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Computer system, redefined staff member roles strengthen medication reconciliation process

Researchers at Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital (MGH) in Boston have found that the use of a better integrated computer system and process redesign could reduce the number of potential medication errors present in the medication reconciliation process. The study, published in the April 27 Archives of Internal Medicine, took place May–June 2006 and focused on using existing technology to compare patients’ medication lists to prevent adverse events.

“We know that good medication reconciliation is not occurring,” says Jeffrey Schnipper, MD, MPH, senior author of the study and hospitalist at BWH. There were 1.44 errors with potential for medication harm in the control group, says Schnipper, and his team’s randomized controlled clinical trial lowered that number to 1.05 during the course of the study.

Of the 322 patients who were part of the study, 160 in the control group receiving the hospital’s normal med-ication reconciliation processes could have suffered 230 potential adverse events; the 162 patients who were part of the intervention could have suffered 170 potential adverse events.

BWH and MGH were using computerized physician order entry (CPOE) systems already, so researchers designed the study around using the existing system and work flow. The study took the existing system and made it easier for staff members to compare a patient’s preadmission medication list with the inpatient and discharge medication lists. This is one area in which many hospitals create medication reconciliation problems, says Schnipper.

“In many hospitals, a lot of people take a patient’s medication history, but it’s done in silos—all of these people keeping separate, different lists,” says Schnipper. The goal of the study was to reduce redundancy by creating a single in-hospital medication list that could be refined by staff members, but with increased attention on verification and communication among caregivers, he says.

Since the study ended, BWH and MGH staff members have worked on further refining the computer application, so that it can detect even more detailed differences in the three medication lists, such as distinctions in the class and dose of medications, says Schnipper. The application alerts caregivers to any such differences, which could help prevent adverse drug events.

Another part of the study involved redefining the roles certain caregivers play in reconciling medications, specifically concerning the home and discharge medication lists. Pharmacists and nurses were given a larger role in checking to ensure that patients’ preadmission medication lists were accurate.

“Pharmacists get this, and they were thrilled to be involved,” says Schnipper. Prior to the study, Schnipper’s team found that pharmacists were spending more time finding and questioning discrepancies between patients’ preadmission medication lists and the inpatient medication lists. However, it turned out that creating inaccurate home medication lists was a bigger problem.

Now, pharmacists at BWH and MGH are doing whatever they can to make sure a correct and up- to-date home medication list is created when a patient enters the hospital. That might mean speaking with family members or calling patients’ home pharmacies to discover their most recent home medications, says Schnipper.

Additionally, nurses, who often are in charge of educating patients about their medication regimens after discharge, have found that because there is one concise list to refer to, they can improve their discharge counseling.


Adapted from Briefings on Patient Safety, July 2009, HCPro, Inc.