Patient Safety Initiative Launched to Prevent Medication Errors

Reconciliation in the physician office setting involves comparing the patient’s current medication list with the list in the medical record, making appropriate adjustments, and ensuring the updated list is shared with the patient and the physician coordinating care.

Injuries from medications, known as adverse drug events (ADE), are far too common and costly in today’s health care system, and most are preventable, according to experts. The Institute of Medicine estimates that at least 1.5 million preventable ADEs occur in the U.S. every year and cost in excess of $3.5 billion in additional hospital and medical costs.

Med List is a form that promotes patient health and safety through three steps:

• Helping patients track their use of medications, herbs, vitamins, and other dietary supplements, and additionally helping to track medication start and stop dates, when the medication should be taken, the purpose of taking it, if any monitoring is required, and possible danger signs;
• Assisting patients in discussing their medication history with physicians; and
• Giving physicians more complete and accurate information about a patient’s medications to help provide a safer level of care.

Med List and the helpful tips for using medications wisely may be downloaded fromwww.macoalition.org/consumerdirectory.shtml.

Paula Griswold, M.S., executive director of the Mass. Coalition for the Prevention of Medical Errors, noted that “poor communication between patients and physicians during office visits is a significant contributor to medication errors. The physician or nurse practitioner may not be aware of all the medications the patient is taking, or may not know that the patient has stopped taking a medication because he’s experienced side effects. The patient may not know the purpose of her medications, or side effects to watch for that might indicate trouble. The medication list we’ve developed includes reminders that improve communication in order to make care safer.”

As physicians see patients for medical appointments, the Med List is reviewed and decisions made whether to continue, discontinue, or change the medications listed. The purpose of the reconciliation process is to avoid medication errors associated with omission, duplication of therapy, drug-drug interactions, and drug-disease interactions. According to the IOM, physicians should educate their patients about the medications they are taking, why they are taking them, what the medication looks like, what time they should take them, potential side effects, and what to do if they experience side effects. Physicians should also remind patients about appropriate medication self-management.

“The distinguishing characteristic of Med List is that it can be an important tool for both patient and provider in reducing errors,” said Dr. Kenneth Peelle, president of the Mass. Medical Society. “It allows the patient to be more involved and more of a partner in his or her health care, and it can facilitate and improve communication between patient and provider — a critical element in improving health care and patient safety.”

To help transition consumers to completing and carrying a medication list, Brooks Pharmacy is participating in this initiative by providing patient medication profiles as well as making the Med List available to its pharmacy customers throughout 165 Massachusetts stores. The patient profile includes medications filled for the customer and can be used to complete the Med List. Patients may check with other Massachusetts chain or independent pharmacies, as they may be willing to do the same.

“Actions for Prescribers,” a checklist for inpatient and outpatient providers, nursing homes, and assisted living facilities with recommendations for improving medication safety, is available to providers at www.macoalition.org/initiatives.shtml. Pharmacists may also access the checklist “Actions for Pharmacists” from the same website.

Med List was developed with the support of the Betsy Lehman Center for Patient Safety and Medical Error Reduction. According to Nancy Ridley, director of the center, “This is an important initiative that will help make the use of a medication list and reconciling medications a common practice at medical visits for patients and providers across Massachusetts.”