How your practice manages medications can have a significant impact on patient outcomes. The Institute of Medicine (IOM) report, Preventing Medication Errors, estimated that 1.5 million preventable adverse drug events (ADE) occur each year in the United States.[1] The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) recommends that medication reconciliation should occur at all handoffs between ambulatory, emergency and urgent care, long-term care, home, or inpatient services.

Reconciliation is an effective way to prevent adverse drug events through identifying all medications the patient has been taking, or had a serious side effect or reaction to, regardless of whether you or another provider prescribed the medication. Does your medication management process make it easy to do the safe thing to prevent adverse drug events?

The process of managing medications

To some physicians, the words medication management imply the process of managing chronic disease medications such as in the case of diabetics or high risk medications such as anticoagulants. While these medications do require close monitoring and tracking, most all medications have the potential to result in adverse drug events and unanticipated outcomes in the ambulatory setting.

Investigators of ADEs in the ambulatory setting at the Division of General Internal Medicine, Brigham and Women's Hospital in Boston discovered that 25% of patients experienced an adverse drug event with selective serotonin-reuptake inhibitors, beta blockers, angiotensin-converting-enzyme inhibitors, and nonsteroidal anti-inflammatory medication classes the most frequently implicated. The rate of ADEs in this study approached 27 per 100 patients, a rate that quadruples those estimated in the inpatient setting. [2] By nature of their practices, internists and family practitioners are the gatekeepers of safe patient care. It is essential that processes are in place to assure safe medication management, especially in coordinating care with consulting physicians or specialists.

Even if your practice or specialty, such as pediatrics, does not routinely prescribe many medications, you may want to take into consideration the Agency for Healthcare Research & Quality’s (AHRQ) study that revealed the overall rate of preventable ADEs in children in the ambulatory care setting was similar to the results cited above.[3] Due to the unique nature of their patient populations, pediatricians should maintain stringent medication management of all medications, specifically those prescribed for diagnoses such as asthma and depression.

Easy to do the safe thing

Non-existent or inconsistent utilization of a medication list for reconciliation is a patient safety hazard. Medication documentation may be inconsistent or difficult to find, perhaps included in an office note buried within a voluminous chart. Imagine the emotional and psychological impact on you, the prescribing physician, if your patient experiences a serious unanticipated outcome secondary to an ADE due to the simple fact that a previous side effect was not documented or was documented but was buried within chart notes, and the same class of medications was prescribed by you again.

The easiest way to do the safe thing is through the use of a medication list that is prominently displayed within the chart jacket for easy reference. At each visit, patients should be asked about all medications they are taking, especially after hospitalization, since medications may have changed. The list should include:

ü  Verification of allergies, reactions, side effects

ü  Prescription drugs

ü  Over-the-counter medications

ü  Herbal remedies, supplements and vitamins

ü  The drug, dose, route, frequency and purpose for each medication, herb or vitamin

ü  A section for you or appropriate staff to document refills of medication you have prescribed