Each day, millions of people rely on over-the-counter medication, vitamins and prescription drugs to treat a wide range of symptoms with relative efficiency and safety. But without the necessary checks and balances, drugs taken at home can easily become deadly if improperly taken with drugs prescribed in an emergency room or upon admission to the hospital.
"Many medication errors occur at 'hand off' points, when patients transition from home to the hospital, from one unit of the hospital to the other, and from the hospital back home. Most people are unaware of the possible negative interactions between the drugs they already use and drugs prescribed at admission or discharge,” according to Dr. Abha Agrawal, Associate Medical Director and Chief Medical Information Officer at Kings County Hospital.
With the help of MedRecon, a new automated decision support feature in the patient’s electronic health records, staff at Kings County can consistently reconcile new medication orders and the drugs patients are taking at home to avoid errors and adverse reactions.
"Too often patients and many doctors forget to discuss medication history. The ER doctor might prescribe Tylenol with codeine for flu symptoms. But if the patient regularly takes Tylenol at home for back pain, this could result in an overdose of acetaminophen, the active ingredient in Tylenol."
With automatic prompts built into the system, MedRecon ensures the medication history present in the electronic medical record is carefully considered at all possible points of care in the hospital – from the ER, to an inpatient unit, the ICU and upon discharge. A required field in the patient record generates a pop-up screen of the entire medication history, forcing physicians to check off each drug or over-the-counter medication and determine what should be continued, discontinued or substituted. As an added safety layer, once the reconciliation takes place and the new prescriptions are ordered, the hospital pharmacist also compares the patient's record to the new drug orders to ensure the right medication and dosage is being prescribed.
"I want it to be easy for people to do the right thing and hard to do something wrong," Dr. Agrawal says. "Adding alerts was a very simple solution to help our staff do the right thing to improve patient safety."
Since the adoption of MedRecon, medication reconciliation rates have dramatically improved from 34% to almost 100% and discrepancies between a patient's medication record and admission orders dropped to 1.4% from 20% during the pilot phase.
The national movement to reduce medication errors led The Joint Commission, the national accreditation organization, to require hospitals to follow specific recommendations at every care transition when new medications are ordered or existing orders are rewritten. Studies cited by researchers at Johns Hopkins University estimated that medication reconciliation can prevent up to 70% of all potential errors and 15% of all adverse drug events.
Kings County's MedRecon project won the 2007 Safety Net Award from the National Association of Public Hospitals and was featured in the 2009 Joint Commission Journal on Quality and Patient Safety.
This month, the prize-winning team was also honored by HHC as one of the 2009 Patient Safety Champions. HHC recognized 21 individuals and teams in hospitals throughout the public hospital system that have been leaders in the organization’s bid to become one of the safest hospital systems in the country by the end of 2010.