain support. Frontline staff was engaged. The PC attended several staff meetings during the months leading up to implementation and scheduled informal visits to build rapport and obtain end-user feedback. A site champion from the PREP center was selected to facilitate enhanced provider engagement. Through collaboration with the clinical informatics team, the cardiac, joint, and spine preoperative order sets were modified to contain the appropriate mupirocin regimen, allowing the APRNs to electronically prescribe from directly within each of the order sets. The APRNs were then thoroughly educated and e-prescribing was implemented at the site. During the final month of implementation, a retrospective chart review was completed to determine the number of preoperative cardiac, joint, and spine patients who received their mupirocin prescription electronically. At the conclusion of the project, all APRNs were invited to complete the System Usability Scale (SUS) survey to determine their perceptions of the usability of the e-prescribing system. Results: All PREP center APRNs (N= 7, 100%) received education prior to initiating e-prescribing. During the final month, the APRNs were compliant with e-prescribing, electronically prescribing more than half of all mupirocin prescriptions (n= 33/53, 62%). All of the PREP center APRNs (N= 7, 100%) completed the post-implementation SUS survey and the mean score was 80. Discussion: Sixty-two percent of prescriptions were transmitted electronically during the final month of implementation, which exceeded the goal of 50%. SUS survey results indicated that the providers felt that the e-prescribing system had a high degree of usability. Organizational support, selection of a project champion, and the positive attitudes among the APRNs, along with the EHR modification were crucial to the success of this project. This project is significant given that the utilization of HIT, including e-prescribing, has become a key feature in the US government’s efforts to reform the healthcare system.