Evidence Based Practice Strategies: Using Price Lists and Peer Coaching to Improve Medication Cost Containment and Documentation Practices in Anesthesia Providers at an Urban Level One Trauma Center

According to the American Association of Nurse Anesthetists (AANA) guidelines for Documenting Anesthesia Care Practice and Policy Considerations, anesthesia provider documentation represents a detailed account of the patient’s anesthesia care during various phases of anesthesia during their hospital stay (Documenting Anesthesia Care: Practice and Policy Considerations, 2016). The primary purpose of anesthesia documentation is to capture accurate and comprehensive information communicating a patient’s anesthetic experience, which includes the documentation of all administered medications. The patient’s electronic or written medical record is a legal document, which is also referenced for reimbursement, quality improvement, and review by external organizations for institutional accreditation. Despite the AANA guidelines and the existence of current hospital policy on medication administration, documentation, and reconciliation, recent discussions with key stakeholders from the pharmacy and anesthesia service departments revealed that the documentation practice of anesthesia providers at an urban level one trauma center are not aligned with policy to document regional anesthetic medications in the medical administration record (MAR) as required (S.J. Hyland, personal communication, May 26, 2020). According to the Anesthesia Practice Administrator at an urban level one trauma center, there are currently $70,000 in unbilled medication charges by anesthesia each month at the facility (J. Lenihan, personal communication, February 25, 2021). This project seeks to address one component of this cost capture gap by implementing evidence-based interventions aimed at improving the rates of local anesthetic and additive medication documentation such as exposure to medication pricing at the site of care and peer coaching (Goetz et al., 2015; Schwellnus & Carnahan, 2014; Silvestri et al., 2016). The following objectives have been established to achieve the aim of this project: 1) create and display price lists for commonly used local anesthetic medications and additives for peripheral nerve blocks at the site of care; 2) facilitate peer-based intervention that involves visual and verbal coaching related to appropriate documentation practice; 3) compare revenue loss data for local anesthetics and additives prior to and for two months following the introduction of peer coaching and placement of pricing lists at the point of care; and lastly, 4) provide recommendations for sustainment and continued monitoring to key stakeholders and anesthesia leadership