Medical errors are common and dangerous. Approximately 20% of medical errors are related to prescription of medications. Most medication errors occur at transitions in care, such as when patients are admitted from ambulatory settings to hospitals or discharged from hospitals to ambulatory settings. Since prescriptions at hospital discharge are intended to be followed in ambulatory care, improving transitional and ambulatory care requires attention to the discharge prescriptions. With medication reconciliation (MR), multiple sources of medication information are reviewed, to determine which medications are currently active, and which medications should be prescribed. The process of MR is tedious and time-consuming. Although implementation of formal MR systems improves the fraction of cases undergoing MR, we know relatively little about the extent to which MR systems alter clinical outcomes. Research also indicates that MR should be integrated with computer-based provider order entry (CPOE), but this seldom if ever occurs.
The specific aims of this study are to integrate an electronic MR system with an electronic prescribing system, conduct a randomized controlled trial of MR, and determine whether electronic facilitation of MR alters MR and the incidence of medication errors in ambulatory care. On a patient's hospital admission, a Web-based MR module will receive an automatically compiled outpatient medication list. Following discussion with the patient, medical personnel will update the list, which will then be delivered to the CPOE system and become actionable for prescribing. Main outcomes include adverse drug events and erroneous discrepancies between the pre-admission medication list and the medication list upon the patient's return to ambulatory care. We hypothesize that electronic facilitation of inpatient MR will improve completion of MR and will decrease the incidence of drug-related medical errors.

Public Health Relevance

Medical errors are common and dangerous. Approximately 20% of medical errors are related to prescription of medications. Most medication errors occur at transitions in care, such as when patients are admitted from ambulatory settings to hospitals or discharged from hospitals to ambulatory settings. With medication reconciliation (MR), multiple sources of medication information are reviewed, to determine which medications are currently active, and which medications should be prescribed. We hypothesize that electronic facilitation of inpatient MR will improve completion of MR and will decrease the incidence of drug- related medical errors.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Demonstration and Dissemination Projects (R18)
Project #
5R18HS018183-03
Application #
8105461
Study Section
Health Care Technology and Decision Science (HTDS)
Program Officer
Roper, Rebecca
Project Start
2009-09-30
Project End
2013-07-31
Budget Start
2011-08-01
Budget End
2013-07-31
Support Year
3
Fiscal Year
2011
Total Cost
Indirect Cost
Name
Indiana University-Purdue University at Indianapolis
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
603007902
City
Indianapolis
State
IN
Country
United States
Zip Code
46202