Medication safety indicators can guide improvement in primary care drug selection, dosing, and monitoring
The fact that nearly 4 billion outpatient prescriptions are purchased annually in the United States and a majority of U.S. adults takes at least one prescribed drug underscores the importance of medication safety in primary care practices to prevent adverse drug events (ADEs). Researchers examined 30 medication safety indicators in 20 primary care practices in 14 States. The indicators included preventable errors in therapy selection, dosing, drug-drug interactions, drug-disease interactions, and monitoring. Each practice used a common commercial electronic medical record (EMR).
Across all practices, inappropriate medication treatment was avoided in 75 percent of the eligible patients, dosing errors in 84 percent, drug-drug interactions in 98 percent, and drug-disease interactions in 86 percent. Appropriate monitoring of potential ADEs occurred in only 75 percent of the eligible patients. The researchers suggest that the classes of medication safety indicators with high adherence (avoiding inappropriate treatment in elderly patients and preventing drug-drug interactions) may be attributed to embedded alerts in the EMR that require a clinician's response before completing the prescription. Those indicators with lower adherence tended to require further action by the clinician, such as calling up additional decision support modules in the software or ordering laboratory tests.
The 20 participating practices had 52,246 active adult patients and included 74 physicians, 10 nurse practitioners, and 3 physician's assistants. The investigators used a consensus development process to identify 90 potential prescribing and monitoring indicators, which they reduced to 30 indicators of importance in primary care practice. The study was funded in part by the Agency for Healthcare Research and Quality (HS17037).
More details are in "Medication prescribing and monitoring errors in primary care: A report of the Practice Partner Research Network," by Andrea M. Wessell, Pharm.D., Cara Litvin, M.D., M.S., Ruth G. Jenkins, Ph.D., and others in the October 2010 Quality and Safety in Health Care 19(5)e21.
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