Abstract
BackgroundMedication reconciliation (the process of creating an accurate list of all medications a patient is taking) is a widely practiced procedure to reduce medication errors. It is mandated by the Joint Commission and reimbursed by Medicare. Yet, in practice, medication reconciliation is often not effective owing to knowledge gaps in the team. A promising approach to improve medication reconciliation is to incorporate artificial intelligence (AI) decision support tools into the process to engage patients and bridge the knowledge gap.ObjectiveThe aim of this study was to improve the accuracy and efficiency of medication reconciliation by engaging the patient, the nurse, and the physician as a team via an iPad tool. With assistance from the AI agent, the patient will review his or her own medication list from the electronic medical record (EMR) and annotate changes, before reviewing together with the physician and making decisions on the shared iPad screen.MethodsIn this study, we developed iPad-based software tools, with AI decision support, to engage patients to “self-service” medication reconciliation and then share the annotated reconciled list with the physician. To evaluate the software tool’s user interface and workflow, a small number of patients (10) in a primary care clinic were recruited, and they were observed through the whole process during a pilot study. The patients are surveyed for the tool’s usability afterward.ResultsAll patients were able to complete the medication reconciliation process correctly. Every patient found at least one error or other issues with their EMR medication lists. All of them reported that the tool was easy to use, and 8 of 10 patients reported that they will use the tool in the future. However, few patients interacted with the learning modules in the tool. The physician and nurses reported the tool to be easy-to-use, easy to integrate into existing workflow, and potentially time-saving.ConclusionsWe have developed a promising tool for a new approach to medication reconciliation. It has the potential to create more accurate medication lists faster, while better informing the patients about their medications and reducing burden on clinicians.
Highlights
This National Action Plan for Adverse Drug Event Prevention (ADE Action Plan) seeks to engage all stakeholders in a coordinated, aligned, multisector, and health-literate effort to reduce the adverse drug events (ADEs) that are most common, clinically significant, preventable, and measurable
Those associated with high-priority ADE targets, can allow for more effective measuring and tracking of ADEs
The effectiveness of oral anticoagulation therapy for the prevention or treatment of venous thromboembolism (VTE) varies with indication; anticoagulation prophylaxis is associated with a 59 percent reduction in fatal pulmonary embolisms (PEs) and a 53 percent reduction in symptomatic deep vein thrombosis (DVT) among acutely ill, hospitalized medical patients [59]
Summary
1) Surveillance—Coordinate existing Federal surveillance resources and data to assess the health burden and rates of ADEs. Federal public health agencies will strive to coordinate ADE surveillance efforts to assess progress in the prevention of anticoagulant, diabetes agent, and opioid ADEs at a populationbased level. Federal Agencies that provide direct patient carei will identify opportunities for assessing progress in preventing anticoagulant, diabetes agent, and opioid ADEs within their health care delivery networks. Those associated with high-priority ADE targets (i.e., anticoagulants, diabetes agents, opioids), can allow for more effective measuring and tracking of ADEs. 2) Prevention—Share existing evidence-based prevention tools across Federal Agencies and with non-Federal health care providers and patients. Federal health agencies will collaborate to identify key research needs and facilitate the basic, translational, and health services research required to identify the most effective strategies for the prevention of anticoagulant, diabetes agent, and opioid ADEs, among high-risk patients. As progress is made toward reducing ADEs from the initial targets of the ADE Action Plan (i.e., anticoagulants, diabetes agents, and opioids), prevention efforts will need to be retooled to include additional and newly emerging medication safety targets
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