Reducing the Potential for Adverse Drug Events in Ambulatory Care Settings

Adverse Drug Events (ADEs) are a significant clinical problem in the United States; many are preventable if a provider has full knowledge of patients' medications. The process of gathering medication information is known as medication reconciliation. There is currently an inadequate focus on medication reconciliation during ambulatory healthcare visits. Many clinics have inadequate processes for collecting complete medication histories; a consistent and effective approach to medication reconciliation in outpatient settings may reduce ADEs. The overarching goal of this project was to improve the method of obtaining medication information from patients in an ambulatory setting. Steps to accomplish this were to 1) perform a literature review, identify the current practices of an ambulatory clinic, identify barriers and potential solutions, and develop a new medication reconciliation process, 2) implement the process, 3) evaluate its effectiveness, and 4) disseminate the results. The existing literature on the subject defines medication reconciliation and specifies which information needs to be included. Also available in the literature are the most common ambulatory setting ADEs, barriers to the collection of accurate information, and some potential methods to improve the accuracy of medication information in ambulatory care settings, including potential processes for collecting a ‘best possible medication history'. To implement and evaluate this project, the following steps were completed: 1) a literature review, 2) an analysis on the ambulatory setting's current process and perceptions of providers and staff, 3) a new process developed, 4) data points to measure improvement identified, 5) a questionnaire developed, 6) a change in process instigated to assist taking a best possible medication history, 7) the clinic's medication list updated with the new process, 8) a conversation instigated with patients on informing all providers of all medications taken; use of memory aids recommended to patients, 9) patients asked to participate in anonymous questionnaire, 10) a tally of improvement data points kept, 11) data compared using a paired t-test, 12) questionnaire results organized and evaluated, 13) results disseminated to clinic stakeholders, and 14) application to a poster presentation at a conference submitted. Results of the project indicate that accuracy of medication information available to the provider is increased by taking a best possible medication history, obtained through viewing physical bottles of medications and interviewing the patient. Questionnaire results and impressions indicate that most patients are not currently knowledgeable about the potential for ADEs and that future directions for encouraging greater patient participation may include the use of technology, such as smart-phones. Ambulatory clinics should consider the ‘best possible medication history' as a potential process to obtain the goal of safer medication management. ADEs are a significant problem. Ambulatory clinics are facing the challenge of caring for more complex patients and many currently may not have adequate medication reconciliation policies and processes. The main objective in this project was to improve an ambulatory healthcare clinic's process of collecting medication information from patients; the ultimate goals are to increase patient and provider awareness, encourage change, and increase patient safety.