Harnessing health IT to reduce medication errors
To address gaps in provider knowledge of health IT to improve medication management, a panel convened by the Agency for Healthcare Research and Quality (AHRQ) delved into the latest efforts to improve patient safety with targeted inventions.
At Massachusetts General Hospital, Stephen Atlas, MD, director of the Primary Care Research & Quality Improvement Network, shared his work to launch the Medication Metronome project to “create an infrastructure to support planned medication dose adjustment.”
Medication Metronome is a health IT application that tracks lab test due dates and results, reports results to patients and providers and facilitates between-visit medication dose adjustment. Atlas and his team analyzed whether the project impacted the frequency and content of office-based visits for patients with Type 2 diabetes, hypertension and hyperlipidemia.
The researchers randomly assigned the intervention to two primary care practices within Mass General, and compared their experiencse against a control group. As part of Medication Metronome, patients received a mailed letter and lab slip before a test was due; a second letter and lab slip one week after a missing test; and notification of persistently overdue lab results three weeks after a scheduled lab.
“In terms of Medication Metronome, there are some indications that it improved processes of care, but it did not have impacts on risk factor controls over the long term,” he said, citing results of a study.
While primary care physician advisors were enthusiastic at the beginning, they discovered barriers including lack of financial assistance under the fee-for-service model to run such a program. Also, patients who received labs outside the system of care were confused why they were getting notices to get labs, Atlas said.
Among his recommendations were financial assistance to help increase buy-in for the program.
Drugs that look alike and sound alike (LASA) can be the source of prescribing errors, and William Basco, MD, MS, professor at the Medical University of South Carolina, shared his work to mitigate these errors in a pediatric setting.
His research has found that while rates of pediatric LASA errors appear to be much lower than other types of pediatric medication errors, health IT can still play a role in eliminating these mistakes through automated screening and targeted alerts. Health IT also can improve the readability of prescriptions and the ability to cross-check any new prescriptions with those a patient has received before.
In his research, he created pairs of drugs that look and sound alike, and conducted surveys to determine the level of harm that would occur if a mistaken prescription were to happen: both if the patient failed to receive the required medication and the effects of the wrong medication.
The researchers then developed alerts based on the level of potential alarm that would be triggered if both medications in a pair were taken within six months of each other.
The researchers found 608 potential LASA medication pairs, and that 17 percent of them posed patient safety risks. For the minority that could cause harm, alerts are appropriate so clinicians could intervene if necessary. The ability to whittle down the number of alerts would also help prevent potential alert fatigue.
“We’d like to put together a process for real-time screening of this in pharmacies. That is where we are trying to go eventually,” he said.
In the meantime, there are some challenges, including the ever-growing list of generic medications and the potential for substitutions—both of which would need to be considered in the alert systems.