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Conquering Medication Errors: Better Tools, Better Reconciliation

Posted on February 27, 2018 I Written By

The following is a guest blog post by Greg Anderson, Senior Business Advisor, Surescripts.

For years now, prescribing has been growing more complex. Between 1994 and 2014, the percentage of the U.S. population taking three or more prescription drugs nearly doubled, and as of 2014, nearly 11 percent had taken at least five prescription drugs within a 30-day period.

As important as these medications may be, every new drug prescribed introduces a new possibility for error. And this increased complexity is indeed having dangerous effects. Medication errors made by patients and their caregivers outside healthcare facilities doubled between 2000 and 2012, according to a 2017 study. That’s not even counting the estimated 40 percent of medication errors that spring from another source: inadequate reconciliation.

Accurate Reconciliation: High Barriers, High Stakes

Medication reconciliation can be a frustrating task in any setting. Compiling an accurate medication list can easily take 45 minutes when care providers need to not only consult with the patient, but also reach out to pharmacies, pharmacy benefit managers, other physician offices and family members to get the full story. Achieving accuracy is especially daunting in acute care settings, when time is of the essence and memory-impeding stress is heightened. Records of medications prescribed and taken are often far from complete, leaving care teams reliant on whatever history patients and their families can patch together.

A lot can go wrong when medications fall into the gaps. One study of hospital patients taking at least four prescription medications found that a majority of patients had at least one medication not identified upon admission, and 38.6 percent of these reconciliation errors had the potential to cause significant discomfort or adverse health outcomes. A recent study of 306 medically complex patients found up to seven errors per patient in medication histories.

When a healthcare provider misses a drug, consequences can range from treatment interruptions to incorrect treatment decisions. Inevitably, some of these medication errors lead to the most common cause of iatrogenic harm: adverse drug events (ADEs), which send nearly 700,000 people to emergency departments each year.

The Best Defense Against ADEs

Not all medication errors can be foreseen and eliminated, but there’s reason to believe we can greatly reduce the 10 percent of ADE-related emergency department visits that stem from medication errors. Researchers estimate that 50 to 70 percent of ADEs that lead to hospital admissions are preventable.  And there’s one tactic in particular that’s been shown to make a serious difference: consistent medication reconciliation, aided by access to electronic medication history. More than half of the medication errors in one 2008 study of primary care clinics could have been prevented with the help of electronic tools. That’s in line with the Agency for Healthcare Research and Quality’s findings that “anywhere from 28 to 95 percent of ADEs can be prevented by reducing medication errors through computerized monitoring systems.”

Recent studies in clinical settings have borne out insights like these. In 2016, the Cedars-Sinai Health System performed a study assessing medication history errors among older adults on complex medication regimens. Researchers determined that accessing pharmacy fill and PBM claims data for those patients via Surescripts Medication History for Reconciliation would likely have prevented 35 percent of admission medication history errors and 31 percent of resultant inpatient order errors. Those percentages rise when considering only severe errors.

By helping doctors avoid prescribing errors, effective medication history solutions can also help patients make fewer medication mistakes at home. Eliminate redundant or conflicting prescriptions, and you also eliminate opportunities for patients and their caregivers to become confused. Even in a world of increasing prescription complexity, we can work as an industry to reduce many types of medication errors. We just need the right tools to collaborate and to make informed care decisions together.

Laying the Best Foundation for Medication Reconciliation

Posted on September 6, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest blog post by Brian Levy, MD, Senior Vice President and Chief Medical Officer for Health Language.
Levy Low Res
Effective medication reconciliation across the continuum of care is a critical element to eliminating medication errors and adverse drug events (ADEs). It is a focal point of such national initiatives as Meaningful Use (MU) and the Joint Commission’s National Patient Safety Goals and will also be crucial to ensuring performance metrics are met under Value-Based Purchasing and the Hospital Readmissions Reduction Program.

Simply put, one of the primary end-goals of current industry movements is to eliminate the revolving door effect in healthcare where patients are readmitted soon after discharge due to ADEs or lack of good information across the continuum. A growing body of research points to enhanced medication reconciliation as an effective way for hospitals to reduce readmission rates to meet this objective.

A 2012 study published in the Joint Commission Journal on Quality and Patient Safety found that accurate preadmission medication lists—acquired as part of medication reconciliation strategies— reduced ADEs both in the hospital and following discharge. Another paper published in the November 2012 edition of Pharmacotherapy also points to the critical role ADEs play in readmission rates and how ineffective care transitions, especially as they relate to medication management, exacerbate the situation.

The logistics of medication reconciliation has historically been an uphill battle for many clinicians. Without an electronic method for capturing information, the scene usually comes down to a Q&A session where physicians, nurses or other clinicians rely on patients to give them an accurate medication list. When a patient is unaware of the name of a medication, it usually results in a protracted delay in patient care while phone calls are made and consults conducted to accurately identify medications and avoid the potential for error.

EHRs provide the first step to correcting this inefficient way of gathering information. And while these systems are great repositories of patient information, the difficulty for medication reconciliation has been a lack of standards—specifically the lack of a standardized medical vocabulary. A number of proprietary medical terminologies exist within the industry, and without a standard for information exchange, the risk is that one drug could be identified by a number of different terminology codes depending on the proprietary system used.

Clinicians need an effective method for exchanging patient medication information between disparate systems in a standardized format that can be translated accurately by various healthcare organizations, providers and departments involved in patient care. MU is addressing this issue on one level through the introduction of RxNorm, a normalized naming system produced by the National Library of Medicine for generic and branded drugs and a tool that supports semantic interoperability between drug terminologies and pharmacy knowledge base systems.

RxNorm is a critical first step to ensuring the feasibility of building and accessing an accurate medication summary, thus minimizing the possibility of duplicate therapies, drug allergies and drug interactions. By adopting this standard, healthcare organizations and providers will begin receiving RxNorm codes in important CCD summary of care documents and HL7 messages. This standard will complement the use of the Systematized Nomenclature Of Medicine Clinical Terms (SNOMED CT®), a widely-used clinical terminology set also required under MU for the creation of problem lists.

While RxNorm provides efficient and accurate capture of medication information from external systems, healthcare organizations and providers will still require a method of converting codes from RxNorm to internal systems and visa-versa. This step ensures that internal medicine systems and drug information and interactions databases like Medi-Span, First Databank, Micromedex and Multum can also reconcile important patient medication information.

To address the full picture of data normalization, healthcare providers can leverage a healthcare terminology management solution to ensure automated mapping of patient medication data received from disparate sources to standardized terminologies. This process de-duplicates data, creating a normalized code across all clinical systems used internally, minimizing the potential for error.

This approach also provides an effective way for leveraging a comprehensive, longitudinal patient record, which is a primary goal of the health IT movement to enhance patient care. A foundation of standardized codes enables healthcare organizations to more fully develop advanced clinical decision support functions, where alerts can be received immediately for clinical activity impacting individual patients or within populations of patients.

As the healthcare’s industry move toward higher-quality care and more efficient care delivery continues to mature, the use of standardized medical terminologies will be paramount to effective clinical information exchange. While some initiatives like RxNorm and SNOMED CT are addressing this need for standardization, healthcare organizations can further advance data normalization strategies by leveraging the efficiencies and advantages of healthcare terminology management solutions.