Pilot program in drug reconciliation aims to avoid errors

One community-based hospital has adopted an automated medication reconciliation program. Fauquier Health System, in northern Virginia, is testing a pilot system that electronically provides the hospital staff with a patient's medication history. Patients often arrive at hospitals unfamiliar with their medications; others may be too ill, young, or disabled to share useful information with the hospital staff. Studies show that inconsistent medication knowledge and record-keeping cause up to 50% of all medication-related errors in hospitals and up to 20% of adverse drug events.

Medication errors such as dosing mistakes and drug interactions can be avoided through medication reconciliation systems. Fauquier's pharmacy department led the development of a new medication reconciliation system to comply with The Joint Commission's mandate to implement a medication reconciliation program by January 2006. The new program relied on the admitting nurse to write down a patient's medications and transfer them into the hospital information system to become part of an electronic medical record that could be accessed throughout the hospital. Even as the paper-based system was being rolled out, hospital officials began to ponder the concept of developing an entirely electronic medical reconciliation process that would bypass handwritten notes and rely instead on third-party prescription information, explained Margaret Rowe, Pharm.D., director of pharmacy at the 86-bed hospital. "Our goal is to circumvent the problem of patients being poor historians of their medications and use an automated process to improve patient safety."

Fauquier partnered with DrFirst Inc., a Maryland-based technology company. DrFirst had developed an electronic prescribing system that several large physician practices connected to Fauquier had earlier adopted. DrFirst adapted its program, called Rcopia, for the acute care setting to assist Fauquier in creating and reconciling an accurate list of patients' medications from admitting to discharge. The prescription information is also provided to the patient and can be electronically accessed by a patient's physician. "We were interested in ways that we could introduce efficiencies into our medication reconciliation system and incorporate outpatient prescription information into the process through an automated fashion, as opposed to relying solely on the patients' accounting of their medications," said Rowe.

DrFirst compiles patients' medication histories from various third-party databases, such as RxHub, which compiles prescription information from prescribers, pharmacies, and pharmacy benefit managers. DrFirst is expected to provide access to prescription information from SureScripts in the near future.

Cautious optimism

Fauquier recognizes that its system is not the perfect solution to medication reconciliation, and it emphasizes that the patient interview process will continue. "With the addition of SureScripts, we expect that our hospital staff will gain access to approximately 90% of patients' prescription information," said Rowe. "However, if a patient's medication history is not found in the database, the nurse will use the paper-based system and rely on the patient's own accounting of his or her medications and dosages."

"We are certainly in favor of using technology to avoid medication errors and adverse drug events, but providers need to be aware of the limitations of automated systems," said Donna Horn, R.Ph., director of patient safety in community pharmacy for the Institute for Safe Medication Practices. "Caution is needed because over-the-counter medications, dietary supplements, and herbals don't go through a third-party system but can cause adverse reactions when taken with the wrong medication."

Fauquier's pilot program will be completed at the end of August, and an enterprise rollout is scheduled for the fall. According to the hospital's chief information officer, Donna Staton, there has been a lot of positive feedback from providers using the new automated system during the testing phase, and it eliminates the problems associated with handwritten documentation.

"We have identified very minor changes to the system," said Staton. More important, she said, hospital employees are excited about the improvements to patient safety that have resulted from changing the process of collecting patient medication information to a more reliable and automated system.

THE AUTHOR is a pharmacy writer based in Brooklyn, N.Y.