- Strong patient engagement and education strategies may be useful for improving medication safety, according to a recent ONC report.
The report, which centers on medication ordering within the EHR, suggests that while technology usability can play a significant role in improving patient safety, patient engagement may also be helpful.
EHR-related medication errors are typically rooted in two main causes, the ONC explained. First, providers sometimes prescribe the appropriate medication for a diagnosis, but select the wrong patient from a drop-down menu. Conversely, some providers may select the correct patient but the inappropriate medication.
These types of medication errors pose a significant threat to patient safety. When providers prescribe patients an inappropriate medication and the patient takes it, it can lead to adverse care outcomes and put the patient as risk of becoming more ill.
While the ONC did suggest some EHR usability fixes to mitigate these problems, it also recommended patient-centered strategies to ensure better medication safety.
First, the researchers recommended clinicians provide patients with after-visit summaries, including detailed medication lists.
There are numerous federal initiatives to promote sharing after-visit summaries and medication summaries with patients. For example, all providers using Certified EHR Technology have the capability to offer an electronic after-visit summary.
The Joint Commission and CMS both require providers to issue after-visit summaries to their patients. For example, as a part of the Merit-based Incentive Payment System, eligible clinicians must offer at least one unique patient access to her health information and specific education materials. Providing after-visit summaries have also been a part of the CMS EHR Incentive Programs.
Offering after-visit summaries can add another layer to the many checks providers should conduct to ensure they have prescribed the appropriate medication to the correct patient. When patients have the opportunity to read which medications they are taking, they may detect an error another clinician had missed.
But it may not be enough for providers to simply offer their patients copies of after visit summaries and medication lists. If patients do not understand these materials, they may not be successful in catching medication errors.
“Although adherence to this policy is increasing rapidly, patients may not always understand the importance of reviewing the after-visit summary, or may not be fully engaged or empowered to ask follow-up questions if the information―including active medications and their relationship with diagnoses―is unclear or differs from their understanding,” the report explained.
ONC and RTI suggested providers bolster patient education through a teach-back strategy. This education strategy checks patient understanding by asking them to explain, or “teach back,” concepts to their providers.
“In the ‘teach back,’ a provider reviews with the patient a summary of the discussions and decisions made during the encounter to ensure understanding,” the researchers wrote.
“If the patient has been given the wrong medication or administration due to a pick list error, careful review of the after-visit summary by the patient is perhaps the most important step in identifying and rectifying the error.”
While the ONC does recommend stronger patient engagement and education strategies to help reduce medication errors, the agency recognizes that patient safety in health IT should still foremost fall on providers and technology vendors.
In addition to patient engagement strategies, the agency suggests providers develop and adhere to best practices for e-prescribing and fully review a medication summary screen prior to completing prescriptions. Clinicians may also offer pharmacists some diagnostic information to assist them in catching medication errors.
Health IT vendors should design technologies to help providers better select patients and medications from drop-down menus and pick lists, as well as create interfaces that make it easier for providers to detect medication errors, ONC said.
Ultimately, these efforts will contribute to better patient care, the researchers stated. As the industry continues to shift toward value-based care models, providers should identify ways to engage their patients to ensure quality care delivery.