Medication reconciliation to improve quality of transitional care.

描述(申请人提供)：医疗差错很常见，也很危险。约20%的医疗差错与处方用药有关。大多数用药差错发生在护理的过渡阶段，例如病人从门诊环境进入医院或从医院出院到门诊环境。由于出院处方的目的是在门诊护理中遵循，改善过渡期和门诊护理需要注意出院处方。通过药物调节(MR)，审查多个药物信息来源，以确定哪些药物当前有效，以及哪些药物应该被开出。核磁共振的过程既繁琐又耗时。虽然正式MR系统的实施改善了接受MR的病例的比例，但我们对MR系统改变临床结果的程度知之甚少。研究还表明，MR应该与基于计算机的提供商订单录入(CPOE)相集成，但这种情况很少发生。这项研究的具体目的是将电子MR系统与电子处方系统相结合，进行MR的随机对照试验，并确定MR的电子促进是否改变了MR和门诊护理中用药差错的发生率。在病人入院时，基于网络的MR模块将收到自动汇编的门诊用药清单。在与患者讨论后，医务人员将更新清单，然后将清单提交到CPOE系统，并成为可操作的处方。主要结果包括不良药物事件和患者返回门诊护理后入院前用药清单和用药清单之间的错误差异。我们假设，住院患者MR的电子便利化将提高MR的完成率，并将减少与药物相关的医疗差错的发生率。

DESCRIPTION (provided by applicant): Medical errors are common and dangerous. Approximately 20% of medical errors are related to prescription of medications. Most medication errors occur at transitions in care, such as when patients are admitted from ambulatory settings to hospitals or discharged from hospitals to ambulatory settings. Since prescriptions at hospital discharge are intended to be followed in ambulatory care, improving transitional and ambulatory care requires attention to the discharge prescriptions. With medication reconciliation (MR), multiple sources of medication information are reviewed, to determine which medications are currently active, and which medications should be prescribed. The process of MR is tedious and time-consuming. Although implementation of formal MR systems improves the fraction of cases undergoing MR, we know relatively little about the extent to which MR systems alter clinical outcomes. Research also indicates that MR should be integrated with computer-based provider order entry (CPOE), but this seldom if ever occurs. The specific aims of this study are to integrate an electronic MR system with an electronic prescribing system, conduct a randomized controlled trial of MR, and determine whether electronic facilitation of MR alters MR and the incidence of medication errors in ambulatory care. On a patient's hospital admission, a Web-based MR module will receive an automatically compiled outpatient medication list. Following discussion with the patient, medical personnel will update the list, which will then be delivered to the CPOE system and become actionable for prescribing. Main outcomes include adverse drug events and erroneous discrepancies between the pre-admission medication list and the medication list upon the patient's return to ambulatory care. We hypothesize that electronic facilitation of inpatient MR will improve completion of MR and will decrease the incidence of drug-related medical errors.