Communities Making a Difference, Part 3:
Med Rec Patient Kiosks at the Oregon VA Hospital
Medications can help or harm. We can empower patients to take an active role in their medication management and build a safer process. Medication errors still account for significant harm from our U.S. healthcare system. Dr. Blake Lesselroth and the team at the Portland, Oregon Veterans Administration Hospital deployed patient kiosks to help with the medication reconciliation process.
This is another example of clinicians and researchers across North America working to solve the Med Wreck problem. In Part 3 in our series on Communities Making a Difference, learn more about the Oregon efforts and how it further supports our efforts to end the current Med Wreck nightmare.
Why we should all care about accurate medication management
The VA's Office of Applied and Clinical Implementation Sciences (OACIS) provides some great videos on You Tube concerning medication reconciliation and the importance of medication safety. The team at the Portland VA have created a series of educational briefs to debunk common myths about medication reconciliation. According to Dr. Lesselroth, "We used them (the video briefs) locally to foster cultural change. Myth #3 generated the strongest positive response from primary care practitioners."
This videos are quite short and worth your time to watch. Listed below are the OACIS Medication Reconciliation briefs on common myths:
Myth #1: Everything is in the Chart. This video reviews how we make flawed assumptions about the accuracy of the EHR medication list. Studies at the VA have shown:
- 15-25% of patients are incorrectly taking or have stopped taking one or more medications in their EHR medication list.
- 11-13% are taking a medication not on their EHR medication list, and
- 6-24% are still taking medications that the provider had previously stopped.
Myth #2: It's Not My Job. This video discusses the various roles in the care process and how the team should work together for optimal medication safety. Various stakeholders contribute to a safer process:
- The patient,
- The physician,
- The pharmacist, and
- The nurse.
Myth #3: It's Not The Priority. Dr. Lesselroth reviews the math behind medical harm from medication errors. Despite a low rate of problems, it adds up to a lot of patient harm at a typical medical center each year. Even with a risk of 0.003 of a serious medication error which causes harm, this still could produce over 3,500 significant injuries a year in a single medical center the size of the Portland VA facility.
Using patient kiosks to improve the medication process
In addition to awareness and education, the Portland VA team created electronic patient kiosks to improve medication lists. The program checks patients in for their appointments and retrieves the patient's medication list from the VA's EHR. It pairs each medication with a photo of the pill/form for each medication. Each patient could then compare the kiosk list to his/her own list and update it through the patient kiosk application. According to their published study (Lesselroth, 2009), over a two-week roll-in period of the technology in February 2008, 82% of the 111 patients in the study completed their check-in and medication review/update via the patient kiosk. They were then compared with existing EHR documentation and clinician interviews. "For each patient encounter, the process demonstrated an average of 4.59 discrepancies and an average of 1.61 clinically significant or potentially lethal discrepancies" (Lesselroth, 2009). The researchers estimated that this reduced nursing time for updating medication lists by 50% and would reduce nursing time by 0.24 full-time equivalent (1/4 FTE).
This study validated several concepts discussed in the Med Wreck... eBook:
- A single source of truth can pre-populate medication lists (in this case the community medication list comes from the VA EHR),
- Engaged patients with visually displayed medication lists can help to improve accuracy of the working medication list.
- Staff time is reduced by leveraging a single source of truth.
Dr. Lesselroth would love to receive funding to expand his concepts to include a large database from which to obtain and compile a comprehensive patient medication list beyond just the VA EHR. It is work like this, and the efforts discussed in Parts One and Two, that reinforce that we could build a safer medication process for all Americans. We hope to share additional stories in the future of more teams who are showing that we have the ability to improve over the current state of Med Wreck.
References for this series:
Lesselroth BJ, Felder RS, Adams SM, , et al. Design and implementation of a medication reconciliation kiosk: the Automated Patient History Intake Device (APHID). J Am Med Inform Assoc, 2009 May-Jun;16(3):300-4. [Abstract]
Lesselroth B, Adams S, Felder R, et al. Using consumer-based kiosk technology to improve and standardize medication reconciliation in a specialty care setting. Jt. Comm J Qual Patient Saf, 2009 May;35(5):264-70. [Abstract]
Pandolfe F, Crotty BH, Safran C. Medication Harmony: A Framework to Save Time, Improve Accuracy and Increase Patient Activation. AMIA Annu Symp Proc. 2017 Feb 10;2016:1959-1966. eCollection 2016 [Abstract with link to Full Article]
Tamblyn R, Winslade N, Lee TC et al. Improving patient safety and efficiency of medication reconciliation through development and adoption of a computer-assisted tool with automated electronic integration of population-based community drug data: the RightRx project. JAMIA. 0(0), 2017, 1-15 [Abstract]