Using the medication safety systems in your EHR to reduce risk

You get a call on a Monday morning from a patient’s spouse. Over the weekend, the patient was hospitalized and is in a coma. The alleged blame is on medication interactions from prescriptions issued by a physician in your clinic. How are systems that can help prevent this situation being used in your practice?

Most EHRs and electronic prescribing (e-prescribing) systems can detect harmful drug interactions and alert physicians and staff, but only if those systems are employed correctly. As key priorities for patient safety, medications and allergies must be reviewed at every visit.

Assessment beyond prescribed medications

Drug interactions cannot be evaluated accurately unless the medication list is reviewed and reconciled with the patient and entered into the electronic record. Ensure that clinicians are capturing over-the-counter (OTC) medications, vitamins and herbal supplements. If there are no changes to medications since the last visit, the review still should be documented for reporting purposes.

Roles and accountabilities

The medical provider — not medical assistants (MAs) or nursing staff — should complete the documentation that medications have been reviewed. The medical provider is ultimately responsible for this documentation, even if the MA initially entered the data. Ideally, this criterion in the physician’s performance review.

Reporting and monitoring

You should be able to run a monthly report on medication reconciliation for each visit (as well as review of patient allergies) for every provider in the practice. A goal of 95% compliance with medication and allergy review at each visit is a reasonable target.

Training

Root-cause analysis of problematic medication review data often will point toward inadequate clinical training on the functions of the EHR or e-prescribing software. Training can be an immediate fix. Also consider how per-diem and locum tenens personnel will be oriented to your medication safety systems and how their performance will be monitored.

Alerts to ensure compliance

Some EHR systems can be programmed to display an alert if the medical provider has not recorded that the medications were reviewed during the encounter. A hard stop in the system will ensure that the review is complete and documented.

Special alerts

Most systems also will create an alert for pregnancy testing if teratogenic medications — causing harm to a fetus — are administered to childbearing-age women.

Patient portal integration

If you have a third-party patient portal, ensure that the medication list entered by patients is populating into the EHR. Otherwise, there is an automatic failure in your patient safety system. A critical problem with some proprietary systems is that the physician is unable to edit the dosage or add medications when the patient has not entered information completely or accurately.

Tracking OTC, vaccine and medication distribution

Typically, distribution of OTCs is documented in the patient’s record. However, if there were a medication recall, it would be difficult to identify and notify patients provided medication within a specific lot. Some accreditation bodies insist on keeping an OTC log, though the documentation is redundant. Check to see if your EHR can track and report on medication lot numbers.

Patient education

Patients should be provided with a full list of their medications at the end of their exam, as well as medication information on any prescriptions issued, including side effects.

Provider reference

Medical providers and nursing staff must have immediate access to current drug information, so practices should consider using commercially available references containing prescribing information. Some physicians find it frustrating to toggle between the drug reference and the EHR. Low-cost solutions for handheld devices are available.

EHRs and e-prescribing systems significantly reduce the risk of harmful medication interactions. Don’t assume that your physicians have checked to ensure that “all systems are go.” A checkup of safety systems usage is part of your risk-reduction strategy.