Medication Management
Summary
Since 2000, the U.S. Food and Drug Administration has received more than 95,000 reports of medication errors. Medication errors can occur any time, in any step of the delivery process. Understanding the types and causes of medication errors can help hospitals identify gaps in the medication management process and allow them to take actions to help make patients safer. Most medication errors are not caused by individual carelessness, but rather by faulty processes that lead people to make mistakes or fail to prevent the mistakes from occurring in the first place.
In 2006, The Institute of Medicine published Preventing Medication Errors as part of its Quality Chasm Series. The book recommends these steps to prevent medication errors:
- Initiate a paradigm shift in the patient-provider relationship. Patients need to understand their medications and take responsibility for monitoring them. Providers should educate, consult with and listen to patients.
- Use information technologies to reduce medication errors. Clinical decision support and e-prescribing show the most promise in reducing medication errors.
- Improve labeling and packaging of medications. The pharmaceutical industry and federal agencies need to work together to improve drug nomenclature and information sheets.
Health information technology also shows promise in reducing the number of medication errors. Providers cannot keep up with all the relevant information available on medications, and point-of-care reference; information technology answers this concern. Additionally, e-prescribing eliminates handwriting errors and can automatically check for allergies, interactions and overly high doses. Hospitals are making slow but steady progress in adopting these technologies. According to the 2010 Most Wired Survey and Benchmarking Study, 29 percent of respondents have medications entered by physicians, up from 12 percent in 2004.
In addition, studies have shown that organizations that have instituted medication reconciliation have benefited from a reduced number of medication errors. Reconciliation is a process of identifying the most accurate list of all medications a patient is taking and using this list to provide correct medications for patients anywhere within the health care system. Reconciliation involves comparing the patient's current list of medications against the physician's admission, transfer and/or discharge orders.Business Case
Medication errors are among the most common medical errors. According to a 2006 report from the Institute of Medicine, an estimated 1.5 million preventable adverse drug events occur in the United States each year, including 380,000 to 450,000 among hospital patients. Although patient harm caused by medication errors is most often temporary in nature, in some cases the harm can be permanent or even fatal.
A 2008 report from the Center for Improving Medication Management estimates that approximately $220 billion is spent on prescription drugs in the United States each year, with more than $50 billion spent on chronic medications. Patient adherence with prescribed medication regimens is less than 50 percent. About 130 million Americans have a chronic condition representing at least 50 percent of all prescriptions. Better medication management can lead to potential medical benefits and reduced costs of emergency room, inpatient hospital admissions and physician practice visits.
An understanding of the costs associated with medical errors may help leaders understand the importance of patient safety from a financial perspective, develop measures to evaluate the impact of patient safety initiatives and efficiently allocate resources to address this important health concern.
Health Care Reform and Medication Management
The 2010 Patient Protection and Affordable Care Act (ACA) calls for the creation of a Medication Management Program by May 1, 2010. The Patient Safety Research Center shall administer grants or contracts for services provided by licensed pharmacists to treat chronic diseases. Further, grant recipients must coordinate with local community health teams. The grant recipients are responsible for the following functions:
- Health and functional status assessments;
- Formulating medication treatment plans;
- Initiating and modifying medication therapy;
- Monitoring for medication safety and effectiveness; and
- Comprehensive medication review.
Beneficiaries who have two or more chronic diseases, take any high-risk medications, take four or more prescribed medications, or who have undergone a transition of care recently are eligible to participate. One goal is to improve patient adherence to therapies while reducing acute care costs and hospital readmissions.
For more information, visit the AHA’s Health Reform: Moving Forward web site. The site hosts a Reform Advisory, which includes comprehensive information on the provisions of the ACA that address medication management.
