Medication Safety

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Medication Safety HIT

• Carla Saxton McSpadden, RPh, CGP
• Assistant Director, Policy and Advocacy
• American Society of Consultant Pharmacists

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What are we trying to achieve through utilization
of technology?

• As previously mentioned
• Safety
• Quality of Care
• Efficiency
• Improved claim submission/reimbursement
• Increased job satisfaction among HC providers
• When it comes to meds, enhanced safety and
  quality of care is realized through
• Better clinical decisions
• Reduction in errors

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Clarification of terms describing this thing
were trying to prevent through use of HIT

• Medication Misuse
• Adverse Consequence - primary term utilized in
  draft SOM, Appendix PP an unpleasant symptom or
  event that is due to or associated with a
  medication This includes ADE/ADRs, medication
  errors, interactions Theoretically Includes both
  preventable and unpreventable outcomes

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Impact of Medication Misuse

• According to IOM Report,
• Errors related to medication orders/prescriptions
  and to administration of medications kills up to
  7000 Americans every year - more deaths than
  workplace injuries
• Costs associated with medication-related
  morbidity and mortality in outpatient setting are
  estimated to be as high as 77 million
• ISMP states,
• Evidence exists to suggest that adverse drug
  events result in considerable number of
  hospital admissions - perhaps as many as 11
• Author Thomas Moore, Prescription for Disaster,
• Americans are 10 times more likely to be
  hospitalized by a prescription medication than by
  an automobile accident

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Contributing Factors to Medication Misuse

• The large number of medications (and doses) that
  are available, both prescription and
  over-the-counter
• The number of concomitant medications taken by a
  patient and the number of prescribers involved
• Frequently changing medication labeling
• Complex medication names that can often be
  confused with one another due to similar spelling
  and/or pronunciation (look alike, sounds alike
  medications)
• Increased pressure to take care of more patients
  in less time with reduced staff
• Illegible handwriting

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Examples of why medication use is difficult

• What is this order for?

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Examples of why medication use is difficult

• What is this order for?

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Examples of why medication use is difficult

• What are these orders for?

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Examples of why medication use is difficult

• What is this order for?

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How HIT might be able to help

• Computerized order entry, which reduces the need
  for handwriting and transcription of medication
  orders - thereby reducing illegibility and
  misinterpretation
• Incorporation of drug information database and
  patient history, which reminds/provides current
  information to providers when it is needed and
  can prompt the provider when something seems
  incorrect - proactive screening

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Sometimes the technology itself is the problem

• What is this order for?

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Technology isnt the perfect solution

• As mentioned previously, studies have been
  published showing influx of new types of
  errors/problems due to technology
• Koppel, JAMA 2005
• Judge, J Am Med Inform Assoc 2006
• ISMP study in 1998 where pharmacists were asked
  to process hypothetical order revealed that 67
  of hospital pharmacies computer systems
  processed a series of fatal overdoses without any
  on-screen warnings
• People can always ignore or find work-arounds
  to get by appropriate alerts/prompts

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Role of HIT and upcoming changes to pharmacy
sections of SOM

• E-prescribing systems can be programmed to screen
  or remind providers when theyre about to
  prescribe medications mentioned in Unnecessary
  Meds section of survey guidance
• If connected to EHR, prescriber could more easily
  document risk-benefit analysis if an Unnecessary
  Med is warranted

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Role of HIT and upcoming changes to pharmacy
sections of SOM

• Medication Regimen Review by consultant
  pharmacist - emerging technology mentioned as
  possible method for accessing resident
  information and communicating recommendations
• Many procedural aspects of pharmacy services
  (e.g. administration, disposition, etc) can be
  tracked and documented electronically - making
  implementation of policies and procedures more
  efficient and consistent

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Summary

• Technology is only as good as its designers and
  end users...people are still involved -
  therefore, mistakes will still occur
• Medications are huge focus right now due to
  Medicare Part D, upcoming changes to CMS survey
  guidance in SOM - We should use this as an
  opportunity to show how technology and
  e-prescribing could be of benefit

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Resources on Medication Errors and Patient Safety

• National Coordinating Council for Medication
  Error Reporting and Prevention (NCCMERP)
• www.nccmerp.org
• www.ascp.com
• www.med-pass.com