Medication reconciliation to improve quality of transitional care.

描述（由申请人提供）：医疗错误是常见和危险的。大约20%的医疗差错与药物处方有关。大多数用药错误发生在护理的过渡阶段，例如当患者从门诊环境进入医院或从医院出院到门诊环境时。由于出院时的处方旨在在门诊护理中得到遵守，因此改善过渡期和门诊护理需要关注出院处方。通过药物核对（MR），可以审查多个药物信息来源，以确定哪些药物目前有效，以及应该处方哪些药物。MR的过程是繁琐和耗时的。虽然正式的MR系统的实施提高了接受MR的病例比例，但我们对MR系统改变临床结局的程度知之甚少。研究还表明，MR应与基于计算机的供应商订单输入（CPOE）相结合，但这很少发生。本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随机对照试验，并确定MR的电子促进是否会改变MR和门诊护理中的用药错误发生率。在患者入院时，基于Web的MR模块将收到自动编辑的门诊药物列表。在与患者讨论后，医务人员将更新列表，然后将其发送到CPOE系统并可用于处方。主要结果包括药物不良事件以及入院前药物清单与患者返回门诊护理时药物清单之间的错误差异。我们假设，住院MR的电子促进将改善MR的完成，并将减少与药物相关的医疗错误的发生率。

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.