Assessing the Accuracy and Quality of Medication History Collection: Effect of Implementation of Electronic Health Record

Abstract from 2013 ACCP Annual Meeting, Alburquerque, New Mexico

Trends in Oral Antidiabetic Medication Initiation and Use in a HMO Population

The ADA (American Diabetic Association) and NICE (National Institute for Clinical Evidence) in the United Kingdom have established evidence based guidelines for the initiation and maintenance of oral antidiabetic and insulin therapy in patients with type 2 diabetes. We hypothesis that not all patients with type 2 diabetes at the University of Kentucky Health Maintenance Organization (UK-HMO) are initiated on oral antidiabetic medication according to guidelines and that many combinations of medication are used. To describe trends and combinations of prescription antidiabetic drugs and insulin usage among patients with type 2 diabetic at the UK-HMO. A retrospective medication utilization evaluation of prescription records at the UK-HMO identified all patients with an oral antidiabetic medicine or insulin in the file for the study period 7/1/2000 to 12/31/2005. A six-month screening period at the beginning of the data collection was used to assure only incident cases of type 2 diabetes were analyzed. Records were sorted by date medication was prescribed and aggregated into various medication combinations used by patients over time. Temporal changes in medication therapy were observed and results were compared with ADA and NICE guidelines. Patients were initially prescribed many different combinations of oral antidiabetic therapy and including monotherapy, double combination, triple combination, and insulin-only therapy. Over time, many different combinations of medication were used to control type 2 diabetes; however some patients did not have any change in initial regimen over the study period. Initial medications for type 2 diabetes in this study are not similar to those recommended by several worldwide guidelines, including the ADA and NICE. Combination therapy may be required for appropriate management of type 2 diabetes; however evidence base guidelines have been established for best clinical results. Further research into the rationale for many different combinations, especially on initiation, and the rationale for their use is being developed

Assessing the Accuracy and Quality of Medication History Collection: Effect of Implementation of Electronic Health Record [abstract]

Abstract from 2013 ACCP Annual Meeting: PURPOSE: We hypothesized that pharmacy staff auditing of previously recorded admission medication histories will identify significant and potential medication errors, and that implementation of an electronic medical record [EMR] will not improve the quantity of discrepancies or the quality of admission medication histories, despite showing Joint Commission and Heart Failure Core Measure compliance. METHODS: At our institution, medication reconciliation is completed at the time of admission through collaboration with prescribers and nursing staff. A pharmacy medication reconciliation team is utilized on the cardiac step down unit and employs pharmacy technicians to obtain an accurate and complete medication history. This history is verified by a pharmacist, compared to the initial medication history and inpatient medication orders. Identified discrepancies are reconciled with a licensed prescriber. A retrospective evaluation assessed the discrepancies identified by the pharmacy team medication history audits, as well as audits completed by clinical pharmacists on other hospital units, and compared the quantity of discrepancies before and after EMR implementation. RESULTS: With support provided by the pharmacy team, medication reconciliation completion was 82% pre-EMR implementation and increased to 91% immediately post-EMR implementation; Core Measure compliance has remained above 90%. The average number of medication omissions per patient upon admission medication reconciliation was 0.55 pre-EMR implementation and increased to 2.32 post-EMR implementation. The average number of incorrect drugs/patient upon admission medication reconciliation 0.16 (pre) and 0.61 (post); and incorrect doses/patient was 0.32 (pre) and increased to 0.63 (post). CONCLUSION: Despite showing medication reconciliation and core measure compliance with the implementation of EMR, our data shows discrepancies between the medication lists collected as a routine part of admission and those lists collected via the pharmacy team audit. In fact, more errors were identified after EMR implementation. The pharmacy team’s activities should be continued and even expanded in order to prevent future discrepancies