Stock Ron, Scott Jim, Gurtel Sharon
Center for Medical Education & Research, PeaceHealth Oregon Region, Eugene, Oregon, USA.
Jt Comm J Qual Patient Saf. 2009 May;35(5):271-7. doi: 10.1016/s1553-7250(09)35038-2.
Although medication safety has largely focused on reducing medication errors in hospitals, the scope of adverse drug events in the outpatient setting is immense. A fundamental problem occurs when a clinician lacks immediate access to an accurate list of the medications that a patient is taking. Since 2001, PeaceHealth Medical Group (PHMG), a multispecialty physician group, has been using an electronic prescribing system that includes medication-interaction warnings and allergy checks. Yet, most practitioners recognized the remaining potential for error, especially because there was no assurance regarding the accuracy of information on the electronic medical record (EMR)-generated medication list. PeaceHealth developed and implemented a standardized approach to (1) review and reconcile the medication list for every patient at each office visit and (2) report on the results obtained within the PHMG clinics.
In 2005, PeaceHealth established the ambulatory medication reconciliation project to develop a reliable, efficient process for maintaining accurate patient medication lists. Each of PeaceHealth's five regions created a medication reconciliation task force to redesign its clinical practice, incorporating the systemwide aims and agreed-on key process components for every ambulatory visit.
Implementation of the medication reconciliation process at the PHMG clinics resulted in a substantial increase in the number of accurate medication lists, with fewer discrepancies between what the patient is actually taking and what is recorded in the EMR.
The PeaceHealth focus on patient safety, and particularly the reduction of medication errors, has involved a standardized approach for reviewing and reconciling medication lists for every patient visiting a physician office. The standardized processes can be replicated at other ambulatory clinics-whether or not electronic tools are available.
尽管药物安全主要关注减少医院内的用药错误，但门诊环境中不良药物事件的范围却非常广泛。当临床医生无法立即获取患者正在服用的准确药物清单时，就会出现一个基本问题。自2001年以来，多专科医生集团和平健康医疗集团（PHMG）一直在使用一种电子处方系统，该系统包括药物相互作用警告和过敏检查。然而，大多数从业者认识到仍存在潜在的错误可能性，特别是因为无法保证电子病历（EMR）生成的药物清单上信息的准确性。和平健康医疗集团制定并实施了一种标准化方法，用于（1）在每次门诊就诊时审查和核对每位患者的药物清单，以及（2）报告在PHMG诊所内获得的结果。
2005年，和平健康医疗集团启动了门诊药物核对项目，以开发一个可靠、高效的流程来维护准确的患者药物清单。和平健康医疗集团的五个地区各成立了一个药物核对特别工作组，以重新设计其临床实践，将全系统的目标和每次门诊就诊商定的关键流程组成部分纳入其中。
PHMG诊所实施药物核对流程后，准确药物清单的数量大幅增加，患者实际服用的药物与EMR中记录的药物之间的差异减少。
和平健康医疗集团对患者安全的关注，尤其是减少用药错误，涉及一种标准化方法，用于审查和核对每位到医生办公室就诊患者的药物清单。无论是否有电子工具，其他门诊诊所都可以复制这些标准化流程。
