TOP 37 - Optimizing Timely Administration of Essential Home Medications in the Emergency Department: A Quality Improvement Initiative

Publication Number: 4739.TOP 37

Alison R. Clarke, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Ursula Parlin, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Ji Young Lee, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Angeliz M. Caro Monroig, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Erin E. Tamulonis Bordo, UPMC Children’s Hospital of Pittsburgh, Coraopolis, PA, United States; Kavitha Conti, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Johanna R. Rosen, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States

Background: Essential home medications such as anti-epileptic drugs (AEDs), steroids, and immunosuppressants are frequently delayed or missed during pediatric emergency department (PED) visits. This increases the risk of preventable adverse events, such as seizures, adrenal crisis, and medication withdrawal which could be mitigated by timely home medication administration. These lapses can also lead to longer PED and hospital lengths of stay (LOS), as well as escalation to a higher level of care. Our PED lacked a standardized process to ensure timely administration of essential home medications. To explore the extent of the problem, we performed a chart review of children who were prescribed essential medications and spent 4 hours or longer in the ED during December of 2024. Only 50% received their essential home medication while in the ED during their typical medication administration times.

Objective: The objective of this project is to increase the rate of essential home medication administration in our PED, for patients with a LOS greater than 4 hours, from our baseline 50% to greater than 80% by November 2025. Due to our institution's specific circumstances, a unique barrier was achieving success without electronic medical record (EMR) updates or interventions, as opposed to EMR-integrated interventions highlighted in previous studies.

Design/Methods: The project team developed a list of time-sensitive essential home medications and defined timeframes for typical administration. The primary outcome measure is the percentage of patients receiving essential home medications in the PED with a balancing measure of PED LOS. Using Plan-Do-Study-Act (PDSA) cycles, we tested the following interventions: (1) visual reminders posted on workroom computers, (2) iterative education at staff meetings and resident education sessions, (3) the development of an essential home medication reconciliation form for families and staff to complete, and (4) integration of QI rounds to remind staff of ongoing initiatives. Our interventions began in March 2025. The project team completes monthly chart review to monitor outcomes using run charts. Preliminary results demonstrate an improvement in administration practices with ongoing monitoring to ensure this improvement is sustained, showing improved practice even without EMR-integrated interventions. This QI project was approved by the institutional Quality Review Committee (Project ID: 35292).

Control Chart for QI Project Progression
This chart demonstrates the rate of essential home medication administration in the PED throughout the course of this study, marking the points at which PDSA interventions were implemented.
UCL=Upper Control Line, CEN= Central Line, LCL= Lower Control Line, PDSA= Plan-Do-Study-Act

Sample Form with List of Essential Home Medications
This form was made available for all staff during this study to give families in the ED to determine which essential home medications the patient is prescribed, when they are due and how they are administered.