Hospitals put emphasis on collection of medication data

Hospitals are ramping up efforts to improve their medication data collection methods in an attempt to reduce the number of preventable adverse drug events that occur annually. They are establishing guidelines for collecting complete drug and allergy histories and comparing those histories with new medications when patients are admitted to a hospital.

Hospitals also are improving their efforts to educate patients and their families about the importance of maintaining their own medication histories-and to make sure that history is current-to avoid any potential mistakes if a trip to the emergency room is necessary.

Last year, the United States Pharmacopeia received more than 2,000 voluntary reports of medication reconciliation errors, and a 1999 Institute of Medicine report estimated that more than 7,000 deaths occur each year in hospitals because of medication errors.

Medication reconciliation is the process of identifying the most accurate list of all medications a patient is taking-including name, dosage, frequency and route-and using this list to manage medications for patients anywhere within the healthcare system.

EFFECTIVE MEDICATION RECONCILIATION

According to JCAHO, medication reconciliation should occur whenever a patient moves from one location to another in a healthcare facility (for example, from a critical care unit to a general medical unit); or from one healthcare facility to another; or upon discharge; and/or when there is a change in the caregivers responsible for the patient.

When effective medication reconciliation does not occur, patients may receive duplicative medications, incompatible drugs, wrong dosages or wrong dosage forms, among the range of potential errors.

The fact that medication reconciliation errors continue to occur, despite repeated warnings and rigorous standards, prompted JCAHO earlier this year to issue an alert on medication reconciliation to the more than 15,000 healthcare organizations it accredits.

Hospitals across the country are participating in a number of initiatives to improve medication reconciliation. The Institute for Healthcare Improvement's 100,000 Lives Campaign includes efforts to improve medication reconciliation, and JCAHO has reconciliation standards as part of its National Patient Safety Goals.

Errors being targeted include inadvertently omitting a medication a patient was taking at home during a hospital stay; failing to ensure that home medications temporarily stopped during a hospital stay are restarted when the patient is transferred or discharged; duplicating medication orders either because the patient may already be taking the drug or because of confusion between brand and generic versions of a drug; and prescribing incorrect dosages.

SOLUTIONS FOR PATIENTS AND PHYSICIANS

Hospitals are trying to be proactive in implementing medication reconciliation programs to ensure the patient is given or prescribed the correct medications at the correct dosage from admission to discharge.

Sandra Sheppard, RN, manager of accreditation and regulatory compliance for Wilkes Regional Medical Center in North Wilkesboro, N.C., says a hospital cannot be completely effective if it doesn't have all medication information.

"A lot of what happens in healthcare is about waiting on information to come in," she says. "You wait for someone else to go get it for you. We're trying to cut down on the wait and turnaround time for the information."

Part of the problem is that no one is really in charge of the patient, says Carol Haraden, PhD, vice president of the Institute for Healthcare Improvement.

"Everybody does the job they are supposed to do, but it doesn't cobble together," she says. "Patients fall through the cracks when they are transferred from one unit to another."

EFFORTS TARGETED THROUGH TECHNOLOGY

Most hospitals use paper-based solutions, such as wallet-sized cards, that can be preprinted or downloaded from their Web sites. Another Web-based program, http://VialofLife.com/, offers medication forms that can be folded up and placed in an empty pill bottle, along with a red sticker that can be displayed prominently in the house to alert paramedics and other emergency personnel.