Medication reconciliation to improve quality of transitional care.

描述（由申请人提供）：医疗事故是常见和危险的。大约20%的医疗事故与药物处方有关。大多数药物错误发生在护理的过渡阶段，例如当患者从门诊进入医院或从医院出院进入门诊时。由于出院时的处方是用于门诊护理的，因此改善过渡性和门诊护理需要注意出院时的处方。使用药物调节（MR），可以审查多个药物信息来源，以确定哪些药物当前有效，哪些药物应该开处方。MR的过程是繁琐和耗时的。虽然正式核磁共振系统的实施提高了接受核磁共振的病例比例，但我们对核磁共振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供应商订单输入（CPOE）集成，但这种情况很少发生。本研究的具体目的是将电子核磁共振系统与电子处方系统整合，进行核磁共振随机对照试验，并确定核磁共振的电子促进是否会改变核磁共振和门诊护理中用药错误的发生率。在病人入院时，一个基于网络的MR模块将收到一个自动编译的门诊药物清单。在与患者讨论后，医务人员将更新清单，然后将其交付给CPOE系统，并成为可操作的处方。主要结局包括药物不良事件和入院前用药清单与患者返回门诊时用药清单的错误差异。我们假设，住院病人磁共振的电子便利将提高磁共振的完成度，并将减少药物相关医疗差错的发生率。

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.