Death. Disability. Hospitalization. These are just some of the more harmful results of medication errors. Every year, the U.S. Food & Drug Administration receives more than 100,000 reports of suspected medication errors — and all are preventable. It is estimated that preventable medication errors contribute to 7,000 deaths, impact more than 7 million patients, and cost almost $21 billion annually across all healthcare settings.
Healthcare organizations should be motivated to eliminate medication errors. Not only can errors significantly harm and even kill patients, they can also lead to lawsuits, uncompensated care, negative patient reviews that damage reputation, and reduced staff and physician satisfaction. With several types of medication management tools designed to improve patient care, organizations have many solutions to help strengthen their medication management processes.
Here are four medication management tools worth considering.
1. Electronic prescribing of controlled substances
Identified by chief medical officers in a survey as a tool that could enhance patient safety, the use of e-prescribing for controlled substances (EPCS) is receiving greater attention by organizations such as the American Academy of Family Physicians (AAFP), which has championed for its use, and state lawmakers, such as those in New York and Maine which have implemented legislation surrounding EPCS.
AAFP notes that, "While e-prescribing is now the preferred method of prescribing medications among the vast majority of prescribers, adoption of e-prescribing for controlled substances has been slow due to implementation complexities." If organizations are able to address these challenges, they will give their clinicians a tool that can help identify issues such as duplicate therapies, interactions, and allergies; prevent mistakes associated with sound-alike drugs; improve adherence; and much more.
2. Bar-coded medication administration (BCMA) systems
As the name suggests, these health technologies are intended for use during the administration phase. A BCMA system typically pairs implementation of an electronic medication administration record (another technology that can help improve medication safety) with bar-coding for item-specific identification.
BCMA is designed to allow users to electronically document medications at the point of care. When it's time for medicines to be administered, a clinician uses a handheld device to scan the barcodes on his or her identification badge, the patient's wristband, and the medication package. The patient's barcode contains all critical information about the patient, including their medication list. When barcode scanning is complete, the system checks various databases to verify that the medication scanned is appropriate for the patient scanned. Based on the results, clinicians receive either an approval or warning.
BCMA helps clinicians comply with the "five rights of medication administration": right patient, right dose, right route, right time, and right medication. As a Leapfrog fact sheet notes, a study of BCMA-electronic medication administration record implementation in an academic medical center demonstrated a more than 41% relative reduction in non-timing errors in medication administration, resulting in a more than 50% relative reduction in potential adverse drug events due to such errors. Furthermore, BCMA implementation in the emergency department has shown a relative reduction of about 80% in medication administration errors.
3. Medication Safety Self-Assessment for Hospitals
This tool, developed by the Institute for Safe Medication Practices (ISMP) and funded by the Commonwealth fund, is designed to help interdisciplinary teams at hospitals assess the safety of medication practices in their facilities.
While the tool was launched in 2011 and hospitals interested in submitting their findings to ISMP for comparison with aggregate data of demographically similar hospitals were required to do so that same year, the tool still has tremendous value without this offering. The process required to conduct the self-assessment, including establishing the multidisciplinary team, reviewing the different areas of the self-assessment's focus (i.e., "core characteristics"), and determining how well the hospital has performed with implementing the items within these core characteristics, should provide ample insight that will help identify opportunities for improvement.
Organizations that endorsed this tool include the American Hospital Association, The Joint Commission, Institute for Healthcare Improvement, and the American Nurses Associations. The ISMP Medication Safety Self-Assessment for Hospitals is part of a series of ISMP Medication Safety Self-Assessment tools that ISMP says is "… among the most important activities we've undertaken to help advance medication error prevention efforts." Other tools in the series include self-assessments for high-alert medications, antithrombotic therapy, and oncology.
4. Medication reconciliation solutions
An integral, and one of the most difficult components of the medication management process is medication reconciliation. The challenge of collecting current and accurate medication information from patients is magnified by memory and recall issues, high quantities of medications, frequent regimen changes, and low health literacy. Further compounding the matter are other obstacles clinicians may face, such as time pressures, distractions, lack of knowledge about medications, and handoff challenges.
There are a variety of solutions designed to help with medication reconciliation. One such resource that I'm partial to is Meds 360°, a medication reconciliation tool offered by Cureatr. This platform was designed to provide clinicians with a single list to document patient's current medications that can be shared and used by all physicians, nurses, pharmacists, and others caring for the patient. Benefits include flagging hazardous drug combinations, duplications, and dose changes; reducing reliance on patients' recall abilities; and easy analysis of medication information that can help make better management decisions and catch potential issues before they become problems.