Limitations
This study has several limitations that may affect its interpretation. The study was retrospective in nature and had a short study period. The data were collected from a single specialty program, which decreases the study’s generalizability, as not all VAMCs have a MHRRTP. Also, the average LOS in 2010 was longer than in 2013. This was related to the restructuring of the MHRRTP in the spring of 2013 to allow for more condensed programming. As a result, it may be reasonable to infer that there were more ECS visits prior to implementation of the PRN medication list due to the longer LOS in 2010. This confounding variable was minimized by normalizing the calculation for the number and percent of ECS visits avoided.
The patient population was limited to male veterans and the satisfaction questionnaires had low response rates. The low patient response rate may have been due to a lack of incentive, decreased health literacy, or possibly lack of time. The low nurse response rate may have been due to limited time and also lack of incentive. A larger response rate may have increased the PRN medication list use and satisfaction reported. This study looked at the change in the number of ECS visits; but, it did not investigate any changes in the number of primary care visits. Patients were able to go to their primary care appointments during their stay in the MHRRTP and may have received medications listed on the PRN medication list at these appointments, which could have been avoided. Last, the accuracy of the documentation in CPRS may be unclear and may have subjected the study to bias. Unfortunately, ECS does not use bar code medication administration, so the administration of medications has to be manually written into the ECS visit note. This method may be vulnerable to human error.
Future Directions
Future directions from this study include discussing the results with the MHRRTP staff and identifying areas of improvement to enhance the medication list. Some discussion points include the reasoning to remove trazodone and examples of inappropriate use. Furthermore, the questions asked by patients and general
suggestions made by the nursing staff identified that increased patient education of the PRN medication list should be implemented during the admission assessment process. This would improve patient understanding and awareness of the PRN medication list, because some patients did not know about the list or what medications it included. Moving forward, the results of this project may provide incentive for future implementation of PRN medication lists at other VA MHRRTPs.
Conclusion
This study confirms that the MHRRTP PRN medication list has been highly used since its implementation in 2010. The study also suggests that the nursing staff and patients are satisfied with the current process. Furthermore, these findings illustrate the PRN medication list’s success at decreasing unnecessary use of ECS and its association with avoiding cost. Further studies are needed to support the results seen in this analysis. Although these discoveries are preliminary, they may provide incentive for future implementation of PRN medication lists at other VA MHRRTPs.