Improving documentation of a beta-blocker quality measure through an anesthesia information management system and real-time notification of documentation errors.
BACKGROUND
Continuation of perioperative beta-blockers for surgical patients who are receiving beta-blockers prior to arrival for surgery is an important quality measure (SCIP-Card-2). For this measure to be considered successful, name, date, and time of the perioperative beta-blocker must be documented. Alternately, if the beta-blocker is not given, the medical reason for not administering must be documented.


METHODS
Before the study was conducted, the institution lacked a highly reliable process to document the date and time of self-administration of beta-blockers prior to hospital admission. Because of this, compliance with the beta-blocker quality measure was poor (-65%). To improve this measure, the anesthesia care team was made responsible for documenting perioperative beta-blockade. Clear documentation guidelines were outlined, and an electronic Anesthesia Information Management System (AIMS) was configured to facilitate complete documentation of the beta-blocker quality measure. In addition, real-time electronic alerts were generated using Smart Anesthesia Messenger (SAM), an internally developed decision-support system, to notify users concerning incomplete beta-blocker documentation.


RESULTS
Weekly compliance for perioperative beta-blocker documentation before the study was 65.8 +/- 16.6%, which served as the baseline value. When the anesthesia care team started documenting perioperative beta-blocker in AIMS, compliance was 60.5 +/- 8.6% (p = .677 as compared with baseline). Electronic alerts with SAM improved documentation compliance to 94.6 +/- 3.5% (p < .001 as compared with baseline).


CONCLUSIONS
To achieve high compliance for the beta-blocker measure, it is essential to (1) clearly assign a medical team to perform beta-blocker documentation and (2) enhance features in the electronic medical systems to alert the user concerning incomplete documentation.
Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, USA. nairbg@uw.edu
Bala G
BG
Nair
Gene N
GN
Peterson
Shu-Fang
SF
Newman
Wei-Ying
WY
Wu
Vickie
V
Kolios-Morris
Howard A
HA
Schwid
D000046:Academic Medical Centers / Q000458:organization & administration; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000758:Anesthesia; D004282:Documentation / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000458:organization & administration; D006745:Hospital Bed Capacity, 300 to 499; D006801:Humans; D019451:Information Management / Q000379:methods; D007256:Information Systems / Q000458:organization & administration*; D019300:Medical Errors / Q000517:prevention & control; D050316:Medical Order Entry Systems; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000458:organization & administration; D019984:Quality Indicators, Health Care / Q000458:organization & administration*; D014861:Washington
D000319:Adrenergic beta-Antagonists