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Improving Safety through Medication Reconciliation

By Dr. David C. Pate, News and Community
November 3, 2013

As a specialist in internal medicine, I know firsthand the importance of patients and all their providers keeping up with the ever-changing list of medications and dosages of medications a patient is supposed to be taking, especially for those who have chronic illnesses and are the most vulnerable. 

Today’s report on our medication reconcilation efforts is another in our series of posts outlining the work being done by St. Luke’s clinically integrated physician network – SELECT Medical Network.

And it's important work that could save a patient’s life. Just this past month, my wife was sent directly from her doctor’s office to the hospital for surgery. My wife is on a number of medications that could have important implications for anesthesia and fortunately, we could look up her medication list on myChart through my iPhone to ensure that we had an accurate and complete medication list for all the providers involved in her care. 

Technology, especially a unified, interoperable electronic health record, is key to helping us ensure that care is integrated for all the providers involved in the care of a patient and seamless for the patient. Here is SELECT Communications Coordinator Chereen Langrill’s report:

Studies show that about 70 percent of potentially harmful medication discrepancies occur because of history errors.

Those errors are often because of omission. For example, patients might not remember medications they are taking when sharing their history with a provider. And since medication history information is typically compiled from several sources, including inpatient or outpatient records, prescription bottles, and outpatient pharmacy records, it is difficult to find a single source of thorough and reliable patient medical records.

The medication reconciliation initiative aims to reduce errors by improving patient-provider communication and streamlining the process surrounding patient medical records and medical histories.

Why is it important?

The statistics are not surprising. Regular blog readers might recall a guest post by Mike Griffiths, pharmacy operations manager at St. Luke’s Boise pharmacy.

Mike and his team have been leading efforts to improve patient safety and care, and his post explained some of the work his team has been doing. He also shared statistics from studies that say about 25 percent of prescriptions are never filled, and that up to 50 percent of patients taking medications to treat chronic diseases are not taking medications as prescribed.

Why would people choose to not take their medication? Reasons vary, but commonly include side effects, inconvenient dosing schedules, and high cost. Sometimes patients stop taking medications because they are feeling better and don’t think they need to keep taking them.

Taking medications improperly also puts patients at risk. This can occur for many different reasons. Perhaps the patient didn’t understand the instructions, or the instructions weren’t clear enough. Sometimes we are reluctant to speak up when we don’t understand something or we don’t have enough information to realize we have misunderstood in the first place.

Medication reconciliation is important because any discrepancy puts a person’s health at risk. Opportunities for discrepancies are reduced when there is better communication between patients and their providers and a streamlined source of information for all providers.

What’s the challenge?

A big challenge is patient-provider communication. Patients routinely are asked to list all the medications they take because without a complete list, physicians can’t help to their fullest potential. Their information won’t be complete. Providers need patients’ help to be as effective as possible.

The challenges with information don’t end there. There isn’t a universal system in place that makes data accessible to all providers, whether or not they are employed by St. Luke’s, and that’s the potential of this initiative.

One of the greatest resources a provider can have is a database that contains important patient information. This allows providers to see the medication a patient is taking so that they can prescribe what is appropriate and safe.

What’s the goal?

A team atSt.Luke’s is developing a strategy for all affiliated clinics through the SELECT Medical Network of Idaho, Inc.

One affiliate strategy is Community Connect, which will be similar to the myStLuke’s electronic health records system and will be accessible to all providers.

Another program, EpicCare Link, is essentially a read-only version of the Epic electronic health records platform used throughout St.Luke’s. It offers a view of medical records that non-St.Luke’s providers can see.

If a patient’s primary care physician happens to be a St.Luke’s provider and that patient needs to see another provider outside of St. Luke’s, EpicCare Link offers that provider helpful access to that patient’s medical records. This can help prevent errors, because that provider will see the information they need to treat and prescribe medication to that patient.

While patients often are their own best advocates, they can’t always remember every critical detail of their medical history, or they may be too ill to communicate their history to the provider they are seeing. In such cases, electronic access to records is critical.

The affiliate strategy team is working on pilot projects for both programs, and you will hear more as these programs develop.

How will it make a difference for patients? What changes will they see?

New tools being developed as part of this initiative will make it easier for patients to communicate with their providers.

Patients will also see improved communication in transitions of care. A streamlined communication process, through such electronic programs as EpicCare Link and Community Connect, will help ensure patients receive consistent guidance and care when they transition from a hospital stay back to their homes or to another facility.

What are the next steps?

The electronic programs discussed above will continue to be developed and then introduced to the broader community within the next year. Special training materials and information will help providers learn how to use these new resources to better communicate with their patients.

What’s the measure of success?

A stronger, more streamlined communication process will improve patient safety, and that improvement will be reflected in data being made available to providers.

These new resources not only will improve communication between patients, they also will improve patient safety, because when patients are more engaged with their providers, there are more opportunities to ensure medication is being taken properly.

Editor’s note: This is the seventh installment of a 10-part series introducing clinical integration initiatives that St. Luke’s is involved in.

Clinical integration is a term used to describe health care providers working together in an interdependent and mutually accountable fashion to pool infrastructure and resources. By working together, providers develop, implement and monitor protocols, “best practices,’ and various other organized processes that enable them to furnish higher quality care more efficiently than could be achieved working independently.

St. Luke’s Health System is a participating provider in the SELECT Medical Network of Idaho, Inc. SELECT is a network of healthcare providers in southwest Idaho that is focused on a coordinated model of care delivery focused on providing enhanced quality and better value to individuals, employers, and insurers.  

In keeping with the clinical integration effort, 10 initiatives were developed for 2013 to help establish the standards of enhanced quality meant to help create a new vision for health care.

The initiatives are:

  • Diabetes
  • Tobacco cessation
  • Back program
  • Advance directives
  • Patient-centeredness
  • Care management
  • Medicine reconciliation
  • Hand hygiene
  • Pharmacy optimization
  • Shared analytics

About The Author

David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.