Errors in medication histories inadvertently put into electronic health records can have potentially disasterous consequences for patients admitted to the hospital. However, Cedars-Sinai Medical Center in Los Angeles is turning to pharmacists and pharmacy technicians—instead of clinicians—to accurately capture the information.
“There’s information already in the electronic health record for a lot of patients when they come into the hospital, but you don’t know how accurate that information is,” says Joshua Pevnick, MD, associate director of the Division of Informatics at Cedars-Sinai and an assistant professor of medicine.
Medication reconciliation, the process of identifying the most accurate list of all drugs a patient is taking, is critical during hospital admissions. Taking the medication histories of patients in emergency departments typically falls to physicians and nurses.
Yet, Cedars-Sinai found in a randomized controlled trial that when pharmacy professionals were assigned the task, errors in both medication histories and orders were reduced by more than 80 percent.
The study, published in the journal BMJ Quality & Safety, included 306 high-risk patients at Cedars-Sinai who were taking 10 or more prescription medications and had chronic conditions.
“Even before this trial, we were using this intervention—some patients were getting seen by pharmacy technicians and some by pharmacists,” notes Pevnick, who is the study’s first author. “Part of the reason for the trial was to study it, prove the benefit, and now the goal at Cedars-Sinai is to try to have as many patients as possible who are admitted to be seen in the emergency department by a pharmacy professional.”
Thanks to the results of the trial, it’s now standard practice for Cedars-Sinai to assign pharmacy staff to take medication histories for high-risk patients in the ED who are being admitted to the hospital. According to Cedars-Sinai pharmacist Jesse Wisniewski, taking a medication history for a complex ED patient can require 40 minutes or more to complete. “There can be a lot of CSI-type investigation,” said Wisniewski, referring to the TV series featuring crime-scene investigations.
“There are all kinds of different sources of information (for medication histories), and that’s part of the reason—especially when patients are taking a lot of medications—that it takes so long to do a good job,” adds Pevnick.
When taking patient medication histories in the ED, Pevnick observes that pharmacy members often have to reconcile EHRs with prescription databases and written lists from the patient, the patient’s pharmacy and the primary care physician, as well as information provided verbally by the patient or the patient’s family or caregiver.
“The EHR is the easiest and, in most cases, the best place to start,” he adds. “We sometimes talk about a ‘chart biopsy’ as the starting point.”
Pevnick also points out that in the study Cedars-Sinai staff did not have the ability to access Surescripts electronic pharmacy claims (SEPCD) data. However, he says that data is now available to the hospital’s pharmacists.
In a study published last year in the Journal of the American Medical Informatics Association, Pevnick and his colleagues determined that the SEPCD data probably would have prevented 35 percent of admission medication history (AMH) errors and 31 percent of resultant inpatient order errors. And, when they excluded the least severe medication errors, they concluded that the claims data probably would have prevented 47 percent of AMH errors and 61 percent of resultant inpatient order errors.
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