Filling Prescriptions in One Place

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Monday, 25 November 2013 15:50

The most common patient safety error involves medications. A third of all Americans already take five or more medications and every year failure to take those medications as prescribed causes more than 1.5 million preventable events. In addition to saving lives, improved medication prescription and compliance could reduce the estimated $290 billion these issues cause.

Whether admitted to the hospital or visiting a new specialist, patients often receive new medications or adjustments in their current ones. As a result, there could be dangerous combinations, duplicated therapies or incorrect dosages. Ultimately, the best system would be one that links every system which dispenses medication to create one central medication list for each patient. Until that occurs, one simple step is encouraging patients to fill their prescriptions in one place.

There are multiple benefits to using one pharmacy. The use of one central pharmacy for a patient can encourage medication reconciliation where inadvertent errors can be caught.

Studies have shown that unintended medication discrepancies occur in nearly one-third of patients at admission and more than half of patients have more than one unintended medication discrepancy at hospital admission. Improving medication safety is one of the critical national goals set by the Joint Commission.

Since most errors occur at transition points, our focus should be on improving quality and reducing number of transitions – one medication source can greatly impact these errors. A “home” pharmacy would have master list of medications prescribed by multiple providers. Physician offices can encourage this by listing a pharmacy in patient’s medical records and offering to order medicines electronically. Hospitals can confirm medication lists through contact with that pharmacy upon patient admission.

Until there is a nationally standardized pharmacy base, there are software applications that can be integrated into hospital’s CPOE system can maintain digital medication reconciliation records within its network. While not complete, it is a step in the right direction. There are also medical reconciliation toolkits developed by organizations such as the American Society of Health System Pharmacists (ASHP) and the Institute for Health Improvement (IHI). While electronic health records and health information exchanges have greatly improved medication reconciliation, they are not widespread enough to solve the issue.
Additionally, patient education about importance of an accurate list and how to share list when not capable. Patients need to understand why a thorough list is critical, even lifesaving. Staffs at physician offices and admission departments should be trained to ask probing questions to ensure every prescription and over-the-counter medication, vitamin and supplement are listed.
Through the use of a medication “home”, technology and old-fashioned interpersonal communication, we can reduce the number of medication errors.