patient and nurse surveys, respectively, available at www.fedprac.com).
Descriptive statistics were used to
analyze collected data. The primary
outcome was assessed for the group
admitted postintervention by calculating the average number of times
each medication on the PRN medication list was used per patient during
their length of stay (LOS) as applicable. The administration totals for
each medication on the PRN medication list during the postintervention
study period were also recorded.
Secondary outcomes were assessed by comparing the recorded
total number of ECS visits pre- and
the average number of ECS visits per
admission and the number of avoidable ECS visits were recorded for
each study group. The cost reduction
from avoided ECS use was estimated
by calculating the total cost of ECS
used pre- and postimplementation.
The difference between the number
of avoidable ECS visits in the pre-and postintervention groups was
assessed for statistical significance
by using a chi-square test. The 2013
cost saving estimation was based
on the average ECS visit cost in the
2013 fiscal year ($657). Of note,
power for this study could not be
calculated as this has not been studied prior; therefore, no precedence
has been set.
On completion of the data collection,
583 patients were assessed for inclusion into the study, 325 in the 2010
preimplementation group and 258 in
the 2013 postimplementation group.
A total of 200 patients were randomized in each group (n = 400); however, 69 (35%) and 63 (32%) were
excluded from the 2010 group and
2013 group, respectively. Sample demographics are described in the Table.
PRN Medication and ECS Use
Between April 1, 2013, and September 14, 2013, 3,959 doses of PRN
medications were administered
to MHRRTP patients who were included in the study (Figure). Prior
to accessing ECS for their problem, 22 (36%) of the 61 patients
who used ECS had trialed the PRN
When comparing the total number of ECS visits, the 2010 group
had 145 visits and the 2013 group
had 96 visits. The preimplementation group averaged 1.1 ECS visits
per MHRRTP admission, whereas
the postimplementation group averaged 0.7 ECS visits per admission.
The difference in the number of
avoidable ECS visits was statistically
significant, with the 2010 group
totaling 15 avoidable visits, while
the 2013 group totaled 1 ECS visit
(P = .0045).
It was estimated that 9 ( 9.3%)
ECS visits were avoided due to the
PRN medication list in 2013. Using
137 patients, who were included in
the postimplementation group, it
can be calculated that $5,867 was
saved due to the PRN medication
list, or $42.83 per patient in 2013.
Using the 2013 MHRRTP census of
898 patients, the financial impact of
the PRN medication list can be extrapolated to produce an estimated
annual cost savings of $38,461.
Patient and Nurse Satisfaction
Of the 120 patients given the patient satisfaction questionnaire,
28 (23%) patients responded. Of
the respondents, 25 (89%) stated
they were aware of the PRN medication list. The median rank of satisfaction reported was 8 on a 10-point
scale. Twenty-two (79%) patients
felt that the PRN medication list
had or may have reduced the need
to go to ECS or urgent care. Twenty-three (82%) patients recommended
not removing any drugs listed on
the PRN medication list.
Figure. Total Number of TImes Each Medication
Was Used (n = 137)
Acetaminophen Antacid/Antigas Throatlozenges Docusate/Senna GuaifenesinIbuprofen Loperamide Loratadine Milkofmagnesia OndansetronRanitidineTrazodone