Not many days pass without new reports of frightening stories on medication errors that could — and should — have been avoided. In a best-case scenario, patients manage to escape no worse for wear, the error is identified, and steps are taken to reduce the likelihood of the error happening again. But concerning medication errors, the best-case scenario is often not the actual scenario. Medication errors frequently lead to significant harm to patients and are caused by systemic flaws that may not have simple solutions.
Statistics reveal the danger and frequency of medication errors:
Deaths caused by medical errors per year
Of adults have experienced a medical error
The estimated annual cost of measurable medical errors that harmed patients in 2008
Medicare patients experience a medical error in hospitals
The percentage of medical errors that involve newly graduated registered nurses with less than a year of experience in patient care.
These figures demonstrate just how important it is for clinicians and organizations to prioritize medication management. This e-book is designed to help you develop a new medication management program or improve an existing program. It includes guidance on an extensive range of medication management-related matters and provides valuable tips and tools that can elevate the performance of any medication management program. When a medication management program is firing on all cylinders, the benefits are evident and significant, including reduced readmissions and medical costs, increased patient safety, and greater achievement of health goals. Leverage the resources in this e-book as part of your ongoing efforts to enhance the overall delivery of care for your patients. Even the smallest of improvements is likely to have wide-reaching, positive effects.
There’s no question that medications are incredibly important for treating patients with acute and chronic conditions. However, with approximately 50% of patients taking medications incorrectly, it’s vital that hospitals and clinicians consistently follow best practices. This helps ensure patients take their medications the right way so their health can improve or, at the very least, they can better manage their condition.
Medication management is a service to help patients manage their medications so they take them as prescribed, and avoid the adverse effects associated with incorrect medication administration.
Some best medication management practices to consider implementing in your facility include the following:
A critical aspect of successful medication management is medication adherence. If patients are failing to take their medication as directed, one could argue that the medication management process loses significant value.
To help clinicians put their patients in the best possible position for successful adherence, here are a few tips you should follow:
Statistics show that every minute, around three Americans call a poison control center because they’ve made a mistake with their medication. Patient education is vital to reduce the frequency of these errors.
There are a few key areas clinicians should focus on when sharing vital information about medications:
Furthermore, make sure patients understand the crucial role they play in their own care. While education is of the utmost importance, if a patient doesn’t understand how to put that knowledge into action, your efforts will to help them will likely come up short.
Clinicians help patients in a number of ways, including diagnosing conditions, providing treatments, recommending services, and prescribing medications. However, clinicians can only do so much when it comes to the action that patients actually take, which is the case with medication management.
To support patients, clinicians can positively influence decisions with patient medication management. A few reasons patients often struggle with adherence include:
Low health literacy
This is the capacity for individuals to obtain, process, and understand the basic health information and services required to make proper health decisions. Clinicians should be prepared to assess their patients' health literacy and support patients with lower literacy using different resources, when applicable.
Believe it or not, cost is most common reason prescriptions go unfilled. Financial challenges often lead patients to delay or skip refilling medications or even rationing medication, which can prove dangerous. It’s for these reasons that clinicians should discuss finances with their patients and provide information about how patients can obtain financial assistance, order medications by mail, and take other steps to aid in patients obtaining and affording the medications they need.
Another reason patients often struggle with adherence is lack of understanding of their prescriptions. This may include the purpose of medication, why it’s necessary, side effects, and how long the medication takes to work. Clinicians must take the time to discuss each medication and the medication’s qualities with patients.
Finally, fear of side effects may also prevent patients from taking or even filling their prescriptions. Clinicians can work to prevent these adherence obstacles by discussing all side effects with patients and any concerns patients may have with following their medication regimen.
Taking education and adherence one step farther, there are medication management activities that can support your efforts to help patients stick with their medication regimen.
Finally, we can’t move on from this section until we address an important — and particularly vulnerable segment of patients: seniors. Adults 65 and older are at greater risk for medication-related problems. Three main reasons: 1) they are more likely to take multiple medications; 2) they’re more susceptible to side effects and (3 they are at a higher risk of drug interactions.
While the best practices we’ve already covered can apply to this age group, there are a few additional steps clinicians can take to improve success concerning medication management for seniors.
Focus on education
Before even discussing a medication, clinicians should ensure that patients can properly manage their medication regimen. This might require addressing obstacles such as poor health literacy, declining memory and eyesight, language barriers, and financial stability. Once you’ve determined if there are any potential obstacles, review information such as the medication’s purpose, how the medication should be taken, possible side effects, and other key details.
Make it a priority to discuss cost
Cost is increasingly becoming a medication adherence barrier for seniors. The top 20 brand-name drugs most commonly prescribed for seniors from 2012 to 2017 have increased in price. Since many seniors live on a tight budget and fixed income, affordability of prescriptions may hinder medication adherence.
Seniors also tend to take more medications, which increases the complexity of their regimen. When possible, reduce the number of medications and their administration frequency.
