An intervention that included computerized identification of medications a patient is taking to help create a more accurate medication list for patients checking in or out of a hospital was associated with a lower rate of potential adverse drug events, according to an article in the April 27 issue of Archives of Internal Medicine.1
Efforts to improve the quality and safety of health care include attention to unintentional medical discrepancies, defined as unexplained differences among documented regimens across different sites of care (e.g., prior to admission compared with hospital admitting orders). “Discrepancies are highly prevalent; up to 67 percent of inpatients have at least one unexplained discrepancy in their prescription medication history at admission,” the authors write.
Because medication discrepancies are an important contributor to ADEs among hospitalized and recently discharged patients, The Joint Commission on Accreditation of Healthcare Organizations has designated medication reconciliation as a priority. Medication reconciliation is a process of identifying the most accurate list of all medications a patient is taking, and using this list to provide correct medications for patients anywhere within the health care system, according to background information in the article. Few studies have shown that medication reconciliation efforts improve important patient outcomes.
Jeffrey L. Schnipper, M.D., M.P.H., of Brigham and Women’s Hospital and Harvard Medical School, Boston, and colleagues conducted a study to determine the effects of a redesigned process for medication reconciliation, supported by information technology (IT), on potential ADEs (PADEs). The trial, at general medical inpatient units in two academic hospitals, included 322 patients, for whom a medication history could be obtained before discharge. The intervention was a computerized medication reconciliation tool (that included a Web-based application that promotes the creation of a preadmission medication list from several electronic sources) and process redesign, which involved changes in the roles and workflows involving physicians, nurses, and pharmacists.
The researchers found that among 162 patients assigned to the intervention, there were 170 unintentional medication discrepancies with potential for patient harm (1.05 PADEs per patient) vs. 230 (1.44 PADEs per patient) among the 160 patients assigned to usual care, a 28 percent risk reduction. Ninety-eight PADEs were considered serious, i.e., to have potential to cause serious harm such as rehospitalization or a change in health function, including 43 PADEs in the intervention group (0.27 per patient) and 55 PADEs in those assigned to the usual care group (0.34 per patient).
“We believe our intervention was successful because it combined effective process redesign with IT. The new reconciliation process encouraged interdisciplinary communication and cross-checks. The Preadmission Medication List (PAML) Builder application facilitated accurate medication histories by presenting several sources of available medication information, and it displayed the PAML with current inpatient medications during the discharge ordering process,” the researchers write.
In an accompanying editorial2, David C. Goff Jr., M.D., Ph.D., and Philip Greenland, M.D., of the Feinberg School of Medicine, Northwestern University, Chicago, write that significant changes are needed in the U.S. health care system.
“As we look back at the results of over a decade of attention to health care quality, we also look forward to the prospects of stimulating real change in the health care system and breakthroughs in health care quality. We believe that the time has come to quit nibbling around the edges of a dysfunctional system. Implementation of proven strategies to enhance quality will require structural changes in our health care system to align incentives so that (1) patients are protected from exposure to medications of dubious cost-effectiveness; (2) providers are reimbursed appropriately for efforts to implement quality initiatives; and (3) payers are armed with information regarding quality and cost-effectiveness during contract negotiations.”
“Rising health care costs threaten our economic future, yet many indicators of the quality of care in the United State s lag behind those reported from countries spending for less. In this time of change, the status quo in health care is not acceptable.”
1. Arch Intern Med. 2009;169:771-780.