Improving Emergency Medicine Clinician Awareness of Prehospital-Administered Medications
Creators: name: Kamta, Jeff
name: Fregoso, Bryan
name: Lee, Andrew
name: Kutsuris, Catherine
name: Kadow, Elizabeth
name: Walker, Christopher
name: Sensenbach, Benjamin
name: O’Donnell, Caitlin
name: Porter, Andrew
name: Blankenberg, Jessica
name: Acquisto, Nicole
name: Mazzillo, Justin
name: Farney, Aaron
name: Cushman, Jeremy T.
name: Dorsett, Maia
Publisher: name: Taylor & Francis
Year: 2023
Subjects: subject: Biochemistry
subject: Medicine
subject: Cell Biology
subject: Genetics
subject: FOS: Biological sciences
subject: Pharmacology
subject: Science Policy
subject: Mental Health
subject: Infectious Diseases
subject: FOS: Health sciences

description: <b>Background/problem:</b> Information transfer between emergency medical services (EMS) and emergency medicine (EM) is at high risk for omissions and errors. EM awareness of prehospital medication administration affects patient management and medication error. In April 2020, we surveyed emergency physicians and emergency department nurse practitioners (NPs) and physician assistants (PAs) regarding the EMS handoff process. Emergency physicians and NPs/PAs endorsed knowing what medications were given, or having received direct verbal handoff from EMS “Often” or “Always” only 20% of the time (<i>n</i> = 71), identifying a need to improve the written handoff process. To assess rates of medication error due to lack of awareness of prehospital administered medications, we measured glucocorticoid redosing in the emergency department (ED) following prehospital dexamethasone administration. In 2020, glucocorticoids were redosed 30% of the time, and our aim was to reduce glucocorticoid redosing to 10% by June 2022. <b>Intervention</b>: We developed and implemented a system innovation where prehospital-administered medications documented in a nursing flowsheet during verbal handoff are pulled directly into the triage note where they are more likely to be reviewed by receiving EM clinicians. <b>Results</b>: Shewhart p-charts were used to evaluate for statistical process change in the process measure of triage note documentation of prehospital medication administration and the outcome measure of glucocorticoid redosing. While the frequency of prehospital dexamethasone administration in the triage note increased, no statistical process change outcome measure of glucocorticoid redosing was observed. However, on repeat survey of EM clinicians in July 2022, 50% now indicated they were aware of prehospital medication administration “Often” or “Always” (<i>n</i> = 61, <i>p</i> = 0.003), 87% maintained they use the triage note as the main source of information regarding prehospital medication administration, and 81% “Always” review the triage note. <b>Conclusions:</b> Innovations that improve accessibility of written documentation of prehospital medication administration were associated with improved subjective assessment of EM clinician awareness of prehospital medications, but not the outcome measure of medication error. Effective error reduction likely requires better system integration between prehospital and EM records.