Provide and recommend resources
While verbal instructions can prove helpful, this type of communication also leaves room for error. As much as possible, clinicians should provide patients with a written list of all current medications and their accompanying information, in addition to other resources that can aid in adherence.
While not all seniors will be comfortable with or even use smart technology, clinicians should take advantage of those that do. A 2018 Pew Research Center survey showed that nearly half of U.S. adults 65-plus years of age owned a smartphone, so there is an opportunity to effectively leverage this technology comfort level. If your patient is tech-savvy, recommend a medication adherence app that can improve their medication management.
Conduct regular medication reviews
Finally, make sure to regularly review senior patients' medications. As a patient's conditions change, a medication prescribed in the past might not be the best option even just a few months later.
Medication management presents a number of challenges in a hospital setting that can contribute to readmissions. However, when steps are taken to improve the medication management process, hospitals can ultimately reduce medication related readmissions. There are many complexities to consider and overcome in order to accomplish this important objective. Let’s explore a few major challenges.
Patient Financial Constraints
One in four Americans report difficulty affording their prescription drugs, and one in eight say that they or a family member have rationed doses due to high costs. So, for many patients, you must be aware of how cost could affect their ability to even fill a prescription, let alone take it correctly.
Not only do patients struggle with medication costs, hospitals do as well. Rising costs are straining hospital budgets, leading some hospitals to pursue alternative medication therapies to better control costs. Such financial stress can prevent hospitals from making the best clinical decisions and providing the highest quality of care.
Approximately 80% of hospitals reported that medication shortages were an issue for them. Such shortages, which can also contribute to rising medication costs, may require hospitals to make difficult medication-related decisions, such as finding substitute medications, conserving supplies, producing their own medications in a compounding pharmacy, and determining which patients need medication right away and which patients can safely have treatment delayed.
Medication errors that occur in hospitals present safety risks for patients. While not all mistakes cause harm, many can lead to injury or even death. The challenge is that there are so many factors that can cause a medication error, making it difficult to determine the best ways to prevent mistakes.
Incomplete Patient Medication Histories
To provide the best medication management, clinicians must have access to a patient’s comprehensive medication history. If even one detail of a patient’s medication history is omitted, this could lead to an adverse event.
Care Transition Breakdowns
With every transition between doctors, departments, or facilities, there’s potential for a breakdown to occur. For example, a breakdown can occur if a patient has limited English proficiency or low health literacy and does not follow their treatment plan correctly or a patient or caregiver is excluded from transition planning.
A newer challenge that has emerged in recent years concerns prescribing opioids. This issue requires clinicians to carefully differentiate which patients are showing drug-seeking behavior, which are planning to sell the drugs, and those that actually require an opioid prescription.
To help keep patients safe from the challenges noted above, there are several steps organizations can take to protect patients from errors:
Another key aspect of medication management is ensuring that medications are administered safely and accurately. Evidenced by the fact that the median error rate of medication administration is 8%-25%, consider ways you can improve medication administration in your facility.
As mentioned in the previous section, educating patients and caregivers can help prevent medication errors. Discuss each of these areas related to drug interactions with your patients and caregivers:
One specific area of medication management that should not be overlooked is opioid pain management. As a serious problem on the rise, opioids claimed more than 64,000 lives in 2017 and data show an almost fourfold increase in overdose deaths from 1999 to 2008.
While healthcare providers should be aware of opioid-related dangers, there are many patients who still require this opioids to effectively manage their pain.
Here are a few initiatives the healthcare industry is undertaking to better manage opioid pain management:
A successful medication management care plan hinges upon collaboration with the patient. Here are some steps you can take to improve the care plan's effectiveness.
As you prioritize improving medication management in your organization, you can help patients with adherence by offering these services.
Medication Therapy Review
This is defined by the American Pharmacists Association as the:
“Systematic process of collecting patient-specific information, assessing medication therapies to identify medication-related problems, developing a prioritized list of medication-related problems, and creating a plan to resolve them.”This review not only sets a solid foundation for future success with medication management, it also allows you to make appropriate medication decisions for patients and provides the most effective guidance.
Comprehensive Medication Analysis
To assemble a comprehensive understanding of a patient’s medications, there is a lot of information to digest, including the names of medications, what they do, when they are taken, and side effects. Beyond this, there may also be non-prescription medications, herbals, supplements, and vitamins to consider.
A thorough, face-to-face discussion with the patient is critical for reviewing all medications, answering questions, and discussing potential ways to improve management, such as using a written medication plan, pill organizer, and/or mobile app.
New Medication Education
One of reasons patients do not take new medications is “misunderstanding.” It’s for this reason that you must take the time to discuss with the patient the new prescription, explain why it’s important, the roles the drug plays in overall care, instructions, side effects, and any questions.
Identify and Recommend Generics
If you identify and prescribe a generic medication, make sure your patient is aware so they can ensure that the correct medication is filled at the pharmacy. Prescribing a generic can help ease the financial barrier to filling and taking their medication as prescribed.
