The following is a guest blog post by Greg Anderson, Senior Business Advisor, Surescripts.
For years now, prescribing has been growing more complex. Between 1994 and 2014, the percentage of the U.S. population taking three or more prescription drugs nearly doubled, and as of 2014, nearly 11 percent had taken at least five prescription drugs within a 30-day period.
As important as these medications may be, every new drug prescribed introduces a new possibility for error. And this increased complexity is indeed having dangerous effects. Medication errors made by patients and their caregivers outside healthcare facilities doubled between 2000 and 2012, according to a 2017 study. That’s not even counting the estimated 40 percent of medication errors that spring from another source: inadequate reconciliation.
Accurate Reconciliation: High Barriers, High Stakes
Medication reconciliation can be a frustrating task in any setting. Compiling an accurate medication list can easily take 45 minutes when care providers need to not only consult with the patient, but also reach out to pharmacies, pharmacy benefit managers, other physician offices and family members to get the full story. Achieving accuracy is especially daunting in acute care settings, when time is of the essence and memory-impeding stress is heightened. Records of medications prescribed and taken are often far from complete, leaving care teams reliant on whatever history patients and their families can patch together.
A lot can go wrong when medications fall into the gaps. One study of hospital patients taking at least four prescription medications found that a majority of patients had at least one medication not identified upon admission, and 38.6 percent of these reconciliation errors had the potential to cause significant discomfort or adverse health outcomes. A recent study of 306 medically complex patients found up to seven errors per patient in medication histories.
When a healthcare provider misses a drug, consequences can range from treatment interruptions to incorrect treatment decisions. Inevitably, some of these medication errors lead to the most common cause of iatrogenic harm: adverse drug events (ADEs), which send nearly 700,000 people to emergency departments each year.
The Best Defense Against ADEs
Not all medication errors can be foreseen and eliminated, but there’s reason to believe we can greatly reduce the 10 percent of ADE-related emergency department visits that stem from medication errors. Researchers estimate that 50 to 70 percent of ADEs that lead to hospital admissions are preventable. And there’s one tactic in particular that’s been shown to make a serious difference: consistent medication reconciliation, aided by access to electronic medication history. More than half of the medication errors in one 2008 study of primary care clinics could have been prevented with the help of electronic tools. That’s in line with the Agency for Healthcare Research and Quality’s findings that “anywhere from 28 to 95 percent of ADEs can be prevented by reducing medication errors through computerized monitoring systems.”
Recent studies in clinical settings have borne out insights like these. In 2016, the Cedars-Sinai Health System performed a study assessing medication history errors among older adults on complex medication regimens. Researchers determined that accessing pharmacy fill and PBM claims data for those patients via Surescripts Medication History for Reconciliation would likely have prevented 35 percent of admission medication history errors and 31 percent of resultant inpatient order errors. Those percentages rise when considering only severe errors.
By helping doctors avoid prescribing errors, effective medication history solutions can also help patients make fewer medication mistakes at home. Eliminate redundant or conflicting prescriptions, and you also eliminate opportunities for patients and their caregivers to become confused. Even in a world of increasing prescription complexity, we can work as an industry to reduce many types of medication errors. We just need the right tools to collaborate and to make informed care decisions together.