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Will Electronic Medication Reconciliation
Improve the Quality of Transitional Care?
Principal investigator Michael Weiner, MD, MPH will produce outcomes to begin to answer this question with Medication Reconciliation to Improve Quality of Transitional Care, a three-year R18 funded by the Agency for Healthcare Research and Quality.
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 medication reconciliation systems improves the fraction of cases undergoing MR,” notes Dr. Weiner, “we know relatively little about the extent to which these systems alter clinical outcomes. Research also indicates that medication reconciliation should be integrated with computer-based provider order entry, 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. The study will target patients at Wishard Health Services.
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. Dr. Weiner hypothesizes that electronic facilitation of inpatient MR will improve completion of MR and will decrease the incidence of drug-related medical errors.
Dr. Weiner’s co-investigators are J. T. Finnell from Emergency Medicine; Paul Dexter and Kirsten Kaisner-Duncan from Medicine; James Fuller and Kerri DeNucci from Wishard Pharmacy; Xiaochun Li from Biostatistics; and Pete Castellucio, Faye Smith, Joe Kesterson, Greg Abernathy and Jeremy Leventhal from Regenstrief Institute.
November 12, 2009