A few ways for clinicians to identify if a generic version of a medication exists include the following:
Provide Education on Pharmacy Services
Finally, services offered by pharmacies can offer an addition means of supporting patients with medication management and adherence. A few helpful services that may be available include:
Whether you’re working to evaluate your medication management process or building a process from scratch, it’s helpful to establish goals to serve as guidelines. Here are some worth considering.
Improve Patient Education — Patients fail to follow medication regimens for many reasons, including fear, misunderstanding, cost, and worry. Each of these problems can be solved by improving patient education.
Doing so might require assessing your organization’s current approach to education and its effectiveness. Education should cover any potential areas that could prevent patients from following their medication plan, including side effects, cost challenges, obstacles to filling or refilling prescriptions, and failing to follow a schedule, as well as steps to take if they have questions or concerns about their medication.
Reduce Medication Errors — While every organization should set a goal of zero medication errors, it may be more reasonable to start by setting achievable goals to reduce the number of medication errors each month, quarter, and year.
To help reach your goals, perform a comprehensive root cause analysis when a medication error and adverse drug event occurs. Using the results from this analysis, you can determine changes that need to be made and measure if the changes you make are preventing medication errors from occurring.
Strengthen Follow-Up Processes — Set a goal for a follow-up plan whenever a patient leaves a hospital or doctor’s office. This will ideally be in the form of a follow-up appointment with a primary care practitioner (PCP). One study showed that “patients lacking timely PCP follow‐up were 10 times more likely to be readmitted for the same condition within 30 days of hospital discharge and nearly seven times as likely to be readmitted for the same condition or receive other care.”
This appointment can ultimately serve to:
Now that we’ve covered how to put together a plan, medication management services, and goals for your organization, what’s left is improving the medication management process as a whole. Here are a few tips for improving various elements of the process.
Another key component of process success hinges upon the software system you use to support medication management. Since there are many options out there, here are a few worthwhile qualities to look for when researching software choices.
Just as crucial as the software you have in place is ensuring that you train staff in safe medication management. Here are a few guidelines to follow:
“Drugs that bear a heightened risk of causing significant patient harm when they are used in error. Although mistakes may or may not be more common with these drugs, the consequences of an error are clearly more devastating to patients.”While ISMP provides a standard list of these medications, it’s a good idea to revise the list according to the medications your facility frequently uses. With this list, you can train staff about the dangers of these drugs and also teach them how to most effectively educate patients about these medications.
Improved medication management ensures that patients receive the maximum benefits from their prescriptions and organizations not only reduce admissions, but also increase savings.
Here are a few tips for providers to help patients with medication management:
While training your staff and following best practices for medication management, it’s also helpful to put tools in place to support your organization’s efforts. Consider these medication management tools:
Electronic prescribing of controlled substances — The use of e-prescribing for controlled substances can enhance patient safety. E-prescribing can help clinicians identify potential issues, such as duplicate therapies, interactions, and allergies; prevent mistakes associated with sound-alike drugs; and improve adherence.
Bar-coded medication administration (BCMA) systems — BCMA systems allow users to electronically document medications at the point of care. Using a handheld device, clinicians scan the barcode on their identification badge, the patient's wristband, and the medication package. This allows the system to determine whether the medication scanned is correct for the patient.
Medication safety self-assessment for hospitals — This tool allows organizations to assess the safety of medication practices in their facilities and identify areas for improvement.
Medication reconciliation solutions — Finally, seek out a medication reconciliation tool that provides all physicians, nurses, and pharmacists with access to a complete list of a patient’s medications. Meds 360° is a solution that provides a clear medication history, allowing clinicians to make better management decisions.
Within this e-book, we have provided you with numerous best practices and resources. Some will be easy to implement and integrate. Others will require more work and substantial coordination between various stakeholders. But all can help you develop the foundation for a successful medication management program or take your current program to higher levels of safety and effectiveness.
As you set out to build or strengthen your program, perform continuous monitoring and evaluation. This will help ensure that the policies and processes you implement achieve their desired results. This should also help you identify problems and inefficiencies that can be fixed and opportunities for positive changes. Engage all stakeholders — including patients and their caregivers, where applicable — for feedback on your efforts and suggestions for improvement. Even the best medication management programs have room for growth.
Finally, and perhaps most important, is to learn from every single medication error made within your organization. Mistakes happen; that is a given. What isn't is that similar mistakes must happen again and again. That's where the importance of a non-punitive culture comes in. With such a culture, team members are encouraged to acknowledge and raise awareness of errors, including their own. In most cases, rather than face punishment for making a mistake, staff are empowered to help with assessing the error and determining its root cause(s). Staff are further engaged to support efforts to strengthen systems and processes to best ensure that the same error is not repeated — by themselves or any other member of the team.
When an organization strives to learn from its shortcomings and places an emphasis on accountability and process improvement, its programs — including medication management — grow stronger by the day. And that means patient care will as well.