Improved integration of care between providers and the use of electronic records that “follow the patient” are needed to reduce serious medication errors in Australian healthcare, new research has found.
Patients are the “one constant” as they transition between GPs, hospitals, specialists, ancillary primary care services and private clinics, according to ‘Reducing medication errors at transitions of care is everyone’s business’ published in the Australian Prescriber journal, and they have the most to lose.
“As patients move between health providers and settings, discrepancies and miscommunication in clinical records are common and lead to serious medication errors. Hospital admissions and discharges, interdepartmental transfers, or care shared between a specialist and a GP are often dangerous times for patients, especially those with long-term conditions or taking multiple medicines.”
A patient-centric approach, new technology and an increased focus on solving the problem by healthcare providers are crucial to reducing errors and the harm they cause.
“Maintaining an accurate, comprehensive and up-to-date medicines list that follows the patient reduces serious medication error. Pivotal to this record is a medicines reconciliation review at error-prone transition points.
“Multiple health professionals involved in a patient’s journey through healthcare services need to embrace accountability for medicines-related outcomes. Emerging technologies for communication between primary care and specialist or secondary services will facilitate this, but importantly, there needs to be commitment from each health professional to undertake this approach.”
Researchers Professor Amanda J Wheeler from Griffith University’s Menzies Health, Dr Shane Scahill from New Zealand’s Massey University, Auckland GP Dr David Hopcroft and Dr Helen Stapleton from Mater Education found that “seamless integration of care between healthcare professionals and the use of technology” could help improve communication within Australia’s fragmented health system.
Between 2-3 per cent of all Australian hospital admissions are medication-related, with at least 230,000 admissions per year caused by patients taking the wrong dose or the wrong drug. Poor medication management during or immediately after hospital admission increases the risk of readmission in the next month by a staggering 28 per cent, while the annual cost of medication mishaps is estimated to be at least $1.2 billion.
“Patient care pathways must be integrated through the health sectors. Electronically shared records would facilitate easy transfer of correct, real-time information,” the researchers found.
Electronic prescribing systems can be critical to improving communication between clinicians and healthcare providers.
“As part of electronic medication management systems, eprescribing can enhance safety and quality by ensuring complete and legible orders, and reducing medication errors and adverse reactions.”
Figures from Queensland Health’s Princess Alexandra Hospital, which became fully digital a year ago, have shown substantial benefits. In 2017, medication errors at PAH dropped by 44 per cent, emergency readmissions within 28 days of discharge were 17 per cent less and drug costs per weighted activity unit were 14 per cent lower.
However, the researchers say eprescribing systems can introduce new types of errors such as incorrect selection of medicines from drop-down menus. They advise that systems should include safety warnings – including for contraindicated medicines or potentially harmful doses – that are prioritised to avoid alert fatigue. With a number of different eprescribing systems available, national standards are recommended to ensure safety and quality criteria. Integration with other clinical systems is essential for decision support and easy exchange of patient data between providers.
My Health Record could provide a step towards integration and patient empowerment, particularly following the significant uptake nationally by Australians after the opt out period ends in October, according to the researchers. However, records could be incomplete.
“While ease of access to medicines information for consumers moving between multiple prescribers is a significant step forward, information may be incomplete. For example, medicines that have been stopped, or doses changed, may not be reflected in prescription or dispensing records.
“Practitioners’ notes may not have been uploaded and made available via the Medicines Information view. Also, consumers may have removed prescription and dispensing information in their record.
“The vital element in all transitions of care is accurate and timely communication between patients, their carers, and health practitioners. This helps to confirm and validate information contained in the shared electronic health record.”
Smartphone apps such as MedicineWise could also help healthcare practitioners, patients and carers ensure the accuracy of prescriptions.
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