Electronic system may reduce adverse drug events

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Researchers at Brigham and Women’s and Massachusetts General hospitals report that using a computerized application to record and track patients’ medications could decrease the occurrence of potentially harmful medication discrepancies. These findings appear in the April 27 issue of Archives of Internal Medicine.

The term “medication discrepancies” describes the unexplained differences in medication regimens that occur as patients move through the health care system, differences that have the potential to lead to adverse drug events. To address this issue, hospitals use medication reconciliation, the process of correctly identifying all the medications a patient was taking before the hospitalization and using the list to correctly order medications during the patient’s hospital stay and at discharge.  

“Improving medication reconciliation is an important patient safety goal across the medical field,” said Jeffrey Schnipper, senior author and hospitalist at Brigham and Women’s Hospital. “We found that in the hospital setting, with the use of an electronic application and a revision to the reconciliation process, there is a 28 percent reduction in the number of potentially harmful medication discrepancies that can happen at admission or discharge.” Schnipper is an assistant professor of medicine at Harvard Medical School.

Participants in the study were randomly assigned based on the medical team and floor to which they were admitted at one of the two participating hospitals. One-half of the participants received traditional procedures for medication reconciliation. The second group of participants — those in the intervention group — were assigned to a medical team that used a new Web-based computer application that pooled medication information from several electronic sources, making it easier to take the medication history and track medication lists until discharge.

The intervention also included reassigning roles, including greater involvement of pharmacists to confirm that medications taken before the hospitalization were appropriately ordered in the hospital, and greater use of nurses to confirm the accuracy of the medication history. “The redesign streamlined the process and eliminated redundant history — taking what was being performed in silos and replacing it with collaboration between doctors, nurses, and pharmacists,” said Schnipper.

Patients in the intervention group still averaged one potentially harmful medication discrepancy after the reduction in risk, compared with 1.4 errors in the control group. “We have found a way to address a number of problems with medication reconciliation, but there is still a need to improve the process further, especially concerning issues of patient and caregiver inaccuracy when reporting medication histories, the lack of compliance with the process from medical staff, and software usability issues,” said Schnipper.

The research was funded by Brigham and Women’s Hospital, Massachusetts General Hospital, Partners Healthcare, and the Harvard Risk Management Foundation.