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Safely Prescribing Medications: Knowing What You Don't Know

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The number of patients taking prescribed medicines is shocking. Nearly half of the U.S. population has used at least one prescription medication in the last 30 days, according to the National Center for Health Statistics. During that same timeframe, nearly 25 percent of individuals have used at least three prescription medications, and more than one out of every 10 individuals has used five or more prescription medications. In the last decade, spending on prescription drugs has increased nearly 50 percent, from approximately $243 billion to more than $360 billion.

The vast majority of prescriptions are written in ambulatory settings. During outpatient and ER visits, one or more medications is prescribed more than 70 percent of the time. Approximately 15 percent of medications are prescribed in a hospital setting. This means hospital-based clinicians may be unaware of the multitude of other prescription medications patients could be taking.

With the introduction of each new medication, there’s the potential for numerous complications. Although the industry has begun to create programs designed to reduce Adverse Drug Events (ADE), the problem remains formidable.

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How Serious is the Issue of ADEs?

An Institute of Medicine report on medication errors suggests that more than 1.5 million Americans sustain medication errors annually while in the hospital. Nearly five percent of hospitalized patients experience at least one medication error daily.

The same report claims ADEs account for nearly 700,000 emergency department visits and 100,000 hospitalizations annually, making them one of the most common types of inpatient errors.

The 2014 National Action Plan for Adverse Drug Event Prevention quantifies the seriousness of ADEs in the inpatient setting, stating they’re among the most significant contributors to hospital-related complications. These errors occur during approximately two million hospital stays annually, accounting for one-third of all adverse events in hospitals and prolonging length of stay by approximately 1.7 to 4.6 days.

There is insufficient data to draw definitive conclusions about the precise effect of ADEs on 30-day readmissions. However, according to research cited in the National Action Plan, in a single-center study of a tertiary-care academic medical center, ADEs were found to be the most common cause of complication within three weeks post-discharge.

An Ounce of Prevention

The National Action Plan addresses a defined group of common, clinically significant, preventable, and measurable ADEs. These ADEs also result from high-priority drug classes and occur largely in high-risk populations. The plan identifies these three key drug classes and their corresponding ADEs as initial targets:

  • Anticoagulants (bleeding)
  • Diabetes agents (hypoglycemia)
  • Opioids (accidental overdoses, sedation, and respiratory depression)

Certain populations are at high risk of ADEs. For example, elderly patients are seven times more likely than younger individuals to experience an ADE. That’s because, on average, the elderly take more medications and are more susceptible to specific adverse effects. Often, their ability to metabolize medications via the kidneys and liver is also suboptimal, so drug levels and risk of ADEs is higher. Pediatric patients are also at elevated risk, particularly when hospitalized, since many medications for children must be dosed according to their weight.

Next, we must address the pathway between the clinician’s decision to prescribe a medication and the patient’s use of it. Each step requires review and consideration.

First, the clinician must identify the appropriate medication, dose, and frequency. Facilities still dependent on a paper-based system will introduce an additional step and opportunity for error: the transcription of the prescription by a clerk or pharmacy technician. Next, the pharmacist will check for drug-to-drug interactions and dispense the medication as prescribed. Finally, a nurse, caregiver, or patient themselves must administer the medication. Errors can occur at each of these steps.

Many ADEs occur because of basic information gaps, hence the need for a thorough medication reconciliation. Providers can safely introduce new medications and provide effective treatment only when they have access to all of a patient’s medication information. Even the most diligent patient or caregiver can forget to mention one or more medications.

It’s widely recognized that the majority of medication errors occur around care transitions. Poor communication at transitions results in an estimated 20 percent of ADEs overall and 50 percent of hospital-related medication errors.

It’s imperative that clinicians have point-of-care access to comprehensive real-time actionable pharmacy data to help reduce ADEs. This must include visibility into prescriptions generated both within their enterprise as well as those generated outside of it. Without the capacity to access and share patient information across the care continuum, organizations will continue to rely on manual processes that are expensive and time-consuming. These processes also introduce the opportunity for errors that will keep ADEs unnecessarily high.

Making dramatic improvements in patient safety is possible thanks to the plethora of tools and guidelines that are available. For example, using accepted best practices, hospitals can establish and implement policies to minimize drug-related errors. They can also measure, track, and internally report any errors. Hospitals can also include ADEs in their internal quality assessments and improvement processes. Track adverse events, investigate the causes, and implement solutions.

Resolve Issues with Medication Reconciliation - Ebook 


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