Methods
A randomized, retrospective case-controlled study involving a chart review was completed for patients admitted to the MHRRTP at the ZVAMC pre- and postimplementation of the MHRRTP PRN medication list between April 2010 and August 2010 and between April 2013 and August 2013, respectively. The ZVAMC is a teaching institution. This study was approved by the ZVAMC institutional review board.
Patients were eligible for the study if they were male, aged > 18 years, and admitted during the study period for treatment in the GEN or SAR programs at the ZVAMC for at least 4 weeks. Patients were excluded if they were female, admitted to the hospital after being seen by ECS, or if they were receiving treatment in the following programs: PTSD, WOM, OEF/OIF/OND, DCHV, and I-ACT. Patients studied in 2010 served as the control group, and patients studied in 2013 were the treatment group.
Objectives
The primary objective of this study was to evaluate the use of the current PRN medication list. Secondary objectives included the evaluation of the use of ECS by patients admitted to the MHRRTP pre- and postimplementation of the PRN medication list, the potential cost reduction due to avoided ECS use, and nurse and patient satisfaction with the PRN medication list.
Data
A list of all patients admitted to the MHRRTP at the ZVAMC between April and August of 2010 and 2013 was generated using the Veterans Health Information Systems and Technology Architecture (VISTA)system. The Computerized Patient Record System (CPRS) was used to evaluate the patient for inclusion and collect pertinent data. The PRN medication list was implemented on September 15, 2010. Data collection terminated as of September 14, 2010, regardless of discharge status. All data collected for this study were entered and stored in a database created by the authors. A table with set criteria to review was created for the 2010 and 2013 group to ensure standardization. The pharmacy resident reviewed all of the patient charts. The following data were collected for each patient in the 2010 group:
- Demographic data: Patient name, last 4 digits of their social security number, age
- Program information: Admitted to GEN or SAR program, admission and discharge date, duration of stay, reason for discharge
- ECS data: Date, type of visit, chief condition, medications administered during the visit, whether the visit resulted in a hospital admission, and whether the visit was avoidable
- Avoidable visit: visit in which the patient received or could have received medication(s) that are on the PRN medication list at the ECS visit to treat their illness
The same information was collected for each patient in the 2013 group in addition to the following: PRN medication data (medications administered from the PRN medication list and the number of times each medication was administered if applicable); and ECS data (along with the aforementioned data, it was noted if PRN medications were taken prior to the ECS visit).
In addition, nurse and patient satisfaction with the PRN medication list were assessed via a simple satisfaction survey. The survey was given to 120 patients admitted to the MHRRTP as well as to 32 nurses at the time of distribution. A cover letter on each survey explained the study and informed the patient that the survey was voluntary and anonymous. Satisfaction was based on 10-point scale, with 1 (lowest) and 10 (highest) in satisfaction. Additional questions were asked to identify areas of improvement (see eAppendixes A and B for patient and nurse surveys, respectively).