How does your hospital or clinic keep patients safe from medication harm? In chaotic emergency departments (EDs), busy clinics, or on understaffed hospital floors, a medication error can lead to a fatal outcome.
Here are 7 steps organizations can take to protect patients from the danger of medication errors.
1. Be consistent about medication reconciliation
Ensuring consistency and using best practices for medication reconciliation are vital to protecting patients from medication harm. I recognize the challenges that impede consistency, but clinicians and teams must do better.
Effective reconciliation includes reviewing the patient’s complete medication regimen at every physician and ED visit as well as at the time of admission, transfer, and discharge, and comparing it against the medication regimen being considered at the current visit. Review your current procedures with everyone on the team at an upcoming meeting to identify problem areas as well as changes that could improve them.
2. Make your medication reconciliation participatory
An interesting editorial from the Society of Participatory Medicine shares the story of one of its authors who had an ADE during an inpatient stay. An important cardiac medicine he brought with him to admission got dropped during the medication reconciliation process - which only involved hospital staff. The article advocates comparing the medication reconciliation lists with the patient or caregiver as a final, participatory step that can avoid omitting (or adding) an incorrect medicine.[1]
Impress upon patients the importance of a current and accurate medication list and their role in helping achieve it. Handouts and verbal prompts at check-in can help get the message across. In clinic environments, print the patient’s list of medications from the EHR at check-in, and ask patients or family members to review and edit the list. That way, they are prepared for the medication reconciliation discussion when the clinician enters the exam room.
3. Ask granular questions about over-the-counter medicines and supplements
Many patients don’t think of these as “medicines” when you conduct a medication reconciliation. Especially “natural” remedies. Asking about them specifically often brings to light a non-prescription that could interact with a medicine being considered by the physician for treatment. Clinicians must review and consider all non-prescription products, herbs, and supplements before prescribing something new.
To tease out a complete list, instead of asking,“are you taking any herbs or over the counter medicines?” which can be answered yes or no, ask an open-ended question such as: “Tell me which vitamins you take” or “What kinds of medicines do you usually buy when you are shopping at Target? Ibuprofen, anti-acids?” These questions can yield better answers.
You might also create a visual cue for people. For example, show them sheets that include photos of common over the counter remedies and supplements.
4. Make drug references tools handy for clinical teams
Whether printed or electronic, it’s smart for organizations to suggest preferred reference tools so that teams use and are familiar with the same apps or guides.
There are a good number of useful and accurate reference apps available these days. Whether it’s the electronic health record (EHR) lookup tables, ePocrates, Medscape, or the Physicians Desk Reference (PDR), the point is to make the data about side effects/adverse reactions, and cautionaries easily available where patients are being seen. This includes providing computers and printed reference sheets or asking teams to load certain apps onto their mobile devices.
5. Engage pharmacists
Pharmacist involvement in medication reconciliation has been shown to keep patients safer. According to the Agency for Healthcare Research and Quality (AHRQ), several systematic reviews indicate that pharmacist-led processes could prevent medication discrepancies and potential ADEs at admission, transitions, and discharge.[2]
Though not historically part of the care team, pharmacists and pharmacy technicians are becoming more common in the hospital medication reconciliation process. Qualitative research we conducted with more than 20 chief medical officers and clinical leaders in early 2018 indicated that organizations that have pharmacists overseeing medication reconciliation are seeing reductions in ADEs in their facilities.
6. Follow up after discharge and office visits
Medication reconciliation alone does not reduce admissions or ADEs after discharge[3]. That’s because people don’t absorb everything they are told when being prescribed a new regimen. They forget to take a medicine. Or they stop taking a medicine because of a side effect. Or they take something with food that should have been taken on an empty stomach and have a reaction. I could go on. The point is that, anything can happen after the patient leaves our care. For these reasons and many others, clinicians or care managers are wise to follow up with patients after visits and discharge to ensure they are taking the right medicines at the right time in the right manner.
7. Encourage older patients to bring an advocate
Even if the patient is not elderly or demented, most older patients will benefit from having a spouse, adult child, or caregiver to the visit. Such advocates can fill in the blanks during medication reconciliation, listen to instructions about new medicines prescribed, and help their loved with with adherence and condition monitoring once they are back home.
[1] Medication Errors Result from Current Medication Reconciliation Practices: It’s Time to Adopt Participatory Reconciliation, John Greene | May 7, 2012, https://participatorymedicine.org/journal/opinion/editorials/2012/05/07/medication-errors-result-from-current-medication-reconciliation-practices-it%E2%80%99s-time-to-adopt-participatory-reconciliation/1
[2] Agency for Healthcare Research and Quality, Patient Safety Primer-Medication Reconciliation, August 2018. https://psnet.ahrq.gov/primers/primer/1. Last viewed: November 6, 2018.
[3] Agency for Healthcare Research and Quality, Patient Safety Primer-Medication Reconciliation, August 2018. https://psnet.ahrq.gov/primers/primer/1. Last viewed: November 6, 2018.
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