Using an electronic prescribing system to ensure accurate medication lists in a large multidisciplinary medical group.
BACKGROUND
Although medication safety has largely focused on reducing medication errors in hospitals, the scope of adverse drug events in the outpatient setting is immense. A fundamental problem occurs when a clinician lacks immediate access to an accurate list of the medications that a patient is taking. Since 2001, PeaceHealth Medical Group (PHMG), a multispecialty physician group, has been using an electronic prescribing system that includes medication-interaction warnings and allergy checks. Yet, most practitioners recognized the remaining potential for error, especially because there was no assurance regarding the accuracy of information on the electronic medical record (EMR)-generated medication list. PeaceHealth developed and implemented a standardized approach to (1) review and reconcile the medication list for every patient at each office visit and (2) report on the results obtained within the PHMG clinics.


METHODS
In 2005, PeaceHealth established the ambulatory medication reconciliation project to develop a reliable, efficient process for maintaining accurate patient medication lists. Each of PeaceHealth's five regions created a medication reconciliation task force to redesign its clinical practice, incorporating the systemwide aims and agreed-on key process components for every ambulatory visit.


RESULTS
Implementation of the medication reconciliation process at the PHMG clinics resulted in a substantial increase in the number of accurate medication lists, with fewer discrepancies between what the patient is actually taking and what is recorded in the EMR.


CONCLUSIONS
The PeaceHealth focus on patient safety, and particularly the reduction of medication errors, has involved a standardized approach for reviewing and reconciling medication lists for every patient visiting a physician office. The standardized processes can be replicated at other ambulatory clinics-whether or not electronic tools are available.
Stock
Ron
R
Center for Medical Education & Research, PeaceHealth Oregon Region, Eugene, Oregon, USA. RStock@peacehealth.org
Scott
Jim
J
Gurtel
Sharon
S
D017598:Efficiency, Organizational; D055695:Electronic Prescribing / Q000592:standards*; D006123:Group Practice; D006801:Humans; D016347:Medical Records Systems, Computerized; D008508:Medication Errors / Q000517:prevention & control*; D008511:Medicine; D009096:Multi-Institutional Systems; D019982:Organizational Case Studies; D015397:Program Evaluation; D017010:Reminder Systems; D017751:Safety Management / Q000458:organization & administration*; D013038:Specialization; D014861:Washington