Medication History: Finding a Better Way to Get the Details

Although a hassle to gather, a recent study from the Pennsylvania Patient Safety Authority (PPSA) confirms the importance of having an accurate medication history at crucial points in the care process.1 After analyzing 501 reports from provider organizations, PPSA found that transitions of care provide ample opportunity for mistakes or omissions to a patient's medication list. These missteps often result from a lack of complete and detailed health information exchange or poor recall on the part of patients and caregivers.

"With the majority of the patients taking more than one medication prior to hospital admission, there is potential for providers to overlook at least one medication when reconciling patients' home medications upon admission," the brief points out.

Indeed, obtaining accurate medication history is a significant problem at healthcare provider organizations across the country. Compiling a complete and accurate medication history, however, is often a cumbersome process, fraught with challenges. According to a Nursing Leadership study, more than 60 percent of nurses reported that determining the medications a patient was taking at home, clarifying medication orders at transfer, and ensuring accurate discharge medication orders was a time-consuming process.2 Even when clinicians do take the time gathering medication histories, mistakes prevail, as up to 48 percent of all records are riddled with errors. Such errors and missing information can have a significant impact on patient care and the care costs.

Fortunately, gone are the days when hospitals needed to rely on patient memory or written records of physicians and pharmacists to begin the process of medication reconciliation. Today, automated electronic processes using external data sources create a more complete and accurate medication history. Armed with this information, care teams can swiftly perform more complete medication reconciliation and, in the process, reduce the risk of ADEs and avoidable hospital readmissions.

For example, Rideout Health, a 179-bed hospital in Marysville, Calif., recently improved its medication history collection efforts by leveraging a partnership that its EMR vendor, Health Care Systems, Inc. (HCS), has with Surescripts, the largest, nationwide health information network. Reubin Felkey, vice president of business operations at HCS, noted they are able to tap into Surescripts' decade of e-prescribing know-how and connections to the nation's pharmacies and PBMs to deliver robust, real-time medication history.

With this integrated approach, clinicians make a medication history query for a patient within their EMR application. The query then goes to Surescripts, which searches data from pharmacies and pharmacy benefit managers (PBMs) that encompasses more than 270 million insured lives and billions of prescriptions. Rapidly, Surescripts feeds the patient-specific medication history back into the EMR.

Using the data provided by Surescripts also changes the dialog the care team has with the patient. "This gave our staff something they could work from, so instead of asking 'what are you taking for medication?' they can now ask them if they are still taking the medications on the list," said Daniel Chibaya, director of information technology and systems at Rideout Health.

For more information about how Rideout Health hospitals are reducing their medication history hassles and closing gaps in care with Surescripts data, view or download the paper Medication History: A Path to Higher Quality Hospital Care

Sources

  1. Gao T, Gaunt M. Breakdowns in the Medication Reconciliation Process. Pa Patient Saf Advis 2013 Dec;10(4):125-36.
  2. Chevalier BA, Parker DD, MacKinnon NJ, et al. Nurses' perceptions of medication safety and medication reconciliation practices. Nurs Leadersh. 2006;19(1):61 - 72