Creating a Unified MARRS (Medication Alert and Refills Renewal System)

From the 2023 HVPA National Conference

Kalyani Dhar MD (Stony Brook University Hospital), Yu Zhuo MD, Lisa Fisher MD, Michele Zito PharmD

Background:
In a resident primary care clinic, it was noted that there were an overwhelming number of messages received daily for medication refills. We streamlined this process by creating a unified medication alert and refills renewal system (MARRS) where we could assess the need for a medication renewal prior to the medication expiring in addition to capturing any medication(s) that a veteran specifically requested electronically.

Objective:
The goal of this system is to lower the rates of adverse events in patients due to delayed medication refills and improve health outcomes in patients through improved medication adherence.

Methods:
In order to address the issue, we created a unified MARRS. The MARRS generates two different reports, a Proactive and a Reactive Report. The Proactive Report generates a list of patients whose prescriptions have zero refills remaining. The Reactive Report generates a list of prescription orders that are requested for renewal that have not been addressed by a provider. The MARRS allows us to run both reports to address all renewal orders in a timely fashion. In the Proactive Report column, the number of medication orders that are expiring that month are listed. In the Reactive Report column, the number of medications requested by veterans that appear as alerts in the EMR are listed.

Results:
With the help of Proactive Report, residents were able to address medications that would have expired in April, May and June in the month of March! When we re-ran the Proactive Report in April for the months of April-June, only 38 medication orders were due to expire. Without the use of MARRS, there would have been a total of 412 medication orders pending renewal. The number of medication requests on the Reactive Report decreased as well. There were 88 requests in the month of February and only 20 requests by May 2021, which we attribute to proactively addressing medication renewals.

Conclusions:
Our data shows that addressing these medication alerts and refills in both a reactive and proactive manner using a unified renewal system results in less medication requests, improved workflow/workload, and likely improved adherence to medication. There are less requests to overnight medication that expired/ran out and patients are not spending time on the phone waiting for medication renewals.

Clinical Implications:
This pilot initiative only involved the resident clinic, but our goal is to have non-resident clinic providers regularly utilize this system as well given the meaningful impact it has had in our clinic. The initiative improved the quality and safety of patient care by ensuring that veterans get their medications in a timely fashion.

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