Cardiac medication errors common after hospitalization

According to the Institute of Medicine,

gaps in medication information collected at interfaces in care may represent

the most common source of preventable health care error. Studies have shown

that unintentional prescribing discrepancies are common and occur in 60%-90% of

hospital admissions (Arch. Intern. Med.

2012;172:1057-6).

Dr. Blake Lesselroth

While systematized processes intended to reconcile

medications have been shown to reduce discrepancies by up to 70% and

potentially reduce downstream adverse drug events, most US hospitals

have not yet fully implemented standardized reconciliation practices (BMJ Qual. Saf.

2011;20:372-38).

Hospitalists have a particularly critical role to play

in the development and diffusion of reconciliation practices for multiple

reasons (J. Hosp. Med. 2010;5:477-85).

First, patients on hospitalist services tend to be

medically complex and have the most to gain from a structured medication

review. Second, hospitalists are well positioned to recognize problems across a

breadth of specialty domains and marshal resources to triage and manage

potential medication errors. Third, hospitalists have assumed a central role in

the quality improvement movement and possess the skills to lead multi-modal

interventions designed to detect and manage high risk discrepancies. Despite

these disciplinary strengths and opportunities, an alarmingly high proportion

of hospitalists are unconvinced that their time is well spent on reconciliation

efforts or that interventions can improve outcomes (J.

Hosp. Med. 2011;6:329-3; J. Hosp. Med. 2008;3:465-72).

Multidisciplinary approaches that are patient centered,

leverage the unique skills of nurses, pharmacists, and physicians, and

capitalize upon information technologies are most likely to be successful.

Dr. Blake J.

Lesselroth, is a hospitalist-informatician at the Portland Veterans Affairs

Medical Center

in Oregon.