AlignMap

… we recognized that the need for accurate information about a patient’s medication spans the continuum and shouldn’t be limited to the inpatient setting.

Indeed, inpatient and outpatient health care professionals rely on each other’s records as patients cross back and forth between care settings. It’s important, for example, for emergency department (ED) staff to know what medications a patient has been taking when he or she arrives for emergency care. And depending on the circumstances, patients arriving at the ED aren’t necessarily the best source. They may not be in a condition to communicate or remember accurately, and patients who do carry their medication lists with them may not have a list that is up to date.

Patients may assume all providers have access to the same information, regardless of the setting, and are often surprised to learn that this goal has yet to be realized. Records aren’t always immediately accessible, and clinicians who see a lot of patients may not have systems in place to quickly update and transmit large amounts of data.

While medication errors in the outpatient setting are harder to measure, in its 2006 report, Preventing Medication Errors, the IOM estimates that about 530,000 medication-related injuries occur annually just among Medicare recipients at outpatient clinics.

Launched in October 2006 after a pilot phase, the project seeks to improve communication about medications between patients and providers, and also among providers, through the use of a paper medication list (called the Med List) that patients maintain and regularly review with their providers.

Effie Brickman, Director of the Ambulatory Medication Safety Project at the Massachusetts Coalition for the Prevention of Medical Errors, says that the Med List helps improve medication safety in three ways.

First, the Med List gives patients a single place to write down all their medications, regardless of how many pharmacies they use. Space is provided to list both prescribed and over-the-counter medications, any herbal, vitamin or dietary supplements they are taking, along with start and stop dates, the purpose of each medication, possible danger signs, and if monitoring is required.

Second, because patients are encouraged to bring the list to each medical appointment, there’s a built in prompt and reference for discussing everything on it, including medications a patient used to take. And third, the Med List enables providers to reconcile the patient’s list with the information in the medical record, looking for omissions, duplications, and potentially problematic interactions.

Putting the patient in charge of creating and maintaining an accurate medication list reflects two things, one a problem, the other an opportunity: the difficulty that physicians’ offices have coordinating information in a fragmented system where electronic record-keeping and reliable communication is still not the norm, and the impact of the movement toward more patient-centered care that seeks to give patients more access to information and involvement in decision making.

Brickman says the practices that tested and helped refine the Med List during the pilot phase often revealed important information. “The biggest surprise for most doctors was how many patients thought the physician already knew all the medications the patient was taking, even those prescribed by other physicians. Physicians also learned how patients were thinking about and using their medications,” says Brickman. “One doctor learned that some patients didn’t consider birth control pills to be medication, for example. And other patients didn’t think it was important to report use of herbal and over-the-counter medications. Doctors do want to know this information because herbals and over-the-counter drugs sometimes negatively interact with prescription medications.”