Stop using sent and closed as the only states
A recommendation can be drafted, delivered, awaiting response, accepted, declined with rationale, deferred, superseded, or resolved in another way. Implementation and resident outcome may remain unknown after a prescriber answers.
Combining those states produces misleading completion numbers and weakens handoffs. Use only the distinctions the practice can maintain reliably, but make them meaningful.
Keep a minimum response record
For each reported irregularity, retain the resident and medication context, recommendation, report date and recipient, response, response date, rationale when supplied, and next action. Avoid claiming verified delivery unless the mechanism actually proves it.
Define who follows up, at what interval, and how facility-specific escalation works. A reminder outside the clinical record may be useful, but it should point back to the authoritative item.
Measure process without inventing an outcome
A practice can safely count open items by age, responses received, or items awaiting a named next step when its definitions are clear. It should not label a response rate as a resident outcome or assume silence means rejection.
Ask software vendors to export the underlying records behind any metric. A summary is more trustworthy when a reviewer can reconcile it to individual items.