Providence Health & Services, St. Patrick Hospital, Missoula, MT, USA.
Skaggs School of Pharmacy, College of Health, The University of Montana, Missoula, MT, USA.
Am J Health Syst Pharm. 2021 Aug 30;78(Supplement_3):S71-S75. doi: 10.1093/ajhp/zxab108.
Medication reconciliation (MR) is a complicated and tedious process but is crucial to prevent errors when ordering patients' discharge medications during a hospital admission. Our institution currently uses a variety of methods to gather a patient's medication history, including review of the medical records and electronic pharmaceutical claims data (EPCD) from a commercial health information exchange organization, as well as a patient or caregiver interview. Occasionally, more information is needed to obtain the most accurate history. To augment current methods, EPCD can also be accessed for patients with Medicaid insurance using a state Medicaid Web portal. We aimed to evaluate the utility of the Medicaid Web portal for reducing medication errors during the MR process at hospital admission.
A single-center, prospective, quality improvement initiative was conducted to evaluate 100 patient medication lists for all nonobstetric Medicaid patients admitted to our institution to identify discrepancies in medication lists when the state Medicaid Web portal was used in addition to standard MR methods. We found that, when EPCD from commercial organizations were available, they matched the patient's current medication list 64% of the time. One in 4 patients had at least 1 discrepancy on their verified medication list that was identified using the Medicaid Web portal. The discrepancies identified were addressed and corrected in real time to improve patient care.
EPCD from the state Medicaid Web portal could supplement the use of current methods to obtain a more accurate medication history and reduce the number of erroneously ordered discharge medications during hospital admission.
药物重整（MR）是一个复杂而繁琐的过程，但在为患者出院时开具药物医嘱时，这一过程对于预防错误至关重要。我们机构目前使用多种方法来收集患者的用药史，包括查看病历和商业健康信息交换组织的电子药物索赔数据（EPCD），以及对患者或护理人员进行访谈。偶尔，为了获得最准确的病史，还需要更多的信息。为了补充当前的方法，还可以使用州医疗补助网络门户访问有医疗补助保险的患者的 EPCD。我们旨在评估使用医疗补助网络门户在入院时的 MR 过程中减少用药错误的效用。
进行了一项单中心、前瞻性的质量改进计划，以评估我院收治的所有非产科医疗补助患者的 100 份患者用药清单，以确定在标准 MR 方法之外使用州医疗补助网络门户时用药清单中的差异。我们发现，当有商业组织的 EPCD 可用时，它们与患者当前的用药清单匹配的概率为 64%。有四分之一的患者在使用医疗补助网络门户验证后的用药清单中至少有 1 处差异。识别出的差异已实时解决和纠正，以改善患者护理。
州医疗补助网络门户的 EPCD 可以补充当前方法的使用，以获得更准确的用药史，并减少住院期间错误开具的出院药物数量。